Struggling with swollen ankles
Francis lives in Spanish Town. He is 60 years old and is in good health generally, but he is worried about his sometimes swollen ankles. He has recently also noted a darkening of the skin near his ankle on both feet, but it's worse on the right side. A friend, who has something looking like it, told him he has circulation problems. Francis asks Check Up what we think is happening to his ankles. He has been treating the rash with eczema ointment.
The skin near the ankle can become discoloured due to several causes such as dye staining from boots being worn and superficial skin conditions. However, circulation disorder is a very common cause of ankle discolouration, especially in older people or anyone with marked varicose veins and recurring ankle swelling. Because of this, it is important not to speculate but to have the ankles checked by a doctor.
When the venous circulation in the legs is poor, pooling of the red blood cells occurs in the ankle veins and some of the red cells are destroyed. The pigment from these stationary red cells, which have been pushed out into the soft tissues at the ankles, stain the skin in the area with a dark discolouration which should be considered to be more or less permanent.
The red blood cells stain the skin around the ankles, leading to reddish-brown patches occurring as the veins in the legs are unable to properly convey blood back up to the heart. Prompt medical attention is needed to prevent progression to chronic ankle swelling and leg ulcer formation.
The poor circulation can be due to causes other than disease in the peripheral veins:
• It can develop after a leg injury and would then be seen on one leg.
• It can also indicate blood clots involving the deep venous system (deep vein thrombosis/ DVT), which can be life threatening. This is why the dark discolouration cannot be ignored when it newly occurs! DVT will require treatment for a protracted time.
• Swelling and discolouration commonly occur from ankle sprain which, due to the conditions of an injury occurring which is associated with pain, is hard to miss.
• Skin discolouration at the ankles can also be due to tick bites and the discolouration is accompanied with fever, chills and headaches. Urgent medical attention is needed.
• Kidney and lymphatic disorders can also cause ankle swelling and need medical intervention.
Once the ankle discolouration has been confirmed by a doctor to be of a more chronic nature, there are treatments which can be used to help lighten the affected skin once the underlying disorder is controlled and with the clear understanding that discolouration due to skin pigment changes, i.e. red blood cell pigment, is hard to impact.
• Lemon juice - Apply the juice from two to three lemons to the ankles for 30 minutes twice daily.
• Baking soda - Mix three tablespoons of baking soda in one gallon of hot water. When cool, submerge the affected ankles in the mixture for 15-20 minutes each day.
• Coconut oil - Massage the ankles for 15 minutes daily to lighten the ankle skin.
• Cocoa butter - massage the ankles for 15 minutes daily.
• Milk and rice flour - Mix three tablespoons of milk with one tablespoon of rice flour and apply this mixture daily for 10 minutes.
Other lifestyle changes which will improve stasis dermatitis and decrease pigmentation in the legs include:
• Avoid standing and sitting for long periods of time.
• Prop up feet when sitting.
n Wear compression stockings.
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