Private swollen ankles clinic in London, same-day cardiology.

One leg

• Deep vein thrombosis — calf swelling, pain, warmth, sometimes redness. Risk raised by recent surgery, immobility, long flights, cancer, pregnancy, the combined pill and HRT.
• Cellulitis — hot, red, spreading, tender, often with fever.
• Ruptured Baker's cyst — sudden calf pain and swelling, mimicking a DVT.
• Chronic venous insufficiency — long-standing, worse by evening, with skin staining.
• Lymphoedema — firm swelling including the toes, after lymph node surgery or radiotherapy.
• Injury, and less commonly a pelvic mass obstructing drainage on one side.

Both legs

• Dependent oedema — from standing or sitting still for long periods, particularly in hot weather. The commonest cause overall.
• Heart failure — with breathlessness, waking at night short of breath, and needing more pillows.
• Kidney disease — often with frothy urine, and swelling around the eyes in the morning.
• Liver disease — with abdominal swelling and sometimes jaundice.
• Low protein, from malnutrition or gut disease.
• Underactive thyroid, obesity, and pregnancy.
• Medicines — a very common cause.

What assessment involves

• Examination of both legs, the abdomen, the heart and the chest, plus blood pressure and weight
• Blood tests — kidney and liver function, albumin, full blood count, thyroid, and NT-proBNP if the heart is in question
• Urine test for protein (ACR) — essential, and frequently omitted
• D-dimer and ultrasound where a DVT is suspected
• Echocardiogram where heart failure is suspected
• Ankle-brachial pressure index before any compression is applied

What helps