The Other Circulatory System
functional, and psychosocial quality of life measures
were assessed with a questionnaire administered
before and after treatment. The study found that pre
and post quality of life scores revealed a significant
improvement in quality of life after CDT treatment.
Moreover, patients who had lower extremity
lymphedema benefited more from CDT than upper
extremity lymphedema patients (10).
Patients with lymphedema have significant volume
increases in the foot and ankle making footwear
difficult to find. Due to the swelling of the leg, ankle,
and foot there is restricted range of motion (ROM)
mainly at the ankle joints. These restrictions force
other joints to have to compensate producing pain
and altered gait patterns (12). Aggithaya et al (2015)
while conducting a study of benefits of yoga for
lymphedema analyzed gait deviations of participants.
The data showed that the most common gait patterns
seen in patients with lower extremity lymphedema
was antalgia. Due to the pain patients have shorter
stride lengths and a shorter stance phase which
ultimately produces an apropulsive waddling gait
(12,13). These risks, as well as the shift in gravity,
can lead to increased risk falls (12). Gait mapping and
video analyzation of gait patterns can be conducted;
yet they are time consuming and expensive. But there
are easier alternative to this problem. According to
James Dodds, a certified Pedorthist (CPed) at Hanger
Corp. Prosthetics and Orthotics in Philadelphia PA,
lymphedema patients benefit from using Oxford style
shoes with an open throat Velcro closure system to
accommodate changes in edema.
Custom or extra depth shoes constructed with Lycra
fabric stretches and contracts as needed during the
different phases of gait. During stance, the throat is
closed over the mid-step and held securely by the
Velcro and stretched Lycra. During swing, the Lycra
contracts and holds the shoe securely on the foot.
50
Pedorthic Footcare Association | www.pedorthics.org
During propulsion the Lycra stretches and flexes
to reduce ankle compression and allow for toe box
flex at toe off. Dodds states that Lycra is the best
fabric available because it does not produce shearing
forces on the skin seen with cheaper materials such
as Spandex®. Lyca® easily expands thus providing
ample space for the edematous extremity and
preventing circulatory constriction. All these facts
are particularly important for maintaining dermal
integrity. Any small lesion in lymphedema patients
could result in ulceration due to poor circulation, and
decreased healing capacity. Shoe companies have
stepped up to respond to the need and produced shoes
that are made specifically for swollen feet and edema.
These models are extra wide, super lightweight, and
have stretch uppers and a soft toe box. Increased toe
spring improves toe off and propulsion.
Lymphedema patients have serious challenges not
the least of which are a lack of availability of medical
professionals who specialize the disease, CDT
therapists who don’t treat lower extremity disease,
limited access to appropriate footwear, and insurance
companies who refuse to cover available treatments.
Hopefully as more clinicians take an interest in
lymphedema management patients will have access
to the treatments they need to address the disease
early and prevent the severe complications seen with
advanced disease. —PFA
REFERENCES
1. Conrad-Stoppler M, Shiels WC. Lymphedema:
Lymphedema Facts. Retrieved from medicinenet.com on
3/20/2018.
2. Konecne SM, Perdomo M. Lymphedema In The Elderly:
A Special Needs Population. Geriatric Rehabilitation. 2004;
20(2): 98-113.
3. Goss JA, Maclellan RA, Beijnen UEA, Greene AK.
Resolution Of Primary Lymphedema: A Case Report. Plast
Reconstr Surg Glob Open. 2017; 5(2): e1223.