Lymphoedema
Lymphoedema is defined as the swelling of a body part, usually a limb, because of a restriction in the lymph fluid drainage system
It can be related to genetics and occur in childhood, adolescence or adulthood or it can be related to trauma to lymphatic system from any of the following:
- Surgery
- Radiation therapy
- Tumor compression/obstruction
- Traumatic injury
- Infection
- Lymphoproliferative disease
- Tumor/cancer involvement
- Filariasis (parasitic infection)
Lymphoedema that comes from trauma is usually one sided, is associated with reduced movement if around a joint space and often results in substantial disability.
The science behind why it starts is complex but basically involves an increase of protein in between cells which absorbs more fluids to the area. After a while scarring develops and fibers holding cells together become hard. This leads to blockages of the lymphatic drainage and the fluid backs up like a blocked drain.
Lymphoedema progresses through four major stages:
- Abnormal flow of lymphatic system.
- Pitting oedema (ability to leave indents in your skin when pressing it) – this usually returns to normal by mornings.
- Non-pitting (no indents remains when you press into it) early hardening of the flesh under the skin is developing at this stage.
- Brawny oedema / swelling – usually irreversible at this stage – largely due to soft tissue scarring and internal hardening of under skin tissues.
If you have a development of swelling in an area of your body and you are not sure why it may be worth getting an assessment today by clicking here
Otherwise here are some signs you may be developing lymphoedema
- Swelling of involved body part.
- Pain (not always).
- Thickening / hardening / doughiness of flesh under the skin.
Unfortunately, there is no cure for lymphoedema and it requires a large amount of meticulous treatment in order to gain the best outcomes.
Treatment involves four areas:
Medication:
- Antibiotics– primarily when infection occurs.
- Diuretics – which can help with water retention but don’t have impact on protein
Mechanical:
- Elevating the limb.
- Protection of limb from further trauma.
- Manual lymph draining and specialized massage.
- Compression therapy to reduce how much fluid accumulates in the area.
- Exercise – especially effective for the muscles of the limbs.
Surgical:
- Unfortunately, not for curing the disorder but for managing the severity.
Excisional:
- Debulking of excess tissue and decreasing the volume.
Physiological:
- Drainage of area via lymph to lymph or lymph to venous anastomosis
Because it is an incurable disorder, prevention is essential and largely involves appropriate education surrounding:
- The things that contribute to the development of the condition.
- How to take proper care of our limbs.
- Importance of signs and symptoms and early intervention strategies.
- The longer the disease continues without management the worse it becomes! The sooner the better with treatment.
Compression Therapy:
Compression therapy is probably the most effective treatment especially in the early stages of disease progression and can easily be prescribed by Riverside Podiatry. It can take 3 different forms:
- Compression stocking
- Cheaper than the alternatives and good for basic lymphoedema.
- Can be difficult to put on and off and keep in position.
- Other devices may need to be used.
- Best applied early in day.
- Compressive wrapping
- Better flexibility for specific problem areas and for specific patients
- Easier for other helpers to assist with.
- Allow greater activity level than pumps.
- Can be time consuming to put on.
- More expensive.
- Compression pumps
- Not adequate for primary therapy
- Does not address oedema closer to the torso.
- High cost and harder to use.
- Less convenient for associated exercise or mobility.
