The St Lukes Lymphoedema service regularly receives referrals for patients who have long term swelling of their legs; they do not have a true Lymphoedema so they cannot be seen by us and their GP’s often struggle to know what to do. If only these patients had received advice about looking after their legs when they were younger maybe they could have avoided this chronic disabling problem. As a team we discussed how this information and other evidence could be shared with colleagues to improve their health and how it might reduce the number of people being inappropriately referred to the lymphoedema service in the long term.
So if you would like to reduce your risk of leg problems and avoid becoming a potential patient in the future read on…..
A study carried out in Australia in 2004 showed that wearing low grade compression hosiery reduced the effects of standing for long periods (Piller et al 2004). Workers who wore the hosiery for work reported reduced swelling, less discomfort and less tiredness at the end of their working day. The authors of the study suggest that this would translate to an improvement in the health of the tissues and would reduce the risk of chronic venous disease.
Chronic Venous Disease
One of the most common conditions affecting people in old age is chronic venous disease. The symptoms of which can range from swollen aching legs at one end of the spectrum to venous leg ulcers at the other end, the most common sign of chronic venous disease is varicose veins. (Hobson 1997)
Workers who stand for long periods increase their likelihood of swollen legs due to the vascular and lymphatic system having to constantly work against gravity allowing extra fluid to build up in the tissues. This can cause damage to the valves in the veins, which over time can fail, allowing blood to flow backwards, causing enlargement of the veins (varicose veins). Left untreated this can lead to permanent swelling and discomfort and potentially venous ulceration. (Tuscher et al 2000)
Occupations such as teaching, nursing and hairdressing increase the risk of chronic venous disease due to prolonged standing. (Hobson 1997, Piller et al 2004)
Whilst standing for long periods can cause venous disease, it is recognised that sitting at a desk can also be problematic. The venous and lymphatic systems of the body relies upon muscle action to function, long periods of inactivity such as prolonged sitting at a computer and long flights can cause reduce blood flow in the veins leading to deep vein thrombosis as frequently reported in the press. Also there can be pooling of lymphatic fluid causing ankle swelling. (Hughes 2000). Treatment for the effects of inactivity is exercise, regular movement that causes contraction of the calf muscles (O’Donovan et al 2006). Deep vein thrombosis can lead to fatal complications; wearing compression hosiery can reduce the risk of developing deep vein thrombosis (Clarke et al 2010)
The other recognised risk to the health of lower legs is cellulitis, a bacterial infection of the skin. This often occurs following an insect bite or an animal scratch, however it can occur due to bacteria entering through dry, broken or damaged skin (British Lymphology Society 2010, Morris 2003). This best defence against cellulitis is healthy intact skin, which can be maintained through regular moisturising and prompt treatment of fungal infections such as athletes foot. (Linnitt 2000, Nazarko 2012) Repeated episodes of cellulitis can result in long term swelling of the legs. Approximately 80,000 people were admitted to hospital as a result of cellulitis in England in 2009, which is an increase of 300 % over the previous 15 years. In 2010, 917 people died of cellulitis in England and Wales (NHS Choices 2012).
Well if that hasn’t convinced you to take the health of your legs seriously I’m not sure what would. A few minutes in the morning spent moisturising your skin, getting up and doing regular exercise and wearing compression hosiery in the form of support tights bought at a department store or from a hosiery company will make a big difference to your legs, your health and potentially your life.
Share this information with your friends, colleagues and patients now.