Lymphoedema,
A swelling problem
Have you noticed your feet or legs are swelling and you don’t know why?
By Clare Rushmer, Podiatrist
Lymphoedema is a disease which occurs when the lymphatic system fails and fluid accumulated in the affected area. It causes progressive swelling, skin changes, fluid leakage from the skin, and an increased risk of infection. It cannot be cured, but needs to be managed to prevent dangerous complications such as immobility or cellulitis, a serious bacterial skin infection.
How is it Diagnosed?
If lymphoedema is suspected, your GP will refer you to a specialist lymphoedema clinic. Here they will ask about your symptoms and medical history, measure and examine your legs, and possibly perform a lymphoscintigram, where dye is injected and a scanner tracks how it moves through your lymphatic system.
What causes Lymphoedema?
There are two sorts of lymphoedema – primary and secondary.
Primary occurs where a genetic fault causes abnormal development of the lymphatic system, this normally develops early in life.
Secondary arises through damage to a previously normally functioning lymphatic system, and can happen at any time of life. Common causes are injuries, surgeries, cancer treatments and obesity.
What treatments are available?
There are 5 main pillars of lymphoedema management
- Compression. This can initially start as bandaging or velcro wraps in the early stages to control the disease, applied by the lymphoedema specialist. Once under better management, you can use compression stockings, tights, or other elastic garments at home which can be applied by you. There is a huge variety in design of compression so please don’t be put off by something you may have seen in the past.
- Movement. The lymphatics cannot pump themselves, so rely on movement such a deep breathing, stretching and exercising to move the fluid around your body. You can find deep breathing and movement regimes designed by lymphoedema physiotherapists online to follow at home. Swimming is particularly good as provides external compression from the water in addition to internal muscle movement. Simply going for a walk is very good for leg lymphoedema. You must always wear your compression when walking.
- Skin care. Your skin acts as a barrier to prevent infections, and needs to be protected. Avoid sunburn by using a high SPF protection cream, insect bites by using repellent, and injuries by using protective clothing when gardening, cleaning etc. Wash with emollient washes rather than foaming shower gels or soaps which dry the skin, and apply moisturisers daily. If you get skin folds which become damp, or your toes swell, use antiperspirants here to help keep the skin dry.
- Manual lymphatic drainage. This is a very relaxing and gentle massage performed by a trained professional which helps to move the fluid throughout the body, eventually becoming expelled through the urine. You can find an MLD specialist here: https://www.alisonrostron.com/ They will also be able to show you simple massage techniques you can use at home.
- Surgery. Some people with lymphoedema can have surgery. There are a few specialist units in the UK who offer lymphoveno anastamosis, where the non-functioning lymphatic vessel is attached to a vein which performs the function instead. You may also be suitable for liposuction where a large volume of accumulated fat and fluid can be removed from a limb to decrease the size. Occasionally sections of excess skin also need to be surgically removed after liposuction.
Although lymphoedema cannot be cured, you can live a very healthy active life with good management.
