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What Causes Swelling In The Ankles And Feet?

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Posted on Wed, 19 Oct 2016
Question: My 13 year old daughter has always been a normal healthy child - eats well and exercises regularly. She has had swollen painful ankles and feet for over a week. She experiences a lot of pain when walking, and the swelling increases over the course of a day. She had blood work and urine samples and everything so far is normal, but she is very uncomfortable. Do you have any advise?
TSA CBC SED all normal
Electrolyte panel- potassium slightly low 3.7 (3.8 = normal) but dr said this was negligible.
Lyme negative
Urine is normal
She has complained of a heavy feeling in her chest and says it is uncomfortable to draw a deep breath. She has also complained of feeling tired and a sore throat.
doctor
Answered by Dr. Naval Mendiratta (4 hours later)
Brief Answer:
Ankle arthritis

Detailed Answer:
good evening

thank you for writing on health care magic

Well. when you are dealing with ankle. pain and swelling it is usually reactionary, thatid a process is going on somewhere else in the body and that throws a reaction over the ankles causing pain and swelling. I would like to know a few more details before guiding you further

1. did she have any fever before the pain

2. any rashes over the feet? like red spots or something

3. in her blood tests was ESR and CRP done? what are the values

4. has her chest x ray been carried out. sometimes diseases. like Sarcoid can cause these symptoms. so one needs to look at x rays

5. what medications has she tried?

6. does the swelling disappear. on lying straight? in the nights I mean

do let me know these queries. would. guide you further from here. a picture of swelling would be useful

regards
Dr naval
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Naval Mendiratta (36 minutes later)
Hello,
There was no fever or rash. There have been no chest X-rays or X-rays of any kind at this point. I do not have the blood counts you are looking for at this time. Would you recommend I see a rheumatologist or another kind of specialist? What should I be looking for in terms of other symptoms ?
No medication has been tried except Advil which has had very little effect. It does get less swollen if she stays off her feet but the swelling and pain does not go away entirely
Wouldn't there be a marker of some kind in the tests performed so far if it were sarcoidosis/ lupus or arthritis?
doctor
Answered by Dr. Naval Mendiratta (13 hours later)
Brief Answer:
Arthritis

Detailed Answer:
Good evening

Well, yes I would recommend you schedule an appointment with a rheumatologist soon. CAuse somewhere, we are missing out the diagnosis.

For markers of sarcoid/Lupus, we need to examine the patient clinically. As of now, it doesnt fit with lupus as she doesnt have any other symptoms. With kids, there can be a lot of reasons of joint swelling, which may or may not be due to inflammation. SO if you can get al ultrasound of the ankle and feet done( while we wait for appointment), it will give us a fair idea where exactly is the swelling coming from.

A chest X ray is a must for any ankle swelling and Would like to review the other results as well.

Meanwhile, you can try with other anti inflammatory like Celecoxib( in paediatric modified dose according to body weight) and see how the response is. But yes, we need to rule out the diagnosis.

As for arthritis test, I can recommend you a few( markers): ANA, Rheumatoid FActor, Anti ccp antibody and HLA B 27( PCR). But I would suggest a rheumatologist should examine her, as we shouldnt poke the kid again and again for the bloods

Do let me know for more queries

REgards
Dr Naval
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Naval Mendiratta (27 hours later)
Chest X-ray and EKG normal and swelling less pronounced. Thoughts on this possibly being a virus...
doctor
Answered by Dr. Naval Mendiratta (12 hours later)
Brief Answer:
Ankle Arthritis

Detailed Answer:
good evening

Well, that s good that there is no pathology there. As for viral arthritis, it doesnt look like as viral normally involves the small joints of the hands as well .. It can be just reactive arthritis, which is usually self limitting and goes off in 3-4 weeks time.

However we need to make sure the arthritis markers are all negative and it is not a start of a prolonged disease. If it is self limiting, she will not need any long treatment for it.

Continue Anti inflammatory for a week more and I hope it resolves. DO let me know what the rheumatologist says

Regards
Dr naval
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Naval Mendiratta

Rheumatologist

Practicing since :2007

Answered : 754 Questions

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What Causes Swelling In The Ankles And Feet?

Brief Answer: Ankle arthritis Detailed Answer: good evening thank you for writing on health care magic Well. when you are dealing with ankle. pain and swelling it is usually reactionary, thatid a process is going on somewhere else in the body and that throws a reaction over the ankles causing pain and swelling. I would like to know a few more details before guiding you further 1. did she have any fever before the pain 2. any rashes over the feet? like red spots or something 3. in her blood tests was ESR and CRP done? what are the values 4. has her chest x ray been carried out. sometimes diseases. like Sarcoid can cause these symptoms. so one needs to look at x rays 5. what medications has she tried? 6. does the swelling disappear. on lying straight? in the nights I mean do let me know these queries. would. guide you further from here. a picture of swelling would be useful regards Dr naval