Leg swelling and lymphoedema
A lot of patients get swollen legs, often because of a condition called lymphoedema. The majority of patients are female and aged between 40 and 60 years old. Generally speaking the swelling is worst in the foot, ankle and calf – it is quite common for the front part of the foot to become very swollen and bulge out over the top of an open shoe.
The commonest cause is that the tiny lymphatic channels in the legs that carry the tissue fluid away from the legs and back to the heart just stop working for no obvious reason, this is called primary lymphoedema. Other patients develop chronic leg swelling after surgery or radiotherapy on the affected limb, for example, lymphoedema in the arm is a particular problem after surgery for breast cancer.
Lymphoedema usually affects both legs although one may be worse than the other. Swelling occurring solely in one leg is a bit suspicious of something stopping the outflow of blood and fluid from the leg and should be investigated by a vascular surgeon.
For most patients lymphoedema is mild and can be kept under control by simple measures.
In extreme cases patients can have trouble with the skin on the front of the leg. Cracked skin can lead to a bacterial infection called cellulitis where the skin becomes red and inflamed. In serious cases patients need to be admitted to hospital for intravenous antibiotics.
Unfortunately there is no cure for lymphoedema. The majority of patients can keep the swelling under control by the use of compression stockings and simple treatments such as specific massage techniques (sometimes called manual lymphatic drainage). Massage is only a temporary measure and needs to be repeated regularly. Attention to skin care with moisturisers on the front of the legs is important to avoid the development of serious infections.
Foot swelling can be treated by the use of lace-up type shoes which stop the forefoot swelling that a lot of patients suffer from. Although not always fashionable, using these shoes most of the time will keep the foot swelling under control so that you can wear more open shoes for special occasions.
Decent compression stockings need to be properly measured and be of good quality to reduce swelling and changed every three to six months. Most people can only tolerate stockings up to the knee as a full leg stocking tends to roll down the leg.
Patients may find compression stockings difficult to get on especially those who find bending over difficult or have trouble with arthritis in the hands and can’t grip very well. There are some useful gadgets that can help in getting stockings on and off for these patients.