Big legs might not just be fat or swollen

Lymphoedema can be a common side effect in your arm or chest following breast cancer surgery, but what if the pain and swelling is in your legs?

Leg swelling can be the result of surgery to remove lymph nodes from the pelvis because of gynaecological cancers, or removal of nodes from the groin for skin cancers like melanoma. There are many other circulation disorders that can contribute to leg swelling, which will increase the risk of lymphoedema developing after surgery to the groin or pelvis. But leg swelling is sometimes unrelated to surgery, and can also occur in both legs simultaneously. Meet ‘lipodema’: the often misunderstood and misdiagnosed condition that is thought to affect 5-10% of females. 

Lipodema is the deposition of painful, lumpy fat, mostly in the legs, which are big compared to the rest of the body. In particular, it does not affect the feet, resulting in characteristic cuffs that develop above the ankles. Weight loss efforts seem to fail because losing body fat can actually make the disproportion of the legs more apparent. It can exist alongside obesity, in which fatty tissue is soft but does not have the tender lumps, and can also be worsened by obesity. Lipodema can be present with lymphoedema, in which interstitial fluid doesn’t drain effectively causing skin to thicken with congestion, and may lead to pitting where where an imprint remains in the skin after pressure is applied. 

This condition is often inherited, but it’s rare in males. It tends to be symmetrical compared to lymphoedema, which is more often the result of surgery on one side. It is thought to be a fibrotic subcutaneous adipose connective tissue disorder. 

So, how is lipodema treated? Exercise and diet are important in managing lipodema and best results are achieved with professional support from dieticians and exercise physiologists. Bulky legs can affect the alignment of legs, causing adverse strain to knees which are often reported as an added source of pain, especially if there is an associated tendency to have hypermobile joints. This can make it more difficult to participate in weight-bearing activities, but water exercise is well tolerated and improves swelling while also helping to maintain muscle and joint function.

Women with lipodema do benefic from conservative management similar to lymphoedema. Our physiotherapists Mary Shearer and Carolyn Urquart can help manage lipodema symptoms using manual lymph drainage, deep tissue massage, low level laser therapy, and by offering advice about compression garments and intermittent pneumatic compression pumps.