Understanding Leg Lymphedema

The lymphatic system serves as one of the body’s most vital systems, composed of an extensive network of lymph 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 visible swelling and skin changes.

What causes lymphedema in legs?

Leg lymphedema occurs when the lymphatic system is impaired, blocked, or underdeveloped in the legs or pelvic region. This disruption leads to a buildup of lymphatic fluid, resulting in chronic swelling in one or both legs.

There are two main types of lymphedema:

• Primary lymphedema is a rare, inherited condition caused by abnormal development of the lymphatic vessels. It may present at birth, or develop later in life during periods of hormonal change such as puberty or pregnancy.

• Secondary lymphedema is more common and results from damage to an otherwise normal lymphatic system. This damage can be caused by a number of factors, including:

  • Cancer treatments such as surgery, lymph node removal, or radiation therapy following gynecological cancers (cervical, uterine, ovarian, and vulvar), prostate cancer, testicular cancer, colorectal cancer, and melanoma of the lower extremity.

  • Surgical procedures unrelated to cancer.

  • Infections, including cellulitis or parasitic infections (such as filariasis in some regions).

  • Trauma to the lymphatic system, including injuries, burns, or extensive scarring.

  • Chronic venous insufficiency, where poor vein function leads to fluid overload that overwhelms the lymphatics.

  • Obesity, which places excess pressure on lymphatic vessels and may impair lymph drainage.

  • Lipedema, a chronic fat distribution disorder that can sometimes progress to lipolymphedema when lymphatic function becomes compromised.

In the U.S., cancer treatment is the most frequent cause of secondary leg lymphedema. When lymph nodes or vessels are removed or damaged by surgery or radiation, the lymphatic flow may be permanently altered.

Over time, even previously unaffected pathways can become overwhelmed, leading to fluid buildup. Lymphedema may appear soon after cancer treatment or take months or even years to develop. As a result, following cancer treatments one is risk of developing lymphedema for life.

What are the signs of 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 feel tight in the affected area.

Other signs & symptoms of leg lymphedema include:

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

• Decreased movement and/or flexibility of your leg(s) and/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 lymphedema 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. However, your healthcare provider may recommend certain medical imaging, such as an ultrasound, MRI, or CT scan, to rule out other causes of leg swelling.

Lymphedema Leg Treatment

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.

Lymphedema treatment consists of 5 essential elements:

• Compression Therapy: Compression therapy is crucial for managing lymphedema as it significantly reduces limb volume and prevents the build up of fluid. Compression therapy may include:

  • Wearing multi-layered compression bandages to significantly reduce your swelling and improve your skin changes.

  • Wearing compression garments, such as an leg compression stockings or socks, to maintain your limb size and control swelling.

  • Wearing nighttime garments for ongoing swelling management.

  • Using lymphedema compression pump for the legs

• 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 swollen area. For the treatment of leg lymphedema, MLD should only be performed by a Certified Lymphedema Therapist.

• Exercises: Exercise plays a vital role in managing lymphedema. It helps improve lymph flow as your muscles contract. Your Certified Lymphedema Therapist will provide you with individualized lymphedema leg exercises to improve your swelling, mobility, and flexibility.

• 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 and protecting your skin is essential for preventing lymphedema flare-ups and other complications.

• Education: Education is paramount for long-term management:

  • Focuses on self-care and self-management techniques

  • Includes instruction on self-manual lymphatic drainage

  • Emphasizes the importance of maintaining a healthy weight and following a balanced diet

  • Includes sharing the latest evidence on risk-reduction principles.