A 55-year-old woman presented with a gradually increasing painful forearm swelling since 1 year [Figure 1]. A sign of fluid buildup or inflammation of joint and tissue, ankle swelling is also called edema. If you experience ankle swelling with chest pain, dizziness, light-headedness, confusion, shortness of breath, or any difficulty in breathing, seek immediate medical attention.
There are times when long flights or car rides and standing for long periods of time can lead to swelling of ankles. Certain medications, like antidepressants, calcium channel blockers and hormones like estrogen and testosterone and steroids can cause swelling. Ankle arthritis is another degenerative change of the joint which can be quite painful and could cause swelling. Treatment for ankle edema depends upon the analysis of the underlying disease condition and its diagnosis. To soothe tendinitis, sprains, strains and aches, alternate hot and cold vinegar wraps can do wonders.
Ice can be applied to a sprain for about 15 minutes daily and every two hours for about two days to reduce bleeding, inflammation and pain.

It can also result from serious infections, trauma or circulatory disorders, cardiac disorders or other conditions.
Swollen ankles can be indicative of potentially serious disorders such as congestive heart failure, deep vein thrombosis and liver failure.
Blood clots, known as DVT (deep vein thrombosis), are a common vascular obstruction of blood flow which can cause swelling around the ankles and can also extend further up the leg. Heat equal amounts of vinegar and water, soak a towel and wrap it around the foot for about five minutes. Since urine has some fluid-retaining salt in it, the more it is diluted, the easier it is to remove salt and prevent edema.
Pregnancy, obesity, vascular problems or orthopedic conditions are other possible causes for ankle edema. It is complicated by preeclampsia, a serious condition that includes high blood pressure and swelling. Those suffering from gout exhibit abnormal accumulation of uric acid within the joints leading to inflammation and resultant swelling. Histopathology revealed a fibrocollagenous cyst wall [Figure 2] lined by well formed granulomas composed of multinucleated Langhan's as well as foreign-body type of giant cells and histiocytes admixed with dark brown yeast forms [Figure 3].

Possible symptoms that occur with ankle swelling include fatigue, joint stiffness, redness in the ankle join and reduced range of movement. Subcutaneous infection results in a single, discrete, well-encapsulated cyst with central necrotic area filled with pus. The surrounding granulomatous wall and multinucleated giant cells show hyphae with irregularly spaced branches and constrictions around the septae resembling pseudohyphae.
Amongst phaeohyphomycosis, Phialophora jeanselmei, Phialophora spinefera, Phialophora dermatidis, and Phialophora richardsiae are common isolates. Treatment with newer azoles seems promising, and excision alone or combined with azoles is a good therapeutic modality.

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