Lymphedema is a specific type of swelling that involves the lymphatic system and lymph nodes 3. Lymphedema in the foot can be reversible, which is curable, or irreversible, which is incurable 3. Irreversible lymphedema can be treated, but it requires lifelong maintenance 3. For both types, the doctor often prescribes a safe and effective treatment regimen, called complete decongestive therapy, or CDT, which involves several processes. The prognosis, granted the patient is compliant with the sessions, is excellent. However, it is important that the medical diagnosis of lymphedema is correct before the patient undergoes CDT; faulty treatment of lymphedema is detrimental to a patient's health 3.
Manual Lymph Drainage
The doctor's prescription for foot lymphedema treatment might include CDT with manual lymphatic drainage, or MLD 3.
MLD is a special massage performed by a licensed, certified lymphedema therapist, or CLT 3. CLTs are often medical doctors, nurses, physician assistants or physical, occupational or massage therapists.
MLD helps effectively decongest, or decrease swelling, in the lymphedematous foot by directing the flow of the lymph fluid to drain in the body. If performed incorrectly, however, the massage can lead to more swelling and detrimental side effects, such as pooling of fluid in the toes or skin breakdown.
**Once the massage is performed, the swelling in the foot may immediately decrease; however, it may also take a longer amount of time for any changes to take place.
** After the massage, the CLT may wrap the foot in short stretch bandages to maintain the decongestion.
The pressure of the bandages will help squeeze lymph fluid in the skin back into the body's draining system. The residual lymph fluid in the skin causes the lymphedema 3. In simple terms, the pressure from the bandages prevents the foot from becoming any larger or more swollen.
- The doctor's prescription for foot lymphedema treatment might include CDT with manual lymphatic drainage, or MLD 3.
- If performed incorrectly, however, the massage can lead to more swelling and detrimental side effects, such as pooling of fluid in the toes or skin breakdown.
Foot Massage & Lymphatic Drainage
Every day, when foot lymphedema decongestion occurs, the patient should wear a compression garment 3. Compression garment types include special compression pantyhose, tights, knee-highs or thigh-high stockings. The pressure of the compression should start at 30 to 40 mm HG, a Class II garment.
The compression garment should fit snugly, like a layer of second skin, but it should not be too tight at any given area. If the compression garment is too tight, the patient may lose circulation in her toes and develop more lymphedema 3.
When a patient does not wear a compression garment daily to maintain the decongestion, the foot may become more swollen. When the patient exercises without wearing a compression garment, the lymphedematous foot will have increased swelling.
At night, the patient should remove the compression garment and sleep with the foot elevated on pillows.
She can wear a special night compression foam garment or bandage her own foot if her therapist has taught her how to self-bandage. A doctor can prescribe a special night compression foam garment; however, as of 2010, most insurance companies do not cover these.
- Every day, when foot lymphedema decongestion occurs, the patient should wear a compression garment 3.
- If the compression garment is too tight, the patient may lose circulation in her toes and develop more lymphedema 3.
Skilled exercises are highly recommended for treatment of foot lymphedema 3. **Swimming is recommended because water acts like a compression garment, adding external pressure to the patient's skin to squeeze lymph fluid back into the body's draining system.
** The patient should exercise regularly when wearing the compression garment. He can ride bikes, run or jog. As long as he wears a compression garment, he can perform all his regular physical activities.
- Skilled exercises are highly recommended for treatment of foot lymphedema 3.
- The patient should exercise regularly when wearing the compression garment.
Skin Care and Hygiene
Kidner Procedure Rehab Protocols
Long-term self-maintenance is important for treatment of foot lymphedema 3. Self-maintenance includes good skin hygiene. A patient should not cut or hurt her foot. She should avoid pedicures at nail salons and visit a podiatrist to cut her toenails if she has trouble doing so herself.
She should not sprain her ankle, and she should moisturize her foot daily so fungi and bacteria don't grow on the skin. Skin infection includes cellulitis, which may require intravenous antibiotics and hospitalization.
**Patients should keep hydrated with water and maintain a healthy diet and lifestyle.
** They should eat fruits, vegetables and foods rich in fiber. Excess alcohol, drinks with caffeine and smoking should be avoided.
- Long-term self-maintenance is important for treatment of foot lymphedema 3.
- She should not sprain her ankle, and she should moisturize her foot daily so fungi and bacteria don't grow on the skin.
Foot Massage & Lymphatic Drainage
Kidner Procedure Rehab Protocols
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How to Fix Cracked Heels
What Is the Difference Between Stasis Dermatitis & Cellulitis?
- Google Health: Lymphatic Obstruction
- National Cancer Institute: General Information About Lymphedema
- Medline Plus: Lymphedema
- American Cancer Society. What Is Cancer-related Lymphedema?
- Gillespie TC, Sayegh HE, Brunelle CL, Daniell KM, Taghian AG. Breast cancer-related lymphedema: risk factors, precautionary measures, and treatments. Gland Surg. 2018;7(4):379-403. doi:10.21037/gs.2017.11.04
- Johns Hopkins Medicine. Breast Cancer: Lymphedema After Treatment.
- Co M, Ng J, Kwong A. Air Travel and Postoperative Lymphedema-A Systematic Review. Clin Breast Cancer. 2018;18(1):e151-e155. doi:10.1016/j.clbc.2017.10.011
- Co M, Ng J, Kwong A. Air Travel Safety in Postoperative Breast Cancer Patients: A Systematic Review.Clin Breast Cancer. 2018 Oct;18(5):e813-e817. doi: 10.1016/j.clbc.2018.05.003. Epub 2018 May 17.
- Karafa M, Karafova A, Szuba A. The effect of different compression pressure in therapy of secondary upper extremity lymphedema in women after breast cancer surgery. Lymphology. 2018;51(1):28-37.
- Michelotti A, Invernizzi M, Lopez G, Lorenzini D, Nesa F, De Sire A, et al. Tackling the diversity of breast cancer related lymphedema: Perspectives on diagnosis, risk assessment, and clinical management.Breast. 2019 Apr;44:15-23. doi: 10.1016/j.breast.2018.12.009. Epub 2018 Dec 17.
Kat Lieu was first published in "Seventeen" magazine in 2006. Following the publication of her short story, she published an inspirational piece for "PT Magazine" in 2008. In 2009, she self-published a young adult novel for Amazon Kindle. Holding a doctorate in physical therapy from SUNY Downstate, she is a licensed doctor of physical therapy and certified lymphedema therapist.