"If we can make the correct diagnosis, then the healing can begin."
Dr Andrew Weil

Legs

LIPEDEMA

Usually swollen legs and ankles with normal feet

Foot

LYMPHEDEMA

Classically has swollen feet and toes

Foot

LIPODERMATOSCLEROSIS

Reddish discoloration inner lower leg

Lipedema

Lipedema is a relatively common fat disorder that affect up to 11% of women. For reasons not yet known, fat is abnormally distributed usually in the buttocks, hips, legs and occasionally the arms. Although it begins as a cosmetic concern, it can eventually cause pain and other problems. In fact, lipedema is sometimes called The Painful Fat Syndrome. Lipedema can be mistaken for regular obesity or lymphedema, however, there are many distinguishing features of Lipedema. In Lipedema, usually the midriff area is spared, so there is a disproportionate enlargement of the lower body as compared to the upper body. Also the lower legs tend to take on a columnar shape w swelling to the ankle, but the foot is usually spared. There are other classic findings, as well.

One hallmark of Lipedema is the fat is relatively unresponsive to diet and exercise. The skin tends to bruise easily and the consistency of the skin can become soft and spongy. Currently, the cause for lipedema is unknown and there are no definitive treatments, other than a specialized type of lymphatic sparing liposuction, but insurance companies consider liposuction a cosmetic procedure, so it is not covered by insurance.

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Lymphedema

Lymph is protein rich fluid in the interstial space (tissue around the cells) and in the soft tissue. The lymphatic system is designed to move the lymph from the interstial space through delicate lymphatic channels, with interspersed lymph nodes, back to the heart. If the lymphatic system becomes damaged or becomes overwhelmed, the lymph accumulates and creates swelling in the soft tissue called lymphedema. Lymphedema most commonly occurs in the legs, but can occur in all parts of the body where there is soft tissue. Lymphedema is a very complicated condition with numerous causes.

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Lipodermatosclerosis

Lipodermatosclerosis (LDS), also called panniculitis, is a chronic condition usually affecting the skin on the inner lower leg just above the ankle.
Lipo (fat) dermato (skin) sclerosis (scarring) is exactly what the name says, scarring of the skin and fat tissue under the skin. The scarring usually results from chronic pressure and inflammation in the skin. When severe, the scarring can progress and make the leg appear like an upside down champagne bottle.

The exact mechanism occurring in the skin of LDS patients is not fully understood, however, the increased pressure, tissue inflammation and resultant tissue scarring seen in LDS usually occurs because of a combination situations.

1) Chronic Venous Disease / Insufficiency or venous stasis is caused from increased pressure in the leg veins, especially in the lower leg and ankle. The increased pressure in the veins, in turn, causes inflammation of the skin.

2) Limited ability to walk – When there is limited ability to walk, patients usually utilize a cane or walker and tend to spend more time sitting. The calf and feet muscles are critical to squeezing blood and fluid out of the lower leg. If someone’s ability to walk is affected, then the calf and feet muscles can’t effectively pump, and fluid and blood accumulate in the lower leg increasing pressure and causing inflammation. This mechanism is sometimes called calf-pump failure.

3) Idiopathic, means the actual cause of the inflammation resulting in LDS is unknown. Approximately 50% of the time, the underlying cause for LDS is idiopathic.

Treatments are aimed at decreasing the pressure and inflammation in the lower leg. Treating the underlying venous disease, use of graduated compression stockings, leg elevation, increased exercise and anti-inflammatory topical creams can all help the condition. Once LDS is established, scarring can replace the skin and fat underneath the skin. Once the scaring process begins, the skin in the lower leg can become permanently and irreversibly damaged. Treatment at this stage is only to prevent further progression.

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