Lymphedema In The Legs

Lymphedema in the legs happens when there is an abnormal collection of lymphatic fluid beneath the skin. This causes swelling that is made of protein-rich lymph fluid, not a watery fluid. Because it is a protein-rich fluid, diuretics (water pills) are ineffective and can worsen lymphedema.

As Pam Wedeking, OTR/L, MLD/CDT, Cert. MDT, an occupational and lymphedema therapist with Franciscan Health, explains, “Lymphedema occurs when lymphatic vessels or nodes are removed surgically, damaged or overloaded by lymphatic fluid in a body area.”

Key Takeaways: Lymphedema In The Legs

• Lymphedema is a chronic condition characterized by swelling caused by a buildup of lymph fluid in the body's tissues.
• Common causes include damage to the lymph nodes from cancer treatment, surgery, or infections.
• Managing the condition requires a combination of compression therapy, specialized massage, and meticulous skin care.
• Early diagnosis is critical to prevent the swelling from becoming permanent or leading to serious skin infections.

What Causes Lymphedema In The Legs?

The most frequent causes of lymphedema in the legs include cancer treatments, such as surgical removal of lymph nodes and radiation often related to pelvic, gynecological or prostate cancer.

Another common cause of lymphedema in the legs is chronic venous insufficiency (CVI). 

“In CVI, the valves in the leg veins no longer work correctly and cause blood to pool in the legs instead of being carried up toward the heart,” Wedeking said.

In cases of untreated or severe CVI, “it can progress to phlebolymphedema, which is a combination of CVI and lymphedema.” Although less common, people born with lymphatic vessels or nodes that do not work optimally also can develop lymphedema.

Can Lymphedema In The Legs Be Prevented?

There are steps you can take to decrease your risk for lymphedema in the legs. These include:

• Avoiding prolonged exposure to heat and application of heating pads to the affected area.
• Drinking plenty of water to help lymph fluid move through the body.
• Eating a healthy diet, maintaining a healthy weight and avoiding foods with high sodium like canned foods, processed meats, sauces and fast foods.
• Exercising regularly.
• Lowering your risk for cuts and wounds.
• Moisturizing the skin to maintain the skin barrier.

“Protecting your skin with sunscreen is important, and so is using insect repellant during warm months,” Wedeking said. “If you already have lymphedema or are at risk and are not currently exercising, it’s important to talk to a lymphedema therapist to ensure that exercises are appropriate, and you should progress slowly.” 

If you are newly diagnosed with cancer and need either surgery or radiation treatment, undergoing a bioimpedance spectroscopy test could be beneficial. 

“This test is ideally performed before any procedures, such as surgery or radiation, can alter the lymphatic system.  It sends a low electrical impulse through the body to measure the total body fluid and how much resistance there is to fluid flow,” said Wedeking. “It is a quick and pain-free test, and when performed every three months, it can detect early lymphedema before it is visible and measurable externally. In some cases, treatment at this stage can reverse lymphedema.”

Risk Factors For Leg Lymphedema

Although lymphedema cannot be cured or completely prevented, you can decrease your risk. Risk factors for leg lymphedema include:

• Removal of lymph nodes or injury to the lymphatic vessels in the abdomen, pelvis or legs.
• Surgery in, or radiation therapy to, the abdomen, pelvis, or legs.

Leg Lymphedema Signs And Symptoms

The first sign of leg lymphedema is a feeling of tightness or heaviness, Wedeking said. 

“This occurs before any visible swelling is present,” she said. “As lymphedema worsens, visible swelling often resolves or decreases when elevating the legs.” 

However, if lymphedema persists, elevation may only partially decrease the swelling. 

Complications Of Untreated Leg Lymphedema

Untreated lymphedema can lead to:

• Lymphangiosarcoma, a type of cancer occurring in very rare cases of chronic lymphedema
• Severe skin changes including thickening or hardening of the skin, hyperpigmentation or darkening of the skin, abnormal wart-like growths and increased fat deposits
• Skin infections
• Wounds that can become chronic or difficult to heal.

Treatment For Leg Lymphedema

Wedeking said the best natural methods to control lymphedema include maintaining a healthy weight, exercising regularly and drinking enough water to stay hydrated. Also, the use of compression garments can be helpful. 

“Compression garments or bandages help increase external pressure and assist the lymphatic system to move the fluid from the leg up toward the heart,” she said. “I tell my patients to be consistent with a maintenance program.” 

People who stop wearing their compression garments without the guidance of a lymphedema therapist often regress and their limb(s) will become swollen again. The best way to decrease your risk for skin changes and repeated infections and wounds is to keep the swelling down with the program developed with your therapist. This typically involves wearing compression garments during the day and often at night, using moisturizer and caring for your skin and performing at least a few simple exercises.

For some, using a home pneumatic pump or massaging the skin to improve lymphatic drainage can help, but research shows that compression is much more effective than pumps or massage in controlling the swelling.

The traditional and most effective approach to treating lymphedema is lymphedema therapy. 

“This is also called complete decongestive therapy,” Wedeking said. “It involves a combination of treatment with compression, manual lymph drainage, exercise and skin care.” 

Even severe lymphedema cases will often improve significantly with lymphedema therapy.

Surgery For Lymphedema

Surgical procedures for lymphedema treatment are designed to decrease the severity but not necessarily cure lymphedema. These are:

• Lymph node transfer – where a lymph node from one body area is transferred to the area affected with lymphedema.
• Lymphovenous bypass – where lymphatic vessels are connected to venous vessels so the blood vessels can take on some of the lymph fluid load.
• Debulking – which is used rarely and in only very severe chronic cases. It involves surgical removal of fibrotic, hardened tissue.

Exercise And Physical Therapy For Leg Lymphedema

Some studies suggest aquatic therapy as part of lymphedema treatment. 

“Water-based exercises can be helpful because of the additional water pressure on the lymphatic system,” Wedeking said. 

However, in severe cases, even water pressure may not be enough and wearing compression garments in the pool may be recommended.

Trampoline exercise may be recommended for lymph fluid movement, but Wedeking said there’s no evidence proving it’s more effective than land-based exercises. Ultimately, Wedeking suggests you find an enjoyable, sustainable exercise program you can stick to long-term. 

Stories Of Success 

Over the years, Wedeking has worked with patients with chronic leg lymphedema. 

“With lymphedema therapy, they were able to significantly reduce the size of their legs to improve their mobility and have an easier time fitting into clothing,” she said. “It’s a joy to see them so excited about how small their legs have become.” 

Wedeking recently worked with a patient with such limited mobility that he couldn’t participate in the things he enjoyed. 

“After lymphedema therapy, the pain decreased so much that he could attend church, participate in family celebrations, and go grocery shopping without a motorized shopping cart,” she said. “He refers to his leg bandaging as his ‘armor,' which decreases the pain to the point that he hardly notices it.”

Advocating For Proper Care

Wedeking urges patients to be proactive in their care, especially since not all physicians are well-versed in lymphedema treatment. 

“There are medical issues that can cause swelling, so it’s important to work with your physician to determine the cause of your swelling,” she said. 

For lymphedema and phlebolymphedema, it is important to get a referral to a lymphedema therapist. If you have risk factors for lymphedema, asking your doctor for a referral to lymphedema therapy for instruction in ways to decrease your risk for lymphedema in the legs and the associated complications may be helpful.

Frequently Asked Questions: Lymphedema

What causes lymphedema?

The lymphatic system carries lymph fluid throughout the body. If the vessels become compromised, fluid can accumulate, resulting in chronic swelling. 

What is lymphedema rehabilitation?

A combination of manual lymph drainage, compression bandaging, decongestive exercise and increased patient mobility can allow a patient to manage their lymphedema."