What is the reason behind Donald Trump's big swollen ankles?
Photo credit: AP, Stuff 18 July 2025
You may have seen in various news media here and overseas that Donald Trump's ankles appear swollen. The diagnosis, according to his personal doctor, is chronic venous insufficiency. Is there cause for concern?
What is Chronic Venous Insufficiency and Swollen Ankles?
Chronic venous insufficiency (CVI) is a condition characterised by failure of the venous valves within the surface and deep veins of the legs. This causes blood to pool in the legs causing varicose veins, leg and ankle swelling and sometimes skin problems, such as ulcers. CVI is a relatively common condition and can deteriorate over time. People with leg swelling should consult with their general practitioner (GP) or vascular specialist for diagnosis and appropriate management.
Some other causes of leg swelling include heart failure and other major medical conditions, lymphoedema, and lipoedema.
What Causes Chronic Venous Insufficiency?
CVI usually results from venous valve failure, which impairs the upward flow of blood from the legs towards the heart. Other risk factors include:
- Prolonged standing or sitting: this causes increased venous pressure over time contributing to valve damage. People who stand at work for long periods or who travel long-distance regularly.
- Deep vein thrombosis (DVT): a dvt is a blood clot in the vein. Blood clots can damage valves.
- Obesity: being overweight can increase pressure on the veins and valves.
- Pregnancy: sometimes hormonal changes, with the corresponding increased blood volume, can stress venous valves.
- Age: valve function diminishes naturally over time.
- Family history of the condition: a family history of CVI can mean the condition is passed on.
What are the symptoms of CVI?
The most common symptom of CVI is leg swelling, especially swollen ankles. Fluid gathers, mostly worse when standing, and improves when legs are elevated. Varicose veins, large ropey-looking veins on the surface, are also associated with CVI. Along with varicose veins, patients often describe a feeling of heaviness in the legs. And their legs also ache. A patient might also notice skin changes on their legs. These may become itchy with eczema and noticeably red or darker and patchy. An ulcer may form if the skin continues to deteriorate, often after minor trauma.
Any leg swelling is uncomfortable; the legs may feel hot, heavy and as if they are 'bursting'.
What treatment do we recommend for CVI?
Following a consultation, advice on risk factor management and a venous ultrasound scan, we will recommend the best treatment path. In the first instance, and for more immediate relief, we will recommend medical-grade compression stockings/socks. These are graduated so help to disperse the fluid and encourage blood flow. All in all, a patient will get some relief from the pressure that has built up to cause the swelling.
If varicose veins are present, we will recommend non-invasive treatment to close off the veins so blood can re-route via healthy veins.
Donald Trump meets many of the risk criteria above: age, long periods sitting, because of his extensive long-distance travel, and swelling in his ankles. Ultrasound scans will confirm a diagnosis of CVI and rule out any other serious conditions, such as DVT.
Refs:
Eberhardt RT, Raffetto JD. Chronic venous insufficiency. Circulation. 2014;130(4):333-346
Nicolaides AN. Investigation of chronic venous insufficiency: A consensus statement. Circulation. 2000;102:E126-E163.
