Both ankles or one? That single question separates the harmless from the urgent.
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Call 999 or go to A&E for ankle swelling with chest pain or breathlessness.
Seek same-day assessment for:
One-sided swelling is the one to act on. Both ankles swelling gradually is usually benign; one is not.
Ankle swelling is extremely common, particularly after a long day standing, a flight, or in hot weather, and most of it means nothing.
The single most useful question is one leg or both. Both ankles, coming on gradually, points to something systemic or simply to gravity. One ankle, particularly if it came on quickly, points to something local — a clot, an infection, or an injury — and needs assessing quickly.
Both legs, gradual — usually benign
Both legs, and worth investigating — heart failure, typically with breathlessness and worse lying flat; kidney disease; liver disease; underactive thyroid; low protein.
One leg — deep vein thrombosis, cellulitis, injury, or a ruptured Baker's cyst behind the knee. The first two need same-day attention.
If you take amlodipine, felodipine, lercanidipine or nifedipine, that is the likeliest explanation — and it is missed remarkably often.
These calcium channel blockers cause ankle swelling in a substantial proportion of people who take them. The swelling is usually both ankles, worse by evening, worse in hot weather, and not accompanied by breathlessness. It is a nuisance rather than a danger, and it often resolves entirely on a lower dose or a different drug.
Do not stop it yourself — uncontrolled blood pressure is considerably worse than swollen ankles. Raise it and have it changed.
Other medicines that commonly do this: ibuprofen and other anti-inflammatories, gabapentin and pregabalin, steroids, pioglitazone, and some antidepressants.
Press a thumb firmly into the swelling just above the ankle bone and hold for fifteen seconds. If it leaves a dent that takes a moment to fill, that is pitting oedema — fluid. Note how deep it is and how long the dent lasts; it is a genuinely useful thing to report.
A footstool is not enough. The ankles need to be above the level of your heart to let fluid drain, which in practice means lying down with legs up on cushions or against a wall, for 20 to 30 minutes a few times a day.
Reducing salt genuinely helps, and most of it comes from bread, processed meat, sauces, ready meals and eating out rather than the salt cellar. Do not restrict your fluid intake unless a doctor has specifically told you to — it does not help and can cause harm.
Properly fitted class 1 or 2 compression stockings, put on first thing before the swelling develops, are effective for venous swelling.
Do not use them if your foot is cold, pale, or painful when elevated, or if you have known arterial disease in the legs — compression is harmful where the arterial blood supply is poor. Get assessed first if you are unsure.
The consultation establishes one leg or both, how quickly it came on, whether it improves overnight, and what else is happening — breathlessness, how many pillows you sleep on, any change in urine output.
The medication list is the highest-yield part. Amlodipine-related ankle swelling is very common, entirely reversible by switching, and often endured for years because nobody made the connection.
Testing usually includes kidney function, liver function, thyroid function and a full blood count, with blood pressure assessment alongside.
What we cannot do is examine the leg, feel for pitting, or listen to your chest. For one-sided swelling, or any suspicion of a clot, this is not the right service — that needs same-day in-person assessment and we will say so.
If you take amlodipine or a similar calcium channel blocker, very probably. It is one of the most common medication side effects in general practice and one of the most frequently overlooked. The pattern fits: both ankles, worse as the day goes on, worse in warm weather, no breathlessness, and no improvement from anything you try.
It is dose-related, so a reduction often helps, and switching drug class usually resolves it entirely. Diuretics do not fix it, because the mechanism is leaky capillaries rather than fluid overload — which is why people are sometimes put on a water tablet that achieves nothing.
Because they are different problems. Both legs points to something systemic — gravity, medication, veins, heart, kidneys or liver. One leg points to something local — a clot, an infection, or lymphatic obstruction.
New swelling in one leg with calf discomfort needs assessing the same day, because a DVT is time-critical.
Heart-related swelling almost never comes alone. The features to look for are breathlessness — particularly on lying flat, or waking you an hour or two after falling asleep — needing more pillows than you used to, breathlessness on mild exertion, and rapid weight gain over days.
Weighing yourself daily is more sensitive than looking at your ankles, and gaining more than about 2kg in a week with worsening swelling is a reason to be seen promptly.
Yes, more than most people expect — particularly where the heart or kidneys are involved. The catch is that around three quarters of dietary salt is already in food when you buy it: bread, breakfast cereal, processed meat, cheese, sauces, ready meals and restaurant food. Putting the salt cellar away changes little; changing what you buy changes a lot.
They work well for venous swelling, provided they are the right compression class, fitted properly, and put on first thing in the morning before the leg has swollen — putting them on over an already swollen leg is both difficult and much less effective.
The important exception: do not use compression if the arterial circulation to your legs is poor. Warning signs are a cold or pale foot, pain in the calf on walking that eases with rest, or pain that is worse when the leg is raised. Compression in that situation causes harm, so it warrants checking first.
Only if a doctor has identified a reason for one. Diuretics are the right treatment for heart failure and some kidney and liver conditions. They are the wrong treatment for swelling caused by amlodipine, by prolonged standing, or by venous insufficiency — in those cases they do not work and can cause dehydration, kidney strain and salt disturbance. Never take someone else's.
Both are possible and both are worth excluding with a blood test. Kidney-related swelling often involves puffiness around the eyes in the morning as well as the ankles, and sometimes frothy urine. Liver-related swelling tends to come with abdominal swelling, easy bruising, and yellowing of the skin or eyes. Kidney function, liver function and a urine protein check cover both.
Yes — both are common and benign. Warm weather dilates blood vessels, and long periods of sitting still let fluid pool. Swelling from either should settle within a day or two of getting home, moving about and elevating the legs. What is not normal is swelling that persists afterwards, or swelling in one leg only after a flight, which raises the question of a clot.
Clinically reviewed by Dr Mohammad Zubair Khan, GMC 7563469
Last reviewed
August 23, 2026
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