Achy ankles are a common complaint, affecting nearly one in five adults over 55, making it the second most frequent joint pain after knees. However, for many individuals, the underlying cause remains a mystery, even for medical professionals. This issue has prompted numerous readers to report similar experiences of stiffness and pain, particularly during warmer weather.
While several factors can contribute to ankle discomfort, including menopause-related joint pain and undiagnosed injuries like strains or sprains, experts highlight hidden varicose veins as a surprisingly prevalent cause. Most people associate varicose veins with visible, bulging vessels, but specialists note that many problematic veins lie deeper beneath the skin and are not apparent externally.
Professor Mark Whiteley, a varicose vein expert at The Whiteley Clinic, explains that these deeper veins malfunction when their internal valves fail, causing blood to pool instead of returning to the heart. This condition, which affects an estimated one in five adults and is often genetic, is equally common in men and women. He states, "There’s a misconception that all patients get visible varicose veins, but for many, these are hidden." He further notes that the initial symptoms often manifest as stiff and painful ankles, which may improve when the legs are elevated. Over time, some individuals may develop itchy skin or sores around the ankle, and visible varicose veins may eventually appear, though not always.
Diagnosing these hidden varicose veins often requires a specialist venous duplex ultrasound, a scan that assesses the function of the leg veins. However, access to these scans can be limited, as the National Health Service (NHS) in the UK typically only funds varicose vein treatments for patients experiencing severe pain or complications. This restrictive policy means that only about 20,000 varicose vein operations are performed annually on the NHS, despite millions being affected. Patients often face significant out-of-pocket expenses, potentially thousands of pounds per leg, for private treatment.
While hidden varicose veins are a common culprit, other potential causes for ankle pain should also be considered. Dr. Naomi Potter, a menopause expert, points out that hormonal changes in mid-life, specifically the decline in estrogen, can lead to joint stiffness and aching. She notes that while hormone replacement therapy can be effective, patients experiencing menopausal joint pain usually present with other common symptoms like brain fog and sweating. Additionally, physical injuries to the ankle can cause pain, often accompanied by visible signs such as redness, swelling, and tenderness to the touch.
Despite these other possibilities, experts like Professor Whiteley maintain that a substantial number of achy ankle cases are linked to unrecognised varicose veins. He estimates that 15 to 20 percent of the population suffers from this condition without realizing it and advises individuals with persistent ankle pain to request a referral for a scan from their general practitioner.