best practice for the management of lymphoedema ... - EWMA

TABLE 7 Compression garment recommendations for specific problems in lower limb lymphoedema
Problem Recommendations/notes
Swollen toes Where toe caps are difficult to manage, closed toe garments may be helpful
COMPRESSION
GARMENTS
Forefoot swelling No risk of toe swelling – use open toe garments; flat knit is preferable
Toe swelling – use open toe garment and toe caps, unless toe caps are impractical, when a
closed toe garment may suffice
Lymphoedema of the foot only – inelastic adjustable foot wrap may be useful
Forefoot bulge Custom made flat knit garments may be required to produce sufficient pressure
An individually shaped foam pad can apply additional pressure
Inelastic adjustable footwrap may be useful
Check that footwear is well-fitting and supportive
Retromalleolar swelling Foam, crescent shaped stasis pads can be used to focus pressure
Fat/arthritic knees Low classification pantyhose under a calf stocking may be useful for shape distortion of the
knee and thigh
If using circular knit, use an extra wide calf range
Thickened tissue just below patella Below knee garments can exacerbate the problem; ideally use full leg garments
Pressure can be focused by using a crescent shaped ribbed or foam chip stasis pad over
thickened area
If a below knee compression garment is necessary, a stasis pad can be used with an
orthopaedic elasticated knee support
Inverted champagne bottle legs Limb shape should be corrected with MLLB
Flat knit appears to be more effective than circular knit
May need higher pressure levels
May need custom made garments
If using two garment layers, use a combination of flat knit and circular knit
Lymphoedema extends to groin Flat knit custom made garments, eg one- or two-legged closed gusset panty, should be used
A foam chip pad angled into the groin under the compression garment may be used to focus pressure
Close fitting shorts with Lycra (eg cycle shorts) are convenient for some patients
Obesity May need custom made garments; flat knit may be easier to apply
Garments designed to accommodate pregnancy may be useful
Severe distortion of the lower limb or patient preference may restrict treatment to the lower
part of the leg
Using separate overlapping garments for above and below the knee may make application easier
SAFETY ISSUES
Lower limb peripheral arterial occlusive disease
The lower limb peripheral arterial status of patients with lower limb lymphoedema should
be assessed prior to compression. Patients with ABPI