Understanding Leg Lymphedema

The lymphatic system serves as one of the body’s most vital systems, composed of an extensive network of vessels, lymph nodes, and lymphoid tissue and organs. It has two primary functions: to maintain the fluid levels within your body and to filter bacteria, abnormal cells, and waste products from your tissues. When the lymphatic system is damaged, the system may no longer work as effectively as it once did. As a result, fluid may build up, potentially resulting in a condition known as lymphedema.

Lymphedema is a chronic condition characterized by an abnormal buildup of protein-rich fluid in any part of the body, resulting in eventual visible swelling and skin changes.

Causes of Leg Lymphedema

When the lymphatic system is damaged, blocked, or abnormally developed in the legs or pelvic region, fluid may start to build up and progressively lead to chronic swelling, known as lymphedema.

Cancer treatment is the most common cause of lymphedema in the US. Cancer-related lymphedema in the legs occurs as a result of surgery, radiation therapy, and/or the removal of lymph nodes, following abdominal, pelvic, or lower extremity cancer. 

When the lymphatic system is damaged by these cancer treatments, the remaining healthy lymphatic pathways may become overwhelmed over time, resulting in a backup of fluid in the affected body part. Lymphedema may develop within days, months, or years after the completion of cancer treatments.

Types of Leg Lymphedema

There are two types of lymphedema:

1. Primary lymphedema: It is an inherited condition caused by the abnormal development of the lymphatic system. Leg lymphedema typically appears during infancy, puberty, or pregnancy in such cases.

2. Secondary lymphedema: This is the most common type of lymphedema, caused by damage to the lymphatic system. The lymphatic system may be damaged or blocked due to various reasons, including trauma, obesity, cancer history in the abdominal, pelvic or lower extremity, surgery, lymph node removal, or infection.

What symptoms are associated with leg lymphedema?

The most common sign of lymphedema within your legs is chronic swelling. Swelling can develop very slowly or suddenly following an incident that overwhelms the lymphatic system. However, in the early stages of lymphedema, visible swelling may not be apparent, but you may have feelings of heaviness/fullness in your leg(s).

Other signs & symptoms of leg lymphedema include:

• Feeling of heaviness, fullness, tightness in your leg(s) and/or feet

• Visible swelling

• Decreased movement and/or flexibility of your leg or feet

• Decreased visibility of your veins, tendons, and wrinkles in your feet

• Clothing feels tighter than usual

• Fibrosis: hardening and/or thickening of the skin

• Pitting edema: Indentation of the skin with applied pressure

• Increased swelling on hot/humid days or after physical exertion

Lymphedema is a progressive condition; thus, without proper treatment, swelling and skin changes may continue to worsen throughout the entire legs.

How is this condition usually diagnosed?

Lymphedema is diagnosed by any healthcare professional, including a Certified Lymphedema Therapist, with a physical examination and thorough history of your medical conditions and symptoms. No medical imaging or tests are needed to diagnose lymphedema; it is instead a clinical diagnosis.

However, your healthcare provider or therapist may recommend certain medical imaging tests, such as an ultrasound, MRI, or CT scan, to rule out other causes of leg swelling.

What services and treatments do you offer to treat this condition?

Complex Decongestive Therapy (CDT) is the gold standard treatment for lymphedema, and it is performed by a Certified Lymphedema Therapist (CLT). Many studies have proven the effectiveness of CDT for improving lymphedema swelling, pain, impaired mobility, and poor function.

CDT consists of 5 essential elements:

1. Compression Therapy: Multi-layered compression bandages are used to reduce swelling and improve skin changes. Compression garments are also used to maintain the size and swelling of the affected body part. Velcro garments and nighttime garments can be used to maintain your swelling.

2. Manual Lymphatic Drainage: Manual lymphatic drainage is a specialized light massage technique that enhances lymphatic flow and the movement of lymphatic fluid out of the affected body part.

3. Remedial Exercises: Due to the pumping action created by your muscles contracting as you exercise, lymph flow is enhanced. Exercise plays a vital role in the management of lymphedema.

4. Skin and Nail Care: One of the biggest concerns with lymphedema is the risk of infection and cellulitis. Thus, having a good skin care routine is essential for preventing lymphedema flare-ups and other complications.

5. Patient education: Since lymphedema is a life-long condition, education regarding self-care and self-management is paramount.