Severe Ankle Discomfort and Swelling Each Morning
Recently, I've been experiencing a troubling issue with my ankles. For the past few weeks, each morning has started off with significant pain in both ankles. Initially, I assumed it was just a minor strain and took some Advil. However, as time passed, the discomfort escalated, accompanied by noticeable swelling in both ankles. This pain, which I would rate as a 6 or 7 out of 10, awakens me around 5 AM, and it feels like an intense, burning sensation. My ankles themselves feel unusually warm to the touch. The worst part occurs when I attempt to get out of bed and walk. This action ignites a severe flare-up of pain, prompting me to apply ice packs and take four Advil. After about an hour, the pain subsides enough that I can manage it without tears. When the symptoms first emerged, I visited urgent care, where the doctor prescribed a short course of prednisone, suggesting that it was unlikely to be a blood clot due to the bilateral nature of the pain. Thankfully, the prednisone seemed to provide relief—I felt almost back to normal by the second day, but my supply has since run out. The urgent care physician recommended that I follow up with my primary care doctor; however, I was surprised to find out they do not conduct blood tests there, contrary to what their website indicated. Fortunately, I had a scheduled routine blood test from my endocrinologist, as I manage type 1 diabetes. I went to the lab for that, and the results showed that my kidney function is normal, although my vitamin D level was slightly low. I then saw my primary care physician, who advised me to wait a bit after stopping the prednisone before getting another round of inflammation labs, for which she provided an order. I haven’t had the chance to undergo those tests yet, but I intend to ask her to include a white blood cell count check to rule out any infection. I'm feeling quite overwhelmed by this situation. The pain in the mornings is significantly affecting my daily life—I can hardly walk without ice, elevation, and pain relief. It’s unusual for me, considering I’ve always led an active lifestyle without issues like swelling in my feet and ankles. To provide some background, I’ve been living with type 1 diabetes for 25 years and maintain good control over it. I’m active, exercising four to five times a week, including activities like Peloton workouts and family bike rides. Although I experience occasional eczema-like rashes on my torso, I’m otherwise healthy and have recently entered perimenopause at the age of 50. I take insulin, a low dose of Wellbutrin, and Ozempic to manage insulin resistance. Over the last few years, I’ve noticed some joint pain in my fingers. I weigh 133 pounds at a height of 5'5" and try to eat healthily. Should I consider asking for a cardiovascular evaluation? Any insights would be greatly appreciated!
Answers (1)
7/28/2025, 1:02:12 PM
OpenHealth AI
It sounds like you're experiencing significant discomfort and challenges with your ankles, which is understandably overwhelming given your active lifestyle and long history with diabetes. Persistent pain, swelling, and burning sensations in the mornings can be signs of several underlying issues, including inflammatory conditions, arthritis, or even overuse injuries.
Explanation
Your symptoms, particularly the bilateral swelling and significant morning pain, indicate a process beyond simple strain. Since you found some relief with prednisone, this suggests an inflammatory component could be involved, possibly linked to conditions like gout, inflammatory arthritis, or other forms of arthritis. Your background with type 1 diabetes and the recent transition into perimenopause could also intersect with these joint issues.
Considering your healthy lifestyle and prior activity levels, the sudden onset of these symptoms is indeed concerning and warrants further investigation. Moreover, the slight vitamin D deficiency may contribute to joint pain and inflammation, as vitamin D plays a role in bone and immune system health.
Next Steps
Here are prioritized actions you can take to manage your symptoms and gather more information:
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Follow Up on Blood Tests: Schedule the pending inflammation labs your primary care physician ordered, and ensure to include a white blood cell count to check for any signs of infection or inflammation. It's crucial to understand what's happening internally.
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Monitor Your Symptoms: Keep a daily log of your symptoms, including pain intensity, swelling, and any other changes. Note the time of day these symptoms occur and any activities that seem to worsen or improve them. This information can be helpful for your doctor.
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Vitamin D Supplementation: Since your vitamin D was slightly low, consider discussing supplementation with your healthcare provider. Proper levels may help reduce inflammation and support bone health.
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Modify Activity Levels: While staying active is important, consider adjusting your workout routine to lower-impact exercises or incorporating more rest days to allow your body to recover. Activities like swimming or cycling with lower resistance could reduce strain on your ankles.
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Ice and Elevation: Continue to use ice packs and elevate your ankles when resting, especially in the mornings. This can help reduce swelling and feel more comfortable before getting out of bed.
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Re-evaluate Medication: Discuss with your physician about potentially using a longer-term anti-inflammatory medication if the prednisone provided relief and if inflammation remains a concern.
Additional Consideration
Based on the complexity of your symptoms and history, if your pain and swelling persist despite these measures and tests, you might want to consider asking for a referral to a rheumatologist for a specialized evaluation. This could help determine if an autoimmune process or another chronic inflammatory condition is at play.
It's understandable to feel overwhelmed, but by taking proactive steps, you will be better equipped to tackle the situation. Please keep track of your progress and don’t hesitate to reach out for more guidance or support as you navigate this.
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