What is Lipedema?
Lipedema is the abnormal accumulation of adipose tissue affecting the legs, hips, thigh – the lower half of the body. It is a congenital condition and occurs in stages and its appearance becomes more obvious with age.
Areas affected by Lipedema can be more sensitive to pain and bruising. This is NOT LYMPHEDEMA, which is the abnormal accumulation of lymph fluid. The key to distinguishing between Lipedema and lymphedema (typically) is that LIPedema DOES NOT involve the foot, in and of itself. It will if there is superimposed LYMphedema.
Lipedema affects almost exclusively females, and it is estimated that 10% of women have this condition in some form. It is generally an inherited disorder that is felt to have a hormonal component. The few men we have seen in our practice with this disorder also have additional hormonal imbalances.
Lipedema is felt to have a hormonal relationship. The fat cells are different from the fat cells in the trunk of the body and they are very resistant to diet and exercise. After years of the condition, it can affect the lymphatics of the leg with resultant lymphedema and swelling of the feet.
|Symmetric (buttocks involved)||Not symmetric|
|Foot not involved||Foot Involved|
|Non Pitting||Pitting or non pitting edema|
|Stemmer sign negative – toe involvement absent||Stemmer sign positive – toes involved|
|Tissue feels rubbery||Tissue feels firmer (starting stage 2
|Painful to pressure||Not painful|
|Easy Bruising||No bruising|
|Hormonal disturbances frequent||Generally no hormonal disturbance|
What Are the Signs of Lipedema?
The earliest signs are generally the development of “saddlebags” on the hips in adolescence, the early 20s or during pregnancy. This fatty enlargement then begins its progression toward the feet, causing dimpling of the thighs. Although enlargement is circumferential, eccentric deposits may be found in the lower, inner thighs and upper-inner calves. This is usually symmetrical between the legs, but one side may develop faster.
Often, patients’ chief complaint is of swelling and enlargement of tissue around the ankle NOT the foot. On careful questioning, the “swelling” may not change much as the day progresses, and it may not subside overnight. Ultrasound evaluation at the ankle later in the day will not show fluid in the tissue. If there is coexisting vein and/or lymphatic disease, there can be swelling with the finding of fluid in the tissue. These are easy to diagnose with diagnostic tests such as a duplex and / or lymphoscintigraphy.
Lipedema by itself can create column-like ankles. Sometimes the fatty tissue of the legs is tender and patients may complain of easy bruising. History of the patient will reveal poor-to-no results with diet and exercise from the hips down, although the upper body responds.
Vein Disease and Lipedema
Vein disease in no way contributes to the development or progression of lipedema, but is an independent source of leg swelling. Venous insufficiency in association with lipedema should be treated to avoid swelling and decrease the chances of lymphedema.
How do you treat LipEdema?
Lipedema is typically managed conservatively with manual drainage (MLD). This involves a 30 – 60 minutes session with a Certified Manual Lymphatic Drainage therapist. Massage helps with the pain in the legs, but DOES NOT reduce or change the shape or size of the legs. MLD may be followed with compression bandages / compression stockings, depending upon the patient.
Literature is evolving in regard to more invasive treatments with tumescent liposuction. This clearly has shown benefit in our patients with a significant improvement in their symptoms. These patients had tried MLD, regular exercise and compression bandages for years with only temporary benefit.
However this is invasive treatment and is not for every patient. Nor should it be done for “prevention” of progression.