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Joachim Zuther, Lymphedema Specialist. Read more
Lohmann Rauscher

Tactile Medical

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


  • 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


  • 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


  • 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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121 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.

    • Doreen Von Essen

      My doctor told me to take Lipoflavinoids sold over counter for Miniers . Worked great had to take highest dose for several weeks to see improvment BTW I started with Mineieres when I was 20 yrs old . I wonder if others have this also?

      • Christine M. Kelly-Boyd

        Doreen, what lipoflavinoids did your doctor recommend? I have severe issues with constant ringing & now hearing loss due to the ringing. On top of lymphadema 🙁 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.

    • Anna Ensley

      My very active 11 year old son now has genital lymphedema and now it’s starting in his left leg. We are a very active, athletic family. Our doctor recommends not to be active because exercise increases lymphatic production. I would love to have a resource like you to see how we can get my son back playing soccer and skiing, etc.

  • 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.

    • Pam

      I have lymphedema resulting from substantial radiation to my right breast and under arm. I was prescribed a sleeve and glove but was unable to bear wearing it out in the heat while showing houses to clients. When I came home, my right leg arm and abdomen were severely swollen. Left side was fine, I was not aware lymphedema could travel like that. Can you explain? It improved after elevating my leg and wearing the sleeve within day or two though. Any information or suggestions would be greatly appreciated. Thanks.Pam

  • 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?

    • Joachim Zuther

      Should you see any increase in swelling, you should consider consulting with a trained lymphedema therapist

  • 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.

    • Sarah

      Hi , I have primary le since I was 8 in both my lower limbs. I have 10tattoos my self in various places allover my body except my lower limbs. When you have le you can get,internal bacterial infections. Ive personally had them and they are no joke. do not get any tattos where you have lymphedema. You put yourself at risk for not only bacterial but fungal infections as well and ive had them all. from someone who has many tattoos and had had le for over 20 years I advise against it .

  • 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

    • Joachim Zuther

      Dear Leily:

      Thank you for you kind comments. Primary lymphedema can be hereditary. There is a chance of your swelling to increase during pregnancy, especially during the 3rd and 4th quarter. However, if you know how to manage your lymphedema, you can certainly keep it under control. It is never a good idea to wear compression garments if the extremity is still swollen. Padded short-stretch bandages need to be applied until the limb is decongested and a garment needs to be fitted at that point. I would suggest locating a therapist in your area willing to apply proper therapy, should that fail, here is a link to an article for self-bandaging and self-MLD – hope this helped.
      Compression Therapy and its Role in the Treatment of Lymphedema:

      The Role of Short-Stretch Bandages in the Management of Lymphedema:

      Self Manual Lymph Drainage for Lymphedema Affecting the Leg:

      Application of a padded short-stretch compression bandage on the leg by a patient:

    • Sarah

      Hi , im a le patient mine showed up at 8 years old in my left leg and then durring my first pregnancy my right leg swole. It was 2 times worse,while pregnant for me and in my right leg it became permanant like my left. Eve after pregnancy. All three generations of women have le. Myself , my mother , my grandmother. None of the men got it. Just us women. Ive had several infectionsin my leg and the skin in general. I have to be careful not to hurt them in any way. This blog held true to my case of le and ive had it for 24 years now. Running caused a internal infection. A bacterial infection actually. As far as tattoo ing the affected limbs absolutly not! If I get nasty fungal infections from reg scrapes imagine what a,tattoo would cause. And I have 10 tattoos on my bodyin various other places just not my legs . Any questions please feel free to ask me, ive been though it all and im only 32

  • 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.

    • Joachim Zuther

      Dear Steph: I would suggest contacting JUZO; they do have specialty compression stockings for cases like this one

  • 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?

  • Tracey

    Hello, I’m wondering if laser hair removal is safe on the lymphodema legs or bikini area. Have there been any studies or are certain kinds of lasers recommended? What about other parts of the body? Underarms lower back that are not affected by lymphodema?

  • Carol Schiller

    Hi I have been dealing with LE for the past 5 years. I just wanted to put my 2 cents in about LE and tattoos. I didn’t know I had LE until I got my tat on my right leg. The outline was from ankle to knee and front to back of leg. We just did the outline first visit. The next day half way thru the day, I noticed my leg was draining fluid. Lots of fluid. Couple of days later it stopped draining. Didn’t think too much of it, two weeks later went back to have more work done on it and the next day, same thing. Someone turned on the fauset. That scared me enough to check it out. That’s when I was diagnosed with LE. I started with a therapist and was told to wait to get things under control and then only do a little at a time. I got with my tattoo guy and we worked out a schedule to get it done. It took me almost a year to finish my leg but we did. Unfortunately I have LE in both legs, so I will not be getting anymore tats below the waist. I was lucky not to have gotten any infections, not worth it. I am also having both knees replaced in a few months. I have talked with my surgeon, he is savvy about LE so I am not too concerned there. Hope this helps with tattoo or not to tattoo.

    Thanks Carol

  • Alice

    I have secondary lymph edema of the right leg and have been dealing with it since 1994. I have toenail fungus in 3 of my nails. I have been using Vick’s and two different types of “nail polish” type treatment from my podiatrist for about a year and a half, and using anti-fungal powders. The fungas is not improving and due to the liver issues for the oral medication, I am choosing not to take the oral meds. In the years since 1994, I have only had cellulitus one time, but what can I do to get rid of this fungas so I do not risk cellulitus or other infections??

  • Linda Jarvis

    I have just had surgery and have two of my lymph nodes (legs) removed. Could you please explain to me of when to go see somebody regarding Lymph edema, I have no symptoms and I am very active. Do I wait until something arises if it does?

    • Joachim Zuther

      Since there were only two lymph nodes removed in your case I would not be too worried about the onset of lymphedema. However, it is possible. I would suggest to consult with a trained lymphedema therapist as soon as you experience any symptoms associated with lymphedema. Here is a link assisting you in locating a certified therapist in your area:

  • Jeannette

    I’ve had lymphedema for 15 years in my right leg I am getting ready to retire I have a very physical job do you think it’ll get worst as I get older because I won’t be moving around so much?

    • Joachim Zuther

      Dear Jeanette: There is no reason for your lymphedema to become worse as long as you manage it the way you used to.

  • Carolyn

    I’ve had ankle lymphedema in one leg for a few years, successfully treated and managed with a 30-40 knee high. However, I now have pooling around my knee, just at top of garment. I’m looking for something that will go up to the bra line, so I will be combining shapewear with lymph support wear. I’ve found Solidae leggings, but the compression isn’t high enough. Any sugestions? Thanks.

    • Joachim Zuther

      If Solidea compression was not sufficient, the only other alternative would be a compression pantyhose compression class I

  • Carolyn

    Thanks for your help. I have only been told by a salesperson that the compression isn’t high enough on Solidea, but I plan on giving it a try since I’ve read some positive things.

  • Cindy

    I have had lymphedema for about 35 years. Both of my legs swell. I have it under control most of the time. I wear compression hoes, and I do have a pump. I started a new job last year. I work 10 to 12 hour days. I only work 3 days a week. I was doing great at first, but the last couple of months my legs have felt so heavy when I leave work. Last week both my knees started swelling and above my knee cap was very tender. I took off a week of work. I went back to work this past Monday, and I worked 12 hours. My legs where in awful shape when I got home. I felt like that I was swollen from the waist down. Now I am off of work for another week. I am going to go have my legs wrapped on Thursday. IF I keep my legs elevated they are fine, but as soon as I get up on them wearing my hose they are still swelling. My Dr. is telling me that my job might be too much. I just might can’t work 12 hour days. I need some advice. Should I only work 5 to 6 hours. Can I no longer work a 40 hour week job. I should mention that I have not worked more that 16 hours a week for the past 18 years. My children are older now, and I wanted to go back to work.

    • Joachim Zuther

      Cindy: One option would certainly be to limit your working hours. Another option is to wear an additional knee high compression stocking (compression class I), or an alternative compression device (CircAid, Solaris) on top of your compression hose. This would increase tissue pressure and limit the accumulation of fluid in the tissue of your legs. Here is a link to check alternative compression devices:

  • Cindy

    Thank you for your suggestions. I had my legs wrapped this week. Hopefully the wrapping will decrease my swelling so that I can go back to work. My knees have been swelling a lot. I have never had this problem before. Thank you again for your suggestions.

  • Kimberly

    Hello, I’ve had secondary lymphedema in my left leg for 8 yrs now due to trauma of the inguinal nodes. Before that I was a competitive runner and fitness competitor. I am back to light jogging again which feels good physically and emotionally it lifts my spirits. And I have managed to bring it back from stage 2 with fibrosis to stage 1 with a difference of 1 to 2 cm in the legs. My leg actually reduces and feels better overall after jogging as long as I practice good maintenance with compression garments, elevation, and low sodium foods. But my question is what type of garment or bandage would you recommend during jogging that would help the leg maintain compression, yet breath, and be flexible for an even. less “robotic” (more comfortable) stride with my other leg? It just feels so stiff when I wear my 30-40 compression stocking. Any suggestions?

    • Joachim Zuther

      If your lymphedema predominantly affects the lower leg, you may try to wear a 30-40mm/HG knee high stocking during your jogging activity.

      • kimberly

        No, my lymphedema involves the whole leg and I wear a thigh high. I should have mentioned this. Maybe a lighter compression during exercise? But I’m afraid it will not be enough.

        • Joachim Zuther

          You may try using a lighter compression during exercise. Should it be insufficient to keep the swelling down, you can always go back to your current compression thigh-high

  • Mia

    3 June 2014 LAVH with lymph nodes removed. Cervical Cancer. A year later and my left leg looks like it belongs to someone else. Went to ER and was told I have Lymphedema. Anyone else have this happen? I’m so angry.

  • Kimberly

    Thankyou for getting right back to me. I realize this issue is minor compared to those that are writing to you with very serious medical consequences. You treat every comment and question with respect and courtesy. I appreciate this as I’m sure everyone else does. I’ll try a lighter compression and report back to you on the results. Thanks again. I’m not alone in this after all. And it is refreshing to find someone knowledgeable that cares.

    • Peggy

      Hi Kimberly,

      I was curious about your experience of using a lower numbered compression garment in during exercise. I too have secondary lower leg lymphedema for 8 years and have managed it wearing the 30-40 mmhg panty hose. But the summer heat makes walking and biking tough.

      Wondering how your experiment went? I am afraid to use a lower grade as it has kept the lymphedema under good control so far.

      Thanks for any thoughts!

  • Toni

    I just found out 2 years ago I have lymphedema in both of my legs,I’m on 120 mg Lasix a day with potassium pills I also have a flexi touch machine that I wear to try to control and to get rid of some of the fluid I have wrapped my legs with the bandages and Iv propped my feet and legs up but nothing seems to be working Iv gained like 100 pounds and I’m over weight I do watch what I eat and I only drink water nothing else I go to the dr about every 2 to 3 months or sooner I’ll weigh in and my weight is high and I’ll go back and cut back even more on eating and what I eat but my weight is even higher I have three kids and Iv never in my life been the weight I am now not even when I was prego this is very stressful to me now I’m on depression medication and anxiety medication I don’t even want to go out of the house because of the way I look now before this I was somewhat heavy I had all the curves the hour glass figure with the perfect butt this is a life changing experence for me Iv been thinking about looking into have the lap band surgery does anyone have any thoughts on this , please I can use all the help I can get ! Thanks

  • Kimberly

    Lighter compression during jogging is the answer for me! For the first time in 8 years I felt the muscles (especially my calf) in my left leg respond and contract with every step after switching from 30-40 compression with 28% spandex to 20-30 compression with 20% spandex for exercise. I’m also experiencing much greater fluid return, more mobility, and less pain at the joints while jogging. Lighter compression only during exercise followed by firmer compression at all other times along with healthy eating, low sodium choices, and elevation at night and life is much better. Thankyou Mr. Zuther for your advice.

  • Maria

    I excercise 3-4 times per week and it seems to help. I have had lymphedema for 7 years on my entire left leg. Although I have noticed infections when i overdo the squats or leg excercise. I am getting LNT surgery at the end of the month, praying it helps!

  • Sitt Rees

    I have had progressive swelling in my right leg for about a year now, I started wearing compression socks about 6 months ago and they do help. Im probably a grade 0 as I do not have pitting edema as i don’t swell that much – its just chronically aching, which is annoying cause I have to sit and study A LOT.

    I’m a medical student so I really should be more proactive and actually go get my lymphoscintigraphy done so I can actually get a diagnosis. I have had a duplex U/S already to rule out CVI.
    Would you recommend a fMRI and map the lower lymphatics so then I can pinpoint the source of abnormality ?

    Also have you heard any recent news on whether low level laser therapy is beneficial for peripheral lymphedema, I have been reading some journal articles but the results are divided.

    Furthermore to mention geography, I live in Perth, Australia and was wondering if it is worth getting tested for Lymphatic Filariasis, however rare that could be as I have lived in Thailand and realise that time for nematodes to reach adulthood could take years, during which you could be asymptomatic.

    Lastly, would you recommend a lympho-venous anastomosis as I am in the early stages and that is of course the best time to have one done.

    @Kimberley – I will try your idea of wearing lower pressure compression socks when exercising as I to like to exercise and it swells a little bit more when I wear tighter ones (20-30mmHg).

    ps – sorry for the million questions.

  • Stacey

    Thank you for this website! Our daughter was born with primary lymphedema probably(Milroy disease)We did not have much guidance on what to do for her. Of course when she was born the doctors ran every test thinking it was something worse. She has been a healthy, smart,active girl and we are just getting her fitted for a compression sock. I try to find support and not look at too many pictures because as a mom I do get scared on how it could progress. She is aware and always called it her “fat foot”. We are trying to educate her on taking care of her foot and giving massages. I am hoping the compression will help her and help her to know how to manage as she gets older. We have never kept her from an activity and she loves soccer and dancing.I hope she always feels like she can do anything. If you have any other tips for young kids I’d love to hear.

    • Joachim Zuther

      Stacey: I suggest you consult with a trained and certified lymphedema therapist. You may use the above link labeled “Find a Therapist” in order to locate a therapist in your area.

  • Rish

    Hello, thank you for this page.
    I your article, you have mentioned to Avoid Heat. Recently, a friend of mine suggested me to try using Heated Compression Stockings. What would be your suggestions? Is far infrared radiation therapy good for lymphedema patients? Thank you.

    • Joachim Zuther

      Dear Rish: I am unclear of the potential benefits of heated compression stockings. Since any form of heat increases local blood supply and therefore increases “lymphatic load”, heat should generally avoided by patients affected by lymphedema. However, if other conditions exist in combination with lymphedema, heat may be beneficial. In these cases the potential benefits of heat need to be weighted against the potential aggregating effects of heat to lymphedema. The same goes for FIR; FIR wavelength is too long to be perceived by the eyes, however, the body experiences its energy as a gentle radiant heat which can penetrate up to 1.5 inches (almost 4 cm) beneath the skin. In other words, the temperature and thereby the blood supply in the lymphedematous extremity would increase. Here is a link to an article on FIR:
      Here is also a link to a discussion forum on the topic – please read all comments:

  • Lerato


    Just yesterday I was in hospital and I have been diagnosed with lymphedema and I’m so scared because I’m only 22 years old and a female. On my left leg I have swelling and I’ve started using the stocking. I’m afraid it won’t work even though it’s stage one . People look at me like I’m crazy and have pitty it’s annoying. Does it go down?

    • Joachim Zuther

      Dear Lerato: I would suggest you consult with a trained and certified lymphedema therapist. Please use the “Find a Therapist” button on top of this page to locate a therapist in your area.

  • Holly

    I was diagnosed yesterday as having lymphodema in my right ankle and foot. If I wear flip flops it doesn’t swell in the ankle, only the foot. If I wear tennis shoes, it swells about 4 inches above my ankle amd partly the door but it hurts on the lateral border if my foot. I have seen one orthos, said it was from my back and nerve damage and nerve test showed no sciatic nerve damage so they ruled that out as being cause. Saw ortho for ankle, was told posterior tibial dysfunction and wore boot for 10 weeks and then he said I was healed. I was now swelling on outside of ankle more. Whole foot and ankle changed from eversion to inversion. Mri negative. Although keeps foot still and doesn’t look at biomechanics of ankle in motion. I feel the aso brace damaged something as I now have tingling superficially. Could this be the lymphatic system breaking down? When I got diagnosis yesterday, was told nothing could be done. Live with it. Where do I go now? What type of dr do I see? I just ordered compression hose on my own and hope it helps. Should I see a dr to see where it is coming from? I have never had any previous foot and ankle problems so wouldn’t I need to know where the lymphatic system is disrupted? Just need thoughts due to negligent medical care. Thank you

    • Joachim Zuther

      Dear Holly:
      I would suggest you consult with a trained and certified lymphedema therapist to have the origin of the swelling evaluated. If it is indeed lymphedema, it should not be difficult to get under control. In order to locate a therapist in your area, please click on the “Find a Therapist” button on the top menu of this page.
      Below is a link, which lists MD’s specialized in lymphedema treatment.

      You may also go on our website and cliick on the “Find a Therapist” link in order to locate a therapist in your area.

      Hope this helped,

  • Tia

    I was in the past two months diagnosed with primary Lymphedema, both legs with the left initiating the symptoms 6 years ago. I had a SPY test showing little lymphatic structure beside foot on L side and damaged structure the entire length R leg. I have been doing MLD and bandaging with short stretch bandages for the past 4.5 weeks. The question I have is that the volume of legs has gone down significantly, except for my toes and top of both feet. My therapist wants to move me to thigh high compression 40-50 and took measurements. Since the top of my feet continue to be swollen despite continued bandaging including the toes should I switch over to stockings? I don’t want to be in bandages forever and they seem to not address the tops of my feet. Also, I am a healthy mobile 33 year old, my therapist has never given 40-50 due to the difficulty getting on, should I try lesser compression with a knee high on top? Thanks.

    • Joachim Zuther

      Dear Tia: Has your therapist try foam pieces/chip bags on top of your feet to decrease the swelling? If not, I would suggest trying that first. As for the compression stockings. If the swelling is more pronounced on the lower portion of your legs, you may certainly try a 30-40 mm/Hg compression thigh high with a compression class I knee high stocking on top of it.

  • Esther

    I have multiple issues. 2000 I had an accident and had cartilage removed from my left knee. Had whiplash and hurt my back. 2001 doctors thought because of the type of cells that I had cervical cancer. I had a radical hysterectomy. They removed my lower lymph nodes. I’ve had multiply injuries on my legs and knees because we live in the country and cut wood, garden, build buildings, etc. 2008-2009 I had mild heat stroke and can’t take working outside on a hot day. 2010 I slipped on ice and fell on a 2foot tall concrete filled pipe,outside a convenience store. I have 4 broken ribs, dislocated my right shoulder, tore ligaments on both sides of my shoulder. And popped my rib heads out of place on my back. I was never told about lymph phatic swelling, or edema. So here I am now 63 years old and I have whole body edema. I am overweight but it is mostly water, and lymph fluids. Who can I see to get help? I live in Wyoming.

    • Joachim Zuther

      Dear Esther: Lymphedema generally does not affect the entire body, there maybe other underlying issues regarding your swelling. However, you can locate a lymphedema therapist in your area by using the “Find a Therapist” link on the menu bar on top of this page

  • Suzette

    I had an emergency appendectomy 2 months ago (appendices were located behind my liver and I had several abdominal adhesions to to a past history of endometriosis-after hysterectomy in 2003, endometriosis has not been a problem) but I keep asking my doctor and surgeon why my feet, ankles, and lower calves have edema (ankle and lower calve edema is pitting), abdomen is still swollen, and I have significant pain and aching in my hips and ishial tuberosities and the ache is a deep one. This edema started 2 weeks after surgery and is progressively getting worse. I have never had edema in my life. I am very concerned as my life is significantly disrupted due to all this. The edema is on both sides of lower extremities and I do not have any symptoms of a blood clot, so what is going on?

    • Joachim Zuther

      Dear Suzette – Lymphedema in most cases appears in one extremity only. If both extremities are effected, there is most often another underlying reason for the swelling, especially if the edema appears to be symmetrically. I would suggest you consult with your treating physician.

  • James Morrow

    Diuretics have to be used for some medical conditions other than lymphedema but there actually have been studies done that suggest the use of diuretics promotes a fluid movement which increases the protein content which promotes the growth of fibrosis.

  • […] a huge fan of Joachim E. Zuther’s work at which lists the Do’s and Don’ts for Lymphedema of the Leg in a clear, concise manner.  At least to me, it was finally something I could save on my phone […]

  • Liz

    I have lymphedema throughout my right leg up to the buttock area. Compression pantyhose do not compress in the upper thigh area. is there something that does provide compression in that area? i’m looking for alternatives to the pantyhose or supplication to them.

  • steven thorne

    therapy told me 5 years ago or so that nothing could be done for me drs never brought it back up been battling this for 10 years seeing dr yearly for wrappings now just had donated skin surgically applied 2 days ago need to get help with this frustrating and depressing

  • Gin

    I was diagnosed with lymphedema in 2011, and I have had basically ZERO help in the maintenance or care of my limb. I have had three primary care care givers (two doctors, one nurse practitioner – she sent me to get diagnosed), only the nurse practitioner ever did anything for me, the vascular surgeon she sent me to didn’t even touch me during my appointment. I went in, his staff helped me with my clothing, he popped his head in said “lymphedema, wrap her” that was IT. They wrapped my legs in ace bandages and gave me a prescription for compression stockings.

    I wore the stocking religiously and they only made things worse. No one really instructed me about what to do, other than wear the stockings. My legs continued to swell, at one point so severely I could not bend my legs sufficiently to get in the car. They burst open and clear fluid OR blood would ooze or spurt out. I have scars on the top of my leg where they burst open and the blood spurt out. This went on for two years.

    Within the two years after I was diagnosed, I had other heath issues, one of which was an improperly placed “bladder pacemaker” which kept causing me abscesses. Knowing what I know NOW I’m wondering if that made my leg worse as it was the same leg, though in my upper hip. I wound up in the hospital requiring emergency surgery to have the device and the lead removed, and I then required 8 LONG weeks in a nursing home so my incision could be cleaned and packed. I had about a nine inch long hole in my tukus where the device and the lead had been and since the infection was so persistent, it was packed so it would heal from the inside out.

    While in the nursing home, I discovered that if I stayed in bed with the lower half of the bed raised high enough, the swelling in my legs went down. My left leg is the worst, but my right leg will eventually swell if enough time goes by. So I soon NEVER left the bed except to go to the bathroom and bath. By the time I was able to leave the nursing home, my legs were normal looking, the first time in YEARS and I had lost nearly 60 pounds from JUST elevating my legs.

    When I went home, well, my NEW home, I had no way to elevate my legs. The social worker at the nursing home said she would order me a bed, but I never got one. And recently I tried again to get one, and was told I could not get a double bed (to accommodate both my husband and myself). Our government, whose politicians LOVE to scream from the rooftops that “marriage is sacred” seem to penalize marriage at every turn. So I went for a month or more with nothing to elevate my legs, and immediately, within a week, they were more swollen than they were when I went into the hospital. The back of my upper legs split open and oozed a yellow semi-thick fluid every night. It was disgusting.

    While browsing online for something, I can’t even remember now, I found an ad for leg rests, and then at the bottom of the page I saw an ad for leg rests from a place called Lounge Doctor. I clicked on the ad and low and behold, it was a site for leg rests designed by a vascular surgeon to assist patients and others to elevate their legs at the proper angles and heights. My husband ordered me one immediately and I got it two days later.

    I placed it on the bed and made my way dragging my legs up on the bed and then up on the legrest. FOUR HOURS later, my legs were only one quarter of the size they had been. By the end of the weekend they were back to normal size. It was nothing short of miraculous for me! So I’ve slept on one ever since and spend as much time during the day as I’m able.

    I truly wish there were more I could do, something permanent, something that would allow me to not have to keep my legs up, all the time. It’s great to have normal legs, but once I’m out and about for a couple hours, they’re swollen as much as they had been.

    I’m relatively certain that this was all brought about by a foot surgery I had in 2005 to freeze three joints in my mid-foot to correct a congenital defect. I have at least four incisions in my left foot, and I’m nearly certain that damage to my capillaries is highly likely.The surgery was on my left foot, the same leg that the lymphedema swelling always starts on.

    My reason for bringing this up, is there a surgery that could repair the damage done to the capillaries if it is found that the capillaries in my left foot were damaged.The worst part is I need my left knee replaced, and both hips, AND I have significant damage in my lower back that is in need of who knows what. But, if the lymphedema could be reversed, or at least made just a minor thing I never notice anymore.

    I’m also curious if weight loss is something noticed by those afflicted with lymphedema when you keep your legs elevated correctly? I feel thinner all over, my hands, arms, torso, EVERY where. And back when I was in the nursing home and lost nearly 70 pounds, I have kept that off, and 20 pounds more.

    I’m in the process NOW of keeping my legs elevated at least 18-20 hours a day, even past the time that my legs are normal size, just to see if the weight loss is truly real.

    Do you or anyone else commenting have any situations similar to this?

    Thanks so much for your time,
    Ginny Moore
    Owensville, Ohio

    • Joachim Zuther

      Dear Gin: Unfortunately, there is no surgical procedure to repair damage to the capillaries. The weight loss you are experiencing is most likely due to the increased return or venous blood and lymph fluid secondary to you elevating your legs for extended periods of time. This causes increased return or fluids to the heart and blood circulation and secondary increased activity of your kidneys discharging the excess fluid. I would highly recommend you get into contact with a certified lymphedema therapist. Please use the link on top of this page labeled “Find a Therapist” to locate a therapist in your area..

  • Thank you for sharing this blog about your experience with your intermittent Leg Swelling and how you deal with it, its very educational and i am going to send this information to a friend who seem to be experiencing same degree of pain.

  • Laurel

    I have primary lymphatic edema. Wearing 30-40mmhg compression Juzo thigh high. The therapist recommended that I wear biker shorts as well. The company I am ordering with insists that I need custom made stockings. In the past, I have worn therapeutic grade full pantyhose. Please explain why custom is necessary. I do not want to have tight garment at waist and u comfortable thick short. Thank you

    • Joachim Zuther

      Laurel: The decision is entirely up to you. If you feel comfortable wearing pantyhose in combination with biker shorts, then that is what you should do – especially since your therapist recommended it. Custom garments are necessary if the patient does not fit within the company’s ready wear sizing charts.

  • Linda Cole

    My 81 year old mom has Lymphedema and circulatory issues. She’s temporarily in nursing home now due to a fall. One of the staff put her in a whirlpool this morning, and the Lymphedema has gone out of control. Any ideas on how to get the size of the legs to reduce?

    • Joachim Zuther

      I would suggest to consult with a certified lymphedema therapist. Please click the “Find a Therapist” button on top of this page in order to locate a therapist in your area. I would also suggest to elevate the extremity as much as possible.

  • sharon schneider

    I developed primary lymphedema in right leg at age 45 and now 54 and doing OK. Wear 40-50 compression knee high at work and less on days off. Very active. Right leg is larger than left but most people do not notice. Anyway, I am wanting to travel to Nepal for a 20 day cycling tour in the high Himalayas- going to Everest Base camp. I live in Seattle so this would be big jump to 10-15,000 feet. Am I nuts to be considering this or will I likely adjust and just need to be very careful to manage with compression and massage. Thank you!!!

    • Joachim Zuther

      Sharon – I think I replied to you already, but just to make sure: as long as you know how to manage your leg properly, you should be doing fine. Save travels!

  • Marie

    I found this site very informative, thank you.

    I have lymphedema and am going to a lymphedema clinic where they do the manual skin stretching, bandages and the pump.

    I have also been sent home with a pump and told to pump for 2 hours a day.
    My lymphedema is in both calves.

    My issue is the pump garments go up to my thighs and this pressure on my knees is damaging my knees. Ever since the pumping started, both knees pop, crackle, are extremely painful even to touch. Is there anything I can do to protect my knees during pumping?

  • Anne

    Why wear rubber gloves when putting on compression garments? Thanks!

    • Joachim Zuther

      It helps to prevent damage to the garment and distribute the garment evenly on the extremity

  • Chris

    I got Lymphadema after lymph direction and radiation. What natural supplements help he best. I have tried horse chestnut, burdock root, butchers broom, bromelian are a few.

    • Joachim Zuther

      Chris – I hear horse chestnut to be beneficial. However, there is no evidence that natural supplements help reduce lymphedema

  • Betty Prazzo

    Thank you for your caring attention to our desperation.

    • Joachim Zuther

      Betty: If there are positive nodes, they should be removed in order to manage metastasis.

  • Kathy gannon

    Have had total knee replacement, right knee, a week ago. I have pre existing lymphodema in both legs as a result of tricky surgery (for endometriosis) 10 years ago where surgeon accidentally cut some lymph nodes in my groin. I am very keen to have a good recovery from knee operation but some of the post operative exercises and treatments seem contradictory. Can you tell me how hard I should do the leg exercises I have been given – for a few years I have been doing daily gentle exercises for the lymphodema. But the post knee op exercises get me to push the muscles. Also the ice packs 3 to 4 times a day make my leg stiffer. Can I make mistakes here ? I am very keen to get a really good result from the knee operation. Thank you.

  • Jim

    I’m 36 years old and have a minor case of lymphodema precox. I have slight swelling in my lower calves that’s not really even noticeable.

    I’m going to my first therapy in the coming weeks. Will I need to wear compression socks daily?

    • Joachim Zuther

      Jim – that would be advisable. The current version of compression socks are very fashionable and generally do not look like compression socks.

      • Jim

        For the rest of my life? If the swelling goes down, can I not wear them unless it returns?

  • Joachim Zuther

    Jim, it is recommended to wear compression as often as possible. Ultimately,, you are the judge.

  • Maria Patton

    I’m 67 yrs old and experienced primary lymphedema in my feet and legs since I was approx. 15yrs old. I have worked at managing the condition over the yrs. My current job is short staff resulting in a tremendous work overload which is very demanding. The job requires abnormal extended periods of sitting with computer use as well as standing. It also requires regular overtime with the same working conditions. The working conditions have caused the lymphedema to worsen, although I’ve tried my best to elevate my feet during working hours when I can. I’ve concluded my working conditions have exacerbated my condition. Too I experience a great deal of discomfort in my legs throughout the work day.Oftentimes feel stressed and depressed because of the effects the working condition has on the lymphedema. If I’m to continuing working, although a senior now, I need to work either p/t or identify employment which doesn’t cause my condition to worsen. I tried all the treatment available including prescription compression stockings. My doctors is reluctant to approve short-disability stating I should be able to work under my current work condition with proper support. My doctors has no idea how this condition affects me. Please advise. Thank you!

    • Joachim Zuther

      Maria – it is necessary to reduce your swelling to a normal or near normal size prior to the application of a compression garment. I would suggest you seek consultation with a trained and certified lymphedema therapist. You may use the link on top of this page, labeled “Find a Therapist” in order to locate a therapist in your area.

  • Carolyn

    Can you please explain what a class 1 vs a class 2 is, and how to use this when purchasing off the shelf garments. On the garment websites they don’t mention the class of the items. Thanks for your help.

  • Lisa

    I have secondary leg lymphodema , which is well managed , but I knelt on a foam mat whilst gerdening for 1.5 hrs yesterday, then went mountainbiking for 2 hours (a regular activity) , at the end of the biking I noticed the area below the knee was puffy and maybe a little warm. Clearly the knealing has aggravated the lymphodema, are you able to describe the mechanism , what has happened?

    I have put some small sized mobiderm “dots ” under my comp. Stocking to help ease swelling away from area.

    • Joachim Zuther

      Lisa: There are a number of lymphatic vessels behind your knee, which may have become blocked during the time you were kneeling on the mat, which may have aggravated the swelling.

  • My leg is severely swollen but right now they seemed focused on other health issues and my leg is enormous. Without treatment what can happen?

  • Teresa Johnson

    I have had secondary lymphedema for 17 years. I have stuck with the traditional thinking of less is more. I wear a full leg compression sock. I had a pump early on, and that particular one caused issues. I kept up with the sock but finally decided enough was enough. I got a new pump, have taken on a new chiro, went to a massage therapist and bought a new bicycle – all with the approval of my doctor. I have noticed a decrease in the size of my leg since getting regular massages and biking twice a week. My chiro is planning on doing Frequency Specific Modulation after the first of the year.

  • Mark Vellutato

    I read the do’s and don’ts on this website. One of them was don’t get injections in a limb that has lymphadema. I have lymphadema of both lower legs and I’ve been getting cortisone injections in my knees every three months because I have high risks for surgery and can’t get knee replacements. Am I hurting myself by getting these injections?

    • Joachim Zuther

      Mark: In this case the injections are necessary and if you know how to manage your lymphedema, you should not experience any increase in swelling.

  • I have had bi-lateral lower extremity LE since 1998 following uterine cancer and removal of 17 lymph nodes. For 2 years I had no help. Drs were ignorant. I was in law enforcement. Consequently my LE progressed to my entire right leg into my toes. The LEFT leg is manageable. I spent 2 weeks of extensive therapy at Stanford learning self MDM, wrapping my legs, custom stockings, use of Reid sleeves st night, elevation of the legs, and what to use on the affected skin. I learned that pneumatic pumps are contraindicated for lower extremity LE. I also discovered on my own that refined sugar is a major issue for me causing increased swelling. I massage at least 2x daily. Wear my stockings. I wrap my right leg when I go to the gym. Yes it’s embarrassing but it allows me to lift weights, use the elliptical, stair master, treadmill. Also pool therapy is a major help. I use a foam noodle between my legs, allowing me to be buoyant, thus permitting me to jog back and forth. Excellent exercise. I was able to retire after 29 years bc I took excellent care. Always had antibiotics on hand, antibiotic ointment, and listened to my body. I can’t mountain climb, rock climb, bicycle, run. I wrap more than I wear my thigh high. But I’ve had a good 18 years living with this disease. I just know my limits. Only had one infection but caught it in time so no hospital. Listen to your intuition. Educate yourself. Don’t believe everything so called medical personnel tell you. They know about as much as you. I’ve had to educate ALL Drs. I’ve only had 2 good therapists, at Stanford. All the rest were, although certified LE therapists, either knew little to nothing, told me LE didn’t hurt, or tried experimental BS on me. I now control my destiny and tell Drs and therapists what I need. Read!! Learn about your body. Pay attention. That is my advise. And yes, refined sugar, impacts my LE negatively contrary to therapists that say otherwise. Of course, could be only my body.

  • Eleanor Haughey

    Thank you Lisa, I am also suffering terrible pain even while maintaining control of swelling. I have gone from being able to walk 6 km a day over and above working. Now I can hardly get around the supermarket from the car. If I try to do more I just get a greater amount of pain. I was not a pain wuss before. I feel I am now having difficulty getting medical professionals to believe me. I would love to hear from anyone about this.