Leg Lymphedema: What It Is, Lymphatic Edema and Lymphedema

Swelling in the leg that increases toward evening and almost disappears overnight is easy to attribute to fatigue. But when the puffiness persists for weeks and the skin on the shin becomes firmer, lymphedema may be the cause. Let us look calmly and factually at how lymphatic drainage works, where the failure comes from, and which examinations help distinguish lymphatic edema from other types.

What leg lymphedema is and how the lymphatic system works

The lymphatic system is a network of channels and nodes throughout the body. It has two tasks: helping fight infections and removing excess fluid from tissues. Lymph itself is a fluid containing leukocytes that protect against microbes. When this network is damaged or blocked, lymph accumulates in soft tissues — this is how lymphedema forms: retention of protein-rich fluid in the intercellular space with an increase in the volume of the affected body part. The arms or legs are most often affected.

Lymphedema, lymphostasis and lymphatic edema: are they the same

Three names describe one mechanism: lymph does not leave the tissues and remains in them. Lymphedema is a long-term, chronic condition, not a one-off reaction to a long journey or heat. That is why lymphatic edema of the legs appears persistent: without treatment it usually worsens and turns from "soft, with a pit on pressure" into permanent and firm.

Myth: "lymphedema is just water that will go away on its own." Fact: it is a chronic condition with impaired function of the lymphatic system, and over time, without medical supervision, the puffiness becomes more pronounced.

Why lymphedema occurs: primary and secondary causes

There are two types. Primary lymphedema is associated with congenital developmental features of the lymphatic system — vessels or nodes may be absent, underdeveloped, or altered. It can start at any age, but more often in infancy, adolescence, or young adulthood, and it is rare. The secondary form is far more common: the lymphatic system is damaged from outside.

• Infections, including parasitic ones such as filariasis
• Surgery with removal of lymph nodes, including for cancer, and radiation therapy with tissue scarring
• Tumors that compress or destroy lymph nodes and vessels
• Injuries and burns with scars along the lymphatic pathways
• Inflammation of the limb and lack of movement in it

How lymphatic edema of the legs manifests

The main sign is puffiness of the whole leg or part of it: shoes and socks become tight, rings and watches dig into the skin. At first the edema is soft, a pit remains on pressure, it may appear and disappear, increase during the day and subside overnight. Without treatment, the puffiness usually worsens and persists constantly. Then aching and a feeling of heaviness, difficulty moving, recurrent skin infections, thickening and folds of the skin, wart-like growths, and fluid leakage through the skin come into play.

How lymphedema differs from other edemas and how it is detected

The key is in the mechanism: in lymphedema, fluid is retained because of a breakdown in lymphatic drainage, not because of a one-off load. Therefore, the doctor reviews the history: surgery on lymph nodes, radiation therapy, infections, injuries, inflammation of the limb. Then comes examination and measurement of the circumference of the affected leg — this shows whether it is enlarged. If necessary, imaging is added: vascular ultrasound, lymphoscintigraphy, MRI, fluorescence lymphography with indocyanine green. People treated for cancer who are at risk remain under follow-up after therapy.

When to see a doctor and what complications are possible

The reason for consultation is typical symptoms: persistent swelling of an arm or leg, heaviness, tight shoes. The most common complication is erysipelas (cellulitis), a bacterial infection of the deep layer of the skin: fluid accumulated in the tissues makes them more vulnerable to microbes. Hyperkeratosis, papillomatosis, and lymphorrhea also occur, and the most formidable is lymphangiosarcoma. A chronic condition that changes appearance often affects mental health, up to depression.

Lymphedema itself is not a reason to call an ambulance; 103/112 — if, against the background of edema, redness and heat of the skin, severe pain and rapid worsening of puffiness, high fever, chills, or a feeling of alternating hot and cold appear.

This material is for reference only and does not replace consultation with a doctor.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer