A doctor explains what can cause swelling (edema) in both ankles when your heart, liver, kidney and other key tests are normal and you’re not obese.

The following can cause swelling (edema) in both (bilateral) ankles: heart, liver and kidney failure; low thyroid; celiac disease; kidney stones; PMS; excessive sitting or standing; hot weather; varicose veins; high salt (sodium) intake; old age.

Tests for heart, liver, kidney and thyroid function, as well as a blood test for celiac disease, can easily be taken. What if they’re normal?

Does that mean there can’t be other causes of bilateral ankle edema?

“Ankle swelling in general is common, and when painless can be caused by such simple things as gravity, such as when one is on their feet for long time,” says Jacob Teitelbaum, MD, medical director of the Fibromyalgia and Fatigue Centers nationally, and author of “The Fatigue and Fibromyalgia Solution.”

“Low thyroid will also be a common cause, despite normal thyroid tests.” So if your thyroid test was normal and there seems to be no other cause to the swelling in both your ankles, what should you do?

“Relying on thyroid testing misses over 50% of people who need and would benefit from thyroid hormone,” continues Dr. Teitelbaum.

“In this situation, however, there will also be fluid in the fingers, which would not be especially noticeable except for causing rings to be tight.

“The key discriminant factor also is whether the swelling in the ankles is gone in the morning after one has been lying down for an extended period (i.e., with gravity draining their legs),” says Dr. Teitelbaum.

“If this is the case, there is a greater likelihood of the issue being benign. If the swelling is persisting even through the night, or swelling is very marked even just during the day, I would consider a CAT scan of the pelvis and abdomen looking for evidence of venous obstruction – especially from tumors.”

Keep in mind, though, that bilateral ankle swelling is not a more common symptom of cancer, and it’s not even listed by Mayoclinic.com as a symptom of liver, kidney, lung, colon, stomach (esophageal), ovarian or cervical cancer.

However, Mayoclinic.com lists “swelling in the legs” as a symptom of prostate cancer, which also can yield many other symptoms.

A tumor that obstructs lymphatic flow can cause edema in the ankles, but it’s very unlikely that this would be bilateral.

Periomenopause is associated with bilateral ankle edema. Of course, pregnancy can cause this. But what about menopause?


Menopause and the timeline soon after, during which women can still experience annoying symptoms related to menopause, can cause fluid retention in the body.

Edema in both ankles has been associated with menopause.

The key is determining when you think you began developing the edema, and if this coincides with the timeline right before you began menopause, or during menopause.

If “all the tests” have come back normal regarding the cause of your bilateral ankle edema, consider that pulmonary hypertension can cause this symptom.

However, this condition yields other troublesome symptoms such as dizziness, chest pain and fatigue.

Venous insufficiency can cause swelling in both ankles, but this is usually accompanied by leg pain as well.

Sometimes, the cause of bilateral ankle edema is never found.

Dr. Teitelbaum is a board certified internist and nationally known expert in the fields of fibromyalgia, chronic fatigue syndrome, sleep and pain.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.  


Top image: James Heilman, MD, CreativeCommons