Have you noticed pain or stiffness in your legs? Is a short walk to the bathroom starting to feel like a chore? Maybe you’re beginning to trip over your own feet or walk with a slight limp. Swelling of the ankles could be the culprit. People with kidney disease, especially people on dialysis, are prone to develop swelling of the ankles due to fluid retention. Swelling not only causes joint stiffness, but it can often lead to pain as well. And when your ankles are swollen, the mobility of those joints can be compromised, which in turn can impair your ability to walk.
One of my patients came in and complained that her left hip was hurting. I soon discovered that her right ankle was very stiff and didn’t have full mobility. As a result, she was compensating by putting more pressure on her left hip as she walked. Her gait was abnormal, with her left hip rotating up slightly and causing pain in the other hip. Whenever your gait is abnormal, it will usually lead to pain somewhere in the body. I’ve been working with her on a series of stretches and exercises (some of which I will explain later), and I encourage her to always wear shoes with good support.
What to Look For: The easiest way to tell whether your ankle is swollen is to compare one against the other. When swelling in both ankles is suspected, a simple test can indicate how severe the problem is. Apply moderate pressure with your thumb to the swollen area.
If an indentation is left behind, a form of swelling called pitting edema is present. And if the indentation doesn’t go away after 30 seconds, the amount of swelling is significant. Other signs to look for include not fitting into your shoes any longer and losing the ability to flex your ankle to a normal range. Also, you may notice that your ankles are swollen before dialysis or after you’ve been standing or walking for a while. The fluid around the joint makes it hard to improve the mobility of your ankle when swelling is present, so exercises and stretches should be performed when the swelling is down.
Limiting the Swelling: Fortunately, there are several things you can do to help limit swelling. The most direct method involves controlling your salt intake, adhering to your daily fluid allowance, taking diuretics, and keeping your feet up. But one of the most effective ways to address swelling and stiffness simultaneously is to exercise and stay active. The simple exercises illustrated on the following page, when performed safely and consistently, can limit swelling and improve your mobility at the same time.
To gain the greatest benefit, make these exercises a consistent part of your daily routine. Other simple adjustments, such as minimizing prolonged sitting and getting up frequently, will help you maintain mobility.
When to Seek Medical Treatment
If your swelling and decreased mobility don’t respond to diet, dialysis, medication, and exercise, it’s time to talk to your doctor. Not dealing with these problems can lead to significant functional impairment and the loss of your ability to walk. Additional symptoms such as chest pain and difficulty breathing can be signs of a more serious condition, so don’t ignore your symptoms or hope that they’ll go away.
Calf Raises: When you’re either sitting or standing, push your heels up from the floor and shift weight onto your toes. In addition to strengthening an important muscle for walking, this exercise activates a pump in our calf muscles that helps move fluid back toward the heart.
Calf Stretches: Face the wall and brace your hands against the wall, then lunge forward. Make sure that your back leg stays straight and that the heel stays on the floor. Holding this position for 30 seconds helps stretch the muscle that inhibits ankle mobility the most.
Leg Extensions: As you sit, slowly alternate straightening out your legs. This exercise again activates a pump to help drain fluid, but it also helps strengthen your thighs and stretch the muscles at the back of your legs.
Ankle Alphabet: Elevate your foot slightly above the floor, and use it to draw all of the letters of the alphabet, leading with your big toe. Try to make the letters as big as possible because this will promote the full range of motion for your ankle.
Dr. Jason Luk, PT, DPT is a physical therapist. He and his wife own a clinic which specializes in treating patients with orthopedic injuries, and stresses a whole-body approach to treatment. Joseph S. Luk Physical Therapy, Inc. is located in Glendale, CA.
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