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Lymphedema of the Leg
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Lymphedema of the Leg

Primary Lymphedema

Primary lymphedema of the leg is a disorder of the lymphatic system caused by the malformation of lymphatic vessels or nodes, and is most common in women.  Depending on the type of primary lymphedema, the onset may be at birth, at puberty, or later in life.  Congenital lymphedema, where edema is present at birth, is called Milroy's disease.  When edema presents around puberty, it's called Meige's disease.  

Secondary Lymphedema

Secondary leg lymphedema can be caused by the treatment for lymphoma, melanoma, prostate cancer or urogenital cancers, such as bladder, uterine, cervical, ovarian, testicular or penile.  More specifically, secondary leg lymphedema can be the result of surgical damage of the lymphatic vessels, removal of lymph nodes in the groin and/or pelvis area, traumatic injury of the lymphatic vessels of the leg, radiation therapy of the groin, lower abdomen or lower lumbar spinal column, or inflammation of the lymphatic or blood vessels of the leg or pelvis.

After damage, injury or removal of lymph vessels of lymph nodes, the body is naturally able to find alternative drainage pathways, and there is no significant swelling, but when this doesn't happen, or if the burden becomes too great, lymphedema can result.  Lymphedema may be present in one leg, both legs, the genitals, abdomen, lower back and/or buttocks.

If left untreated, lymphedema will become worse over time, and fibrosis or sclerosis can cause tissues to harden.  In addition to leg swelling and hardening, the risk of an infection called cellulitis or erysipelas becomes a concern.  If a leg with lymphedema goes untreated for a great length of time, there is a small chance the lymphedema can develop into a malignant tumor called lymphangiosarcoma or Stewart-Treves syndrome.

How is lymphedema recognized?

With primary lymphedema, swelling is usually first noticed on top of the foot, just before the toes.  With secondary lymphedema, early onset lymphedema may cause the patient to notice a pulling in the groin and in the inner side of the thigh.  They may also notice a feeling of heaviness and other sensations in the leg, but not usually pain.  In secondary leg lymphedema, swelling will usually begin in the upper leg, but may not be noticed until it has progressed further down the leg towards the toes.  It is pretty common for the swelling to disappear overnight and come back during the day.  When swelling is noticed, it is often after some type of overexertion.  

Lymphedema is generally thought to be a permanent condition that can be treated and managed, but not cured.  Early intervention may possibly "reverse" lymphedema, or provide the best outcome, so it is important for a patient to contact their doctor immediately if they experience any signs or symptoms of lymphedema.

Therapy for lymphedema of the leg

Therapy for leg lymphedema may vary depending on how far it has progressed.  In the early stages, wearing a compression stocking and maintenance with MLD (manual lymph drainage) may be adequate.  The gold standard for treating lymphedema is called "Complete Decongestive Therapy."  Complete Decongestive Therapy, sometimes called "Combined Decongestive Therapy," or "Complex Decongestive Therapy," includes a combination of MLD, bandaging, exercise and skin care.  For the most effective results, patients will usually see their lymphedema therapist on a daily basis, or at least a few times a week for Phase I of therapy (decongestive phase), which may last anywhere from two weeks up to about six weeks.  Phase II, or the "maintenance phase," usually involves wearing a compression stocking during the day, sometimes a different type of compression at night, and MLD given by a therapist or self-MLD on a regular basis.  

Diet and exercise also play an important role in managing lymphedema.  It is recommended patients drink up to two liters of water per day, as adequate fluid intake is important for both hydration and filtration.  The best diet is a stable, well-balanced diet.  For someone who is overweight, a low-calorie, low-protein diet is recommended.  Salt restriction is important because salt causes water retention.  Exercise should be something the patient enjoys doing, which will not over-burden the body.  Swimming is usually an excellent option, as it offers good external compression, can keep the body from over-heating, and is low-risk for injury.  Since obesity contributes to lymphedema, maintaining or striving for an optimal body weight is important.