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Reducing Your Risk of Lymphedema of the Legs

This information explains how to reduce your risk of lymphedema of the legs.

Lymphedema is abnormal swelling that can develop in your legs after your lymph nodes have been removed or injured. Lymph nodes are small, bean-shaped structures that are located throughout your body. They carry fluid out of your legs. If this fluid can’t get be carried out of your legs, the tissue begins to swell.

During your surgery, your lymph nodes were removed in the area of your pelvis to remove any remaining cancer. This puts you at risk for lymphedema in your legs. Your risk is greater if you have had radiation therapy or if you have had groin nodes removed. If only your pelvic nodes were removed, there is less of a risk.

Lymphedema can develop right after surgery or years later.

Risk Factors for Developing Lymphedema

Risk factors for lymphedema include

  • Gaining weight or being overweight
  • Infection in the affected leg
  • Having radiation therapy to the pelvis
  • Having cancer that comes back

There are other factors that may increase your risk, but we do not know for sure. These include:

  • Being inactive
  • Air travel
  • Constricting the leg
  • Exposure to extreme temperatures

Reducing Your Risk of Lymphedema

There is no way to know who will develop lymphedema, but there are things you can do that may lower your risk.

Protect your skin

One way to reduce your risk of getting lymphedema is to protect your skin from injury or infection as much as possible. This is because cells that fight infection go to the injured area and cause swelling. Your legs may not be able to drain this added fluid.

Care for cuts and scratches

  1. Wash the area with soap and water.
  2. Apply antibacterial ointment (such as Neosporin®) to the area.
  3. Cover it with a clean, dry gauze or a Band-Aid®.

Care for burns

  1. Wrap a cold pack in a towel and apply it to the burn for 15 minutes. You can also run cold water over the burn.
  2. Wash the area with soap and water.
  3. Apply antibacterial ointment (such as Neosporin®) to the area.
  4. Cover it with a clean, dry gauze or a Band-Aid®.

Look out for symptoms of infection, which include:

  • Redness
  • Swelling
  • Increased heat
  • Tenderness

If you develop any of these symptoms, call your doctor or nurse. 

Do not wear tight clothing

Do not wear clothing that is tight and leaves deep marks on your legs, such as socks or jogging pants with an elastic cuff. Wear clothing that is looser and does not leave a mark on your legs.

Compression garments that were made to reduce swelling work differently. They provide even pressure and help carry fluid up the leg. You can read more about compression stockings in the “Compression stockings” section below. 

Avoid extreme temperatures

Extreme heat and cold may cause fluid to pool in your leg and cause swelling. Avoid or limit your time in hot tubs and saunas. 

Take precautions when traveling by air

There are several concerns with air travel when you are at risk for lymphedema, including:

  • Cabin pressure. The cabin pressure in planes is usually a little less than the pressure on the ground. This can cause your skin to stretch and allow fluid to pool in your legs.
  • Sitting still for long periods of time. When you do not move for a long time, fluid may start to pool in your legs.
  • Lifting and carrying luggage, which may stress your muscles.
  • Dehydration 

 

Here are some travel tips that will help decrease your risk for lymphedema:

  • Ask for a seat with enough leg room, such as bulkhead seats.
  • Get help carrying, lifting, and pulling luggage that is too heavy for you to manage comfortably.
  • Get up and walk up and down the aisle of the plane, if it is easy to do so.
  • Do simple foot and ankle exercises while you are sitting. Exercising throughout the flight will help with your circulation and movement of lymph fluid. To do this, you can point your toes towards the ceiling and then back down towards the floor. Also, rotate your feet in circles and then reverse the direction.
  • Wear loose, nonconstrictive clothing.
  • Make sure you drink plenty of water to stay well hydrated. Avoid salty foods. 
  • Ask your doctor if you should have a prescription for antibiotics when you travel.

Other ways to reduce your risk

  • Do not have injections or acupuncture in the affected leg(s).
  • Do not use sharp instruments for pedicures. Use cuticle-removing cream and file your nails instead of cutting them.
  • Moisturize your skin often to prevent chapping and chaffing.
  • Keep the area between your toes clean and dry to prevent fungal infections.
  • Do not walk barefoot.
  • Make sure your footwear fits properly to avoid blisters and constriction.
  • Make sure any toe rings or ankle bracelets fit loosely.
  • Try to avoid crossing your legs as much as possible.
  • Wear sunscreen with an SPF of 30 or higher to protect your skin from sunburns.
  • Try not to gain weight because it is a risk factor for lymphedema. Try to lose weight, if you are overweight.
  • Minimize your salt intake. Salt can cause swelling which may overwhelm your lymphatic system. 

Recognizing Early Signs of Lymphedema

All patients will have some swelling in the area near the incision (surgical cut) after surgery. This is normal and should go away within weeks after your surgery.

Swelling that is due to lymphedema usually begins in your lower leg(s). It may move up your leg towards your torso if left untreated. At first, the swelling may come and go. It may improve when you raise your leg above your chest.

Other early symptoms may include a feeling of heaviness in your leg(s) or the feeling that your clothing, socks, or shoes fit too tightly.

Treating Lymphedema

If lymphedema gets worse, the swelling will stay around longer or not go away at all. Simply putting your legs up may be helpful in the beginning, but will not work over time. At this point, you will need to work with a lymphedema therapist to treat the condition. This treatment is called “complete decongestive therapy.”

The treatment includes:

  • Bandaging
  • Manual lymphatic drainage
  • Compression stockings
  • Skin care
  • Exercise

Bandaging

Bandaging is covering your legs with a special, tight bandage. Not every person will need to do this. If you need bandaging, there are many different ways to bandage. You and your therapist will discuss this to decide what is best for you.

Manual lymphatic drainage

Manual lymphatic drainage (MLD) is a gentle type of massage. It moves fluid from your legs to where it can be reabsorbed by your body. MLD is done in a certain order depending on which lymph nodes were removed. Your therapist will determine what order or sequence is best for you.

Compression stockings

Compression stockings help your lymphatic system function better. Some people choose to wear them to reduce their risk of developing lymphedema. It is important to get stockings that fit you well. Poor-fitting compression stockings may cause lymphedema.

  • Make sure the stockings do not cause any irritation or leave an impression on your skin. It is best if your lymphedema therapist fits you with the stockings so you can be sure they fit well.
  • It is best to wear light compression stockings. Light compression stockings will have a label of 15 to 20 mmHg. You may need more compression if your swelling gets worse.
  • Compression stockings come in knee-high and thigh-high lengths and as pantyhose.

Skin care

Keep your skin clean and well-moisturized. This is important for decreasing your risk for infection. Your risk for lymphedema is lower if you do not get infections in your legs.

Exercises

Gentle exercises are a great way to help the fluids in your body move a little better. Talk with your doctor before you start doing any exercises.

The following exercises will help you maintain flexibility and strength. Do them once a day. Stop if you have any pain, discomfort, fatigue, or swelling. 

  1. Deep Breathing - Start with deep breathing to stimulate the movement of fluid. Take no more than 3 deep breaths at a time to prevent light-headedness.
  1. Marching - While sitting, lift one knee, then put it down. Then, lift the other knee and put it down (see Figure 1). Do this 10 to 15 times.

Figure 1. Marching Figure 1. Marching

  1. Kicks - While sitting, straighten one leg at the knee and return it to the starting position (see Figure 2). Then, straighten the other leg at the knee and return it to the starting position. Do this 10 to 15 times.

Figure 2. Kicks Figure 2. Kicks

  1. Ankle Alphabets - Move your feet to spell the letters of the alphabet (see Figure 3). Go through the alphabet at least 2 times with each foot.

Figure 3. Ankle Alphabets Figure 3. Ankle Alphabets

Stretches

Later on in your recovery, you will be ready to do some stretching exercises. These will help to loosen your hamstring and your internal hip rotators. When you will be ready to do these will depend on the type of surgery you had. Start these stretching exercises only when your doctor tells you it is safe.

  1. Calf Stretch - Sit with your legs straight out in front of you. Loop a towel around the ball of one foot (see Figure 4). Gently pull the towel, keeping your knee straight. Hold this position for 30 seconds. Repeat 5 times. Then switch legs and repeat.  

Figure 4. Calf stretch Figure 4. Calf stretch

  1. Hamstring Stretch - Sit with your legs straight out in front of you. Reach to touch your toes, keeping your knees and back straight (see Figure 5). Hold this position for 30 seconds. Repeat 5 times.

Figure 5. Hamstring stretch Figure 5. Hamstring stretch

  1. Hip Stretch - Lie on your back with your knees bent. Cross one leg over the other and pull that leg close to your chest (see Figure 6). Hold this position for 30 seconds. Repeat 5 times. Then switch legs and repeat the stretch. 

Figure 6. Hip stretch Figure 6. Hip stretch

Other Treatments for Lymphedema

Other treatments for lymphedema include:

  • Scar management. The scars left after your surgery can make it harder for your body to drain the lymphatic fluid. Scar management helps the area around your scar become softer and less tight. This will allow your body to better drain the fluids.
  • Improving posture
  • Applying therapeutic sports tape

Talk with your doctor or therapist to see if any of these options are right for you.

Call Your Doctor or Nurse If You Have:

  • A temperature of 100.4°F (38°C) or higher
  • Chills
  • New or unexplained pain or tenderness in your leg(s) or foot
  • Increased warmth in your leg(s) surrounding a skin break
  • Persistent redness in your leg(s) or foot
  • Increased swelling in your leg(s) or foot
  • A feeling of heaviness in your leg(s) lasting more than 1 week

Making an Appointment

To make an appointment to see a lymphedema therapist, talk to your doctor. He or she will decide if lymphedema therapy is right for you. After your doctor makes a referral, someone will contact you to schedule an appointment. If you have any questions, please call the Rehabilitation Service at (212) 639-7833.

You can receive your lymphedema therapy at one of the following locations:

Sillerman Center for Rehabilitation
515 Madison Avenue, 4th Floor
New York, NY 10022
(646) 888-1900
 
MSK Commack
650 Commack Road
Commack, NY 11725
(631) 623-4000
 

If these locations are not convenient for you, you can also refer to the following websites to a find a lymphedema therapist in your local area:

Klose Training
 
Norton School of Lymphatic Therapy
 

 

Academy of Lymphatic Studies
 
Lymphatic Association of North America
 

Resources

American Cancer Society
Provides information about the diagnosis and treatment of lymphedema.
(800) 227-2345
 
Cancer Information Service (CIS)
Provides information about the diagnosis and treatment of lymphedema.
1-800-4-CANCER
 
National Lymphedema Network
Provides educational materials and community referrals.
(800) 541-3259 or (415) 908-3681
 
Lymphology Association of North America
Provides educational materials and community referrals.
(773) 756-8971
 
Lymphatic Education and Research Network
Provides educational materials and supports research on lymphedema.
(516) 625-9675