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Joachim Zuther, Lymphedema Specialist. Read more
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Do’s and Don’ts for Lymphedema of the Leg

 

Certain activities may trigger the onset of lymphedema, or may exacerbate the symptoms of existing lymphedema. Individuals affected by lymphedema and those at risk for developing it (everyone who has undergone lymph node excision and/or radiation treatments) should observe the following precautions. The “Do’s” and “Don’ts” below are based on decades of experience and knowledge of clinical experts in the field of lymphedema management.

Skin Care

  • Keep your skin meticulously clean and check frequently for any cracks, fungal infections or rashes
  • Moisturize your skin daily, especially after taking a shower or bath. Use appropriate ointments or lotions
  • Dry your skin thoroughly with a soft towel after taking a shower or bath; do not scrub
  • If you undergo radiation therapy apply the ointments recommended by your physician to any radiation redness on your skin and avoid direct exposure to sunlight
  • Avoid cosmetics that irritate the skin

Clothing – Jewelry – Compression Stocking

  • Avoid clothing that is too tight, such as underwear, socks or stockings that restrict
  • Do not wear tight jewelry and avoid elastic bands around your ankle
  • Wear your compression stocking or pantyhose all day, and if necessary apply your bandages at night. Use rubber gloves when you put on your compression garment. See your therapist at least every six months (or sooner) to check the condition of the garment.

Avoid any Injuries to the Skin

  • Shaving: use an electric razor to remove hair from the leg or abdominal area; do not use razor blades
  • Nail care: you should keep your toenails short but be careful cutting your toenails, do not cut the cuticles
  • Pets: be careful playing with your pets (scratches)
  • Mosquito bites: wear insect repellants, avoid mosquito infested areas
  • Injections: do not allow injections in the swollen leg (or the leg at risk), in the buttocks on the affected side, or the abdominal area. Do not allow blood to be drawn from the affected leg, or the leg at risk
  • To take care of minor injuries, always carry an alcohol swab, local antibiotic and a bandaid with you
  • Do not walk barefoot and wear solid shoes to avoid ankle injuries
  • No piercing or tattoos on the leg or the abdominal area

Avoid Heat

  • Avoid hot showers
  • Avoid hot packs and/or ice packs on your leg, or the leg at risk
  • Avoid saunas, hot tubs and whirlpools. Do not sit too close to a fire place
  • Avoid traditional massage on the leg and the lumbar area. Note: Manual lymph drainage is not considered to be a form of massage
  • Avoid sunburn – while in the sun, use sunscreen, cover the leg with appropriate clothing or a dry towel

Exercises

  • Discuss proper exercises and activities with your therapist
  • Avoid movements that overstrain. Should you experience discomfort in your leg, reduce the exercise activity and elevate your leg
  • Elevate your leg as often as possible

Nutrition

  • Obesity may have a negative effect on your swelling; maintain your ideal body weight
  • There is no special diet for lymphedema; keep your diet well balanced. Most nutritionists recommend a low-salt and low-fat diet, high in fiber
  • Eating too little protein in the hope to have a positive effect on lymphedema (high-protein edema) is not recommended and may cause serious health problems. Reducing the protein intake will not reduce the protein component in lymphedema

Travel

  • Avoid mosquito-infested regions
  • Wear an additional bandage or stocking on top of your compression garment when traveling by car, train or air. Incorporate frequent stops, or get up from your seat frequently, elevate your leg(s) as often as possible

See your Doctor if you:

  • Have any signs of an infection, such as fever, chills, red and hot skin
  • Notice any itching, rash, fungal infections, or any other unusual changes on the skin
  • Experience pain, or an increase in swelling in your toes, foot, leg or lower body quadrant

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34 comments to Do’s and Don’ts for Lymphedema of the Leg

  • Suzie

    I was diagnosed with Lymphedema 2 years ago and told to never take a diuretic. Now I have Meniere’s Disease and
    the Dr. wants to put me on them.
    Is it safe. He did not know about Lymphedema and diuretics.
    Thanks.

  • Dr. R

    Much of what you list here is reasonable. However, some of it also has never been substantiated by reasonable research and is hearsay. I recommended when making statements about lymphedema treatments and recommendations we stick to what is substantiated by good scientific research. Good patient care does not require unreasonably restricting our patients’ lives and/or unnecessarily increasing their fears.

  • Jane Kepics PT DPT CLT- LANA

    Patients with Primary or Secondary Lymphedema are told that taking diuretics to treat Lymphedema will not really help because the problem is within the lymphatic system . Diuretics may be beneficial for patients whose swelling is due to a vein issue not a lymphatic one. So the idea of ” never take a diuretic” is not a precaution that something terrible will happen if you take these drugs, but rather that diuretics are not indicated in swelling that is due to poorly functioning lymphatics. So you should be able to take the diuretics for your Meniere’s without a problem .

  • Pam Waldorf

    In your comments you mention not to allow shots into the affected leg. I have a major problem concerning that, I need knee replacement surgery but in order to keep going until the surgery can be scheduled I need to have shots of Supartz in my knees to simply be able to function. The shots lasted for close to a year, Can you please tell me why we should not have the shots into our knees and also comment on knee operation with legs that suffer from RLS and Vericose veins (had an EVLT- this happened before I knew about my LE – and severe LE – my doc wants me to have lap band surgery for weight loss so that I can have the knee replacement surgery – please address this also. Thank you

    • Joachim Zuther

      The reason why injections into a lymphedematous extremity should be avoided is because there is a chance that the swelling could get worse. However, in many cases, especially if the lymphedema is well managed, the positive effects of an injection overwrite the possible negative effects.

  • Andrea Carlucci

    I am 38 and have primary lymphedema in my left leg. I was diagnosed at 18 when it made its appearance. I can tell you that I have proven the whole “avoid strenuous exercise ” wrong. I am a personal trainer and marathon runner. I weight train 6 days a week and run 30-35 miles a week. I can tell you that all the strenuous activity has only HELPED my lymphedema. It has increased my circulation and made it stronger. The more I work out, the better the lymphedema has gotten. Some days it’s barely noticeable. I do wear a compression (up to the knee, but sometimes just an ankle one). I elevate my legs at night but that is the extent of how I care for it. Other than that I completely live a normal life with it. I never dwell on it enough to hold me back.

  • David

    I have had congenital lymph edema for fifty years. Three years ago
    I lost 140 pounds to get my weight to about 170. I am 6′ 1″ tall. Since the
    Weight loss my capacity to resort lymph fluid appears to have expanded
    And I am able to wear off the shelf pants for the first time in years. I havel
    taken up running (15-18 miles/week) and my Jobst Elavarex garments are
    Doing fine at managing swelling. So I second the idea of weight control and
    Question over restricting exercise and exertion.

  • Jane Kepics PT DPT CLT- LANA

    I am a PT and a certified Lymphedema therapist for over 26 years. Many of the precautions are anecdotal because no one will do the research – such as take 100 people with Lymphedema and see what would happen if you inject 50 of them in the leg. But since some people get worse with injections, we give them that precaution. There is evidence that exercise is beneficial for arm Lymphedema after breast cancer but good research regarding the benefit of exercise for leg Lymphedema has yet to be published. And we cannot assume that what is beneficial for arm swelling is also beneficial for leg swelling. In my experience, weight control is essential to treat any Lymphedema . It will not eliminate the swelling ( because it cannot negate the anatomical deficiency that causes swelling) but in many cases a good compression routine and periodic manual lymph drainage is all that is needed to keep the residual swelling under control. The task of the Lymphedema therapist and patient is to figure out how much exercise can an individual do before his swelling gets worse. That depends on how much damage there is and how well the garments or compression system does the job. Some patients improve with lots of exercise, some find that there is a limit to how much they can do before the swelling gets worse . So I would not go to extremes and say “Never do this or that” unless I consider the individual circumstances of each patient.

  • colleen

    i have pain in my left leg, near the knee. my lymphedema typically travels around on my right side, as i had radiation to my right jaw. i usually get swelling in my arm and head. is it typical for it to go to the other side? i think i may have a clot and i am going in tomorrow to the urgent care (i know, stupid me to not go now). but assuming i go to er before i get your answer, if they find no clot, could this be lymphedema, now on the other side of my body? also, is it possible to have no flare-up? i was thinking today that i had no real issues, and then my leg started hurting. thank you for your help.

    • Joachim Zuther

      Colleen: Lymphedema usually does not travel to different parts of your body. You should certainly have your MD check out the cause of the swelling

  • Kathleen

    I have primary lymphedema of the leg and wear a 50-60 mmhg support stocking. I am fit and exercise regularly. I perform self manual lymphatic drainage nightly interspersed with occasional use of a pneumatic pump. My question is how often should I be going to a massage therapist for manual lymphatic drainage treatments?

  • Great work, numerous truly strong tips! I truly appreciate you writing this post and the remainder of your internet site is exceptional!

  • Jan

    Does anyone know if there is still a stock (non-custom) pantyhose 40-50 compression that has compression to the waist? The Juzo Varin full knit seems to have disappeared and the Juzo dynamic has thigh high compression and just a panty attached. I am getting a ridge of swelling where the compression ends on the thigh…don’t really want to wear bike shorts and don’t want to go to custom…

    • Joachim Zuther

      Jan – as you know, the compression gradually decreases between the foot and the thigh. if a 40-50 garment does not provide adequate compression, you may have to switch to a pantyhose, or additional bike shorts. Your therapist should be able to give you proper advice.

  • Jan

    I am wearing pantyhose already. Its just that the compression ends at the thigh and I develop a ridge of swelling there. I used to wear Juzo full knit which had compression all the way up to the waist. I am wondering if any other companies have this option. The “custom” fittings have been a disaster…

  • Jan

    They no longer make the ready made product Juzo dynamic varin full knit 3513ATA. The customs have all been very expensive DUDs.

  • Rhonda Dudley

    My skin is aging with the rest of me and the elastic on my compression stockings is irritating my skin. I’m also having issues donning my compression bandages, probably age related also. Any suggestions?

  • Lew Carder

    For ease of putting on compression socks, get a “sock
    donner”. They are great to use! Most “Medical Supply” stores have them and some drug stores. Also available online.

  • Sarah

    I am curious about tattoos and lymphedema… I can’t seem to find any solid answers about yes or no to tattoos after lymphedema, just people not suggesting it (sounds like they wouldn’t support tattoos without it either)
    Anyway, I have lymphedema in my right thigh. I was in a car accident two years ago, I cut across the top of the thigh and had a few surgeries on it to save the leg, it started about 6 months after the accident and the swelling just accumulates around my knee. I have lots of tattoos, but have not had one since the accident. I would like to get a tattoo on the side of my thigh to detract from the scar, its not swollen on the side just around the knee but what would happen if I did tattoo on the same limb?

    What about tattoos in other areas?

    • Joachim Zuther

      The ink used in tattoos is a so-called “lymphatic load”. Part of ink injected in the skin will inevitably enter the lymphatic system putting more stress on it. That and the fact that getting tattoos bears the risk of infections is reason to advise against receiving tattoos on the swollen body area.

  • I have a follower on my site that is asking what to do about blood clots in the legs and/or what can be done for them. I haven’t dealt with blood clots so far in my LE that I have had for better of 10 years now so I am not sure how to respond to that LE pt on my LE site, other than referring them to a therapist and/or doctor for a further prognosis.

    They are asking more specifically for an article on this. Do you have access to such an article?

  • Leily

    Hi JOachim,

    Firstly, I would like to say thank you for the fantastic blog and information you provide for LE patient. Then, i like to ask some questions:
    1. I have primary LE in my left leg which appeared when I was 35 years old last year. After 5 months they diagnosed the swelling with LE. wearing compression stockings and MLD (myself) made a big difference and my foot is now 1/2 size bigger than the other foot (2.1cm difference between two legs from thigh). My concern is pregnancy as we are planning to have kids and I am worry about passing this disease to my next generations. What are the chances of my kids getting LE? Is there a high chance?Also, I know that the swelling wil become worse during pregnancy. Will it be permanent or temporary and will go away after pregnancy?
    2. I am experiencing changes in my bowl movement (more frequent movement, color and texture changes)since I am doing MLD. Are these related? Is it a good sign?
    3. I am having mucous gathering in my mouth (Approx.100 ml daily )specially in the morning when I wake up and after having a big meal. It makes me coughing a lot too. This is happening again since I am doing MLD. Are these related?
    4. My Physio just recommends compression garments for me and says due to shortage of resources ( I leave in a small town) they can not do bandaging. Is wearing compression garments enough at this stage? Do you think I’d better go and find some one doing bandaging for me?
    Sorry too many questions but I really enjoy your comments and knowledge in regards to LE.
    Thank you, Leily

  • Steph Maxwell

    Hi, I got diagnosed today with Lymphedema and was wondering if there was any way of getting compression socks in cotton cause I have eczema and have reactions to the socks that I’ve been given. Thank You.

  • Kathy

    My daughter was diagnosed with stage III ovarian cancer at 17. She is now 35 and has been experiencing lymph edema of her leg. This time it is worse. Seems to occur during hot summer season. She is experiencing soreness all the way up to her arm pit. She has had many surgical procedures including thoracic surgery due to her cancer which involved a teratoma. She is using compression stockings. would a diuretic help. She also sits most of the day at a desk.

  • Jennifer walker

    Hi. Last year I was diagnosed with lymphedema after 3 years of severe ankle swelling. I’ve had 2 ankle surgeries since diagnosis because of mechanical issues. I have been on a compression machine for several months with no change. Prescription stockings for a few years now. What else can I do? I wear flip flops because I can’t for in my shoe.

  • Susan

    Can lymph fluid leak from a toenail?
    My right ankle became very swollen after standing for several hours over this past weekend. On Sunday afternoon, I noticed 2 mosquito bites on that ankle and then on Monday, I had extreme pain in my right big toe – under and around my toenail. I thought perhaps my toenail had been pressing against the tennis shoes that I had worn over the weekend while standing several hours, so I decided to clip my toenail (even though it really wasn’t very long). When I clipped the toenail, a lot of clear liquid began to flow freely from underneath the toenail – at the top, down one side and even from at the bed of the toenail! It was clear with only a very slight color – not really yellow, more like a straw or hay color. It leaked this fluid profusely for about 20 minutes and then continued leaking slightly for more several hours. I kept it elevated for the evening and overnight. This morning the swelling was completely gone and my toe did feel better; however, after being up now for 7 hours, it is hurting and throbbing again. Do you think this could be related to my lymphedema?

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