Question: After several weeks when my polio-affected right leg began to swell, beginning at the foot and now up into the knee, a vascular physician diagnosed the condition as lymphedema
and referred me to physical therapy. The swelling decreases only slightly after sleeping all night, even with my legs elevated. My ability to exercise (walk) is not practical having great instability
and imbalance. I also have symptoms of neuropathy in both feet contributing to lack of balance. I do use a cane.
In 1949, my right ankle underwent a triple arthrodesis with a tendon transfer, which really was a great help although I have had to go to a supportive in-shoe ankle/foot brace to avoid tripping.
My question becomes, is the diagnosis of lymphedema something to be expected and what treatment or medication protocol would be appropriate?
Answer: Lymphedema is a fairly common complication in a paralyzed lower limb, particularly as people age, if there are any open sores on the feet/ankles from minor/major traumas, and/or there is dependent swelling from at least some degree of venous insufficiency.
It is important to treat lymphedema vigorously after it is first diagnosed, because further complications can occur and the longer it is present, the harder it is to treat and sometimes resolve.
Vigorous treatment involves “elevation with specific message” as a one-to-three times per day regimen that can be taught by a “lymphedema therapist specialist” (usually a PT or OT) to a family member or friend.
Additionally, the limb must be wrapped with specialized materials between treatments. Sometimes the therapists must also utilize Jobst pumping sleeves as a specific frequent treatment until the limb circumferences measurements stabilize. Then, one must order custom-sized compression garments that are worn when one will be sitting up with legs dependent.
The vigorous treatment regimens can be time consuming and expensive but are worth it in the long run, and usually aren’t too intrusive of time after one-to-three months. Feel free to share these thoughts with your doctors or therapists.
Post-Polio Health (Vol. 32, No. 4, Winter 2016)