Why is My Ankle Swollen?

Sometime towards the end of 2011 I began to notice that my right foot/ankle area was swollen. I was not too concerned because I had issues with that ankle previously. I had sprained that ankle in 2006, not a bad sprain, but enough to weaken the ankle. I was fine for a few years, the ankle had healed and I had no issues. In December of 2008 I was checking my email,  like I did every morning before I went to work. My cat was sitting in my lap and I guess he must have caused my leg to fall asleep. Usually you can tell when your leg falls asleep, you get that tingling or numbness, I guess it was not quite at that point where I would notice that it was asleep, but enough that some of the feeling was gone in my leg. I finished checking my email and was getting up to grab my keys and jacket to head to work. I got up and stepped forward on my right leg, not realizing that it was partially asleep, instead of landing with my foot flat on the floor the foot was tilted. As I stepped down on it, the foot went all the way over so I landed on my ankle.

 !!!!! The pain was excruciating!!!!  I was sure I had broken it! I was able to drive to work and planned to head over to urgent care as soon as they opened. They were located right near work so I figured I might as well be close. I was not able to step on my right foot at all, I could only step on the ball of my foot. As soon as they opened, I headed over to Urgent Care. They took some X-Rays and determined that it was not broken, just a very severe sprain. There are three levels of sprains:
 Grade 1 sprain is defined as mild damage to a ligament or ligaments without instability of the affected joint.
 Grade 2 sprain is considered a partial tear to the ligament, in which it is stretched to the point that it becomes loose. 
Grade 3 sprain is a complete tear of a ligament, causing instability in the affected joint.^[3] Usually bruising will occur around the ankle.
I had a level 3 sprain. They wrapped my ankle and gave me some crutches to use. Now I have to tell you that the crutches were never going to work. I have no coordination at all, and I could not get the hang of using the crutches. I decided that limping on the ball of my foot was going to have to work.  By the next day the bruising started. My entire foot and ankle on both sides was completely bruised and swollen.

It took about a month to be able to walk on my foot normally again. My ankle was weakened by this experience, so much that I had to get an ankle brace to wear when it really started giving me problems. 
Since my ankle was weak and occasionally gave me problems I did not really think anything when I began to notice occasional swelling in late 2011. The swelling was only occasionally and was gone within a day or so, so it did not seem too bad. I assumed that I must have stepped on it wrong and irritated the already weak tendons. The new year rolled around and I still had the occasional swelling, I don't think I really thought anything was wrong until early March. Now the swelling seemed to be occurring more frequently and lasting longer. It was still only in my right foot at this point, but I finally began to realize that this was not from the sprain. For one thing it did not really hurt. I also noticed that my right shoes were giving me problems and the top of my foot was really irritated when I wore them. Sometime around the end of March I noticed that my left ankle was also starting to swell. OK, now I was concerned. I still had no health insurance, so I applied for a few, but was turned down due to pre-existing conditions. There was a pre-existing conditions insurance, but I needed to have no insurance for 6 months to apply. So going to a doctor was out at this point. Time to do some research. I researched my symptoms and one thing kept coming up, Lymphedema. 

Lymphedema refers to swelling that generally occurs in one of your arms or legs. Although lymphedema tends to affect just one arm or leg, sometimes both arms or both legs may be swollen.

Lymphedema is caused by a blockage in your lymphatic system, an important part of your immune and circulatory systems. The blockage prevents lymph fluid from draining well, and as the fluid builds up, the swelling continues. Lymphedema is most commonly caused by the removal of or damage to your lymph nodes as a part of cancer treatment.

There's no cure for lymphedema, but it can be controlled. Controlling lymphedema involves diligent care of your affected limb.(Mayo Clinic)

Now it began to make sense. I had lymph nodes removed as part of my surgery. From all that I was reading, lymphedema usually starts to occur about two years after surgery, and this was two years so it was right on time.  Lymphedema can't be cured, but it can be managed. I began to try and learn all that I could do to manage it. 

There's no cure for lymphedema. Treatment focuses on reducing the swelling and controlling the pain. Lymphedema treatments include:

• Exercises. Light exercises that require you to move your affected arm or leg may encourage movement of the lymph fluid out of your limb. These exercises shouldn't be strenuous or make you tired. Instead, they should focus on gentle contraction of the muscles in your arm or leg. Your doctor or a physical therapist can teach you exercises that may help.
• Wrapping your arm or leg. Bandages wrapped around your entire limb encourage lymph fluid to flow back out of your affected limb and toward the trunk of your body. When bandaging your arm or leg, start by making the bandage tightest around your fingers and toes. Wrap the bandage more loosely as you move up your arm or leg. A lymphedema therapist can show you how to wrap your limb.
• Massage. A special massage technique called manual lymph drainage may encourage the flow of lymph fluid out of your arm or leg. Manual lymph drainage involves special hand strokes on your affected limb to gently move lymph fluid to healthy lymph nodes, where it can drain. Massage isn't for everyone. Avoid massage if you have a skin infection, active cancer, blood clots or congestive heart failure. Also avoid massage on areas of your body that have received radiation therapy.
• Pneumatic compression. If you receive pneumatic compression, you'll wear a sleeve over your affected arm or leg. The sleeve is connected to a pump that intermittently inflates the sleeve, putting pressure on your limb. The inflated sleeve gently moves lymph fluid away from your fingers or toes, reducing the swelling in your arm or leg.
• Compression garments. Compression garments include long sleeves or stockings made to compress your arm or leg to encourage the flow of the lymph fluid out of your affected limb. Once you've reduced swelling in your arm or leg through other measures, your doctor may suggest you wear compression garments to prevent your limb from swelling in the future. Obtain a correct fit for your compression garment by getting professional help — ask your doctor where you can buy compression garments in your community. Some people will require custom-made compression garments.

When several of these treatments are combined, this therapy may be referred to as complete decongestive therapy (CDT). Generally, CDT isn't recommended for people who have high blood pressure, diabetes, paralysis, heart failure, blood clots or acute infections.

In cases of severe lymphedema, your doctor may consider surgery to remove excess tissue in your arm or leg. While this reduces severe swelling, surgery can't cure lymphedema. (Mayo Clinic)

(this is actually my foot)

Well, I bought some compression socks and found some videos on Youtube that showed me how to massage my lymph swelling. Summer tends to be the worst time because the heat may cause more swelling than during the rest of the year. These are the summertime instructions! :O

Many people with lymphedema find that their affected limb(s) swell more in the summer because of the heat. It's important to stay cool. If possible, be sure that you are in well air-conditioned places while indoors. Try to limit the time you spend outside during the hotter parts of the day, between 11 a.m. and 3 p.m.

If you do get hot, you need to try to cool your whole body as soon as possible. Cool or lukewarm showers or baths work better than very cold water. If you're hot, but it's not possible at that moment to get into a shower or tub, at least cool off your affected limb by wrapping a cold wet towel around it and elevating it with support. To avoid getting your compression garment wet, place a plastic garbage bag between your garment and the towel, encasing either your limb or the towel. Some people prefer to cool off by dampening the garment itself. If you do this, be sure that the garment dries in a reasonable amount of time and that there is no chafing of the skin, especially at the joint creases.

Drink lots of water, even more than you do in the winter, to help keep yourself well hydrated. This makes it easier for your body to regulate its temperature. Even if salty foods don't normally affect your swelling, they may be more likely to in the summer. For crunchy snacks, go for fresh raw vegetables instead of potato chips.

Wear light, loose, non-constricting clothing. Not only will it be cooler; it is also better for the free flow of your lymphatic system. Because of the tendency of lymphedematous limbs to swell more in the summer; clothes and underwear that fit well in the winter may be too tight for summer wear. Check each day to be sure that the edges of your clothing do not leave indentations in your skin. Do not wear the item if it leaves indentations - it can constrict some of your delicate superficial lymphatic system. Moreover, looser, non-constricting clothing will allow more air circulation so that perspiration and moisture won't be trapped next to your body. http://www.lymphnet.org

So management of this issue was going to be something that would take time and planning. This was not going to be easy. I had already determined that most of the shoes that I own had to go. I would not be able to wear them again with the swelling. I was down to a handful of shoes and I did not even know if those few would work. They tended to be the roomiest of my shoes, so I would wait for fall and see if they worked. The only shoes I could really wear at this point were my sandals. They have velcro for both straps across the foot so I could make it as loose as I need it to be. Now having my shoes loose is presenting another problem for me, my feet keep cramping. Foot cramps tend to happen when you wear shoes that don't really fit right, your foot has to work extra hard to keep the shoe on. Since I could not wear my shoes where they fit snuggly, I will have constant foot cramps when I wear shoes. 

So this is where I am right now. I deal with the issues of both Lymphedema and Coccydynia. I guess they are a small price to pay to be cancer free, but my life is more complicated now. I can't just get up and go somewhere, I always have to think about what kind of circumstances I will come across and will I be prepared. Time will tell how this all works out....