Home > Protocols & Procedures > Diabetes > Lower Extremity Compression for Lymphedema

Lower Extremity Compression with Lymphedema

Lymphedema can arise from infection, injury or genetics. In patients with diabetes, we often see swelling in the extremities as the result of circulatory problems.
Whether a patient is experiencing a lymphatic blockage or is showing signs of complications from diabetes, heart disease or venous insufficiency, compression clothing or bandages should be part of the treatment plan.

Compression garments reduce lymphedema by encouraging the flow of fluid out of the limb through the proper avenues. They also act as force for the calf muscles to work against. This reduces the accumulation of fluids and the accompanying swelling, and promotes the flow of oxygenated blood flow throughout the leg, preventing ulcerations from arterial insufficiency.

Compression garments should be worn 24 hours a day and must be replaced regularly. A sigvaris compression socks for graduated compression in diabeticsSIGVARIS sock such as this one delivers graduated compression, with more force exerted at the ankle than at the knee. Socks such as these are ideal for ambulatory patients, and offer the advantage of easy application and removal.

In addition to compression garments, massage and exercise can be beneficial to the patient.

More About Lymph

Lymph is a colorless extra-cellular fluid containing a variety of nutrients and other molecules such as proteins, salts, glucose and water. In addition, lymph plays an important role in immune defense because it carries white blood cells.
In healthy adults, lymph circulates throughout the body at about 20 liters per day. While some lymph is naturally not reabsorbed in the filtering process, about 85 percent of all lymph manages to re-enter the blood vessels to rejoin the cardiovascular system.

Lymph has different compositions in different parts of the body. In the small intestine, for example, lymph is higher in certain fats and in the liver, the concentration of proteins is about ten times higher than elsewhere.


More About the Lymphatic System

A healthy cardiovascular system pumps blood into capillary beds, which allows for the exchange of nutrients via oxygen. Once the blood has gone through this process, it circulates back to the lungs to pick up more oxygen and is subsequently pumped back out to the rest of the body via the heart.

To do all of this work, the heart exerts quite a bit of pressure. This pressure forces fluid out, particularly through the capillaries. As lymph leaves the capillaries, the concentration of smaller proteins such as albumin is lowered while the concentration of red blood cells and larger proteins increases. This change affects the pressure on the outside of the capillaries, making blood more osmotically active, and pulling molecules on the outside of the capillaries back in.

Without the lymphatic system, fluids would accumulate and a buildup would occur. The lymphatic system addresses the issue of accumulation by acting as the body's internal plumbing system. Lymphatic vessels collect excess fluid and bring it back into circulation. These vessels are different from blood vessels because they don't function in a loop. Rather, fluids are picked up from outside of the blood vessels and then redeposited back in the blood vessels.

This process is necessary for surrounding cells as it provides nutrients, proteins, glucose and more.

Signs of Lymphedema

  • Swelling, particularly in the extremities
  • Discomfort
  • A feeling of heaviness
  • Recurring skin irritation and infection
  • Thickening of the skin
  • Restricted range of motion