Lipedema is the accumulation of fat. There are several types of lipedema, depending on where the fat accumulates. It can be in the arms and in the legs. If fat accumulates in the legs it can cause lipedema leg pain and heavy legs. The main challenge with this condition is telling it apart from lymphedema. Many people end up trying the wrong therapies because of a wrong diagnosis.
Lipedema is Different than Obesity
Not all fat is made the same. For instance, fat tends to build up in different places in the body. Many men will develop “apple” obesity. The fat accumulates in their abdomen making it look like a big apple. On the other hand, many women will develop “pear” obesity. The fat accumulates around the pelvis, giving their bodies the shape of a pear.
Lipedema is a completely different type of fat buildup. True, people who are obese might also have lipedema. And it definitely does not help to be obese. But the fat accumulates because of a different type of bond between the fat molecules and the body. In fact, different families tend to have different patterns of fat accumulation. I am sure you have heard of women say that they have never had “skinny ankles” and that their mother and grandmother were the same. That might actually be a sign of lipedema and fat buildup in the lower legs.
Once the fat bonds to the body area, it tends to stay there. In fact, a person can lose a considerable amount of weight and the affected areas of the body will stay the same.
Lipedema Leg Pain Diagnosis
The only way I know of to make the diagnosis is by examining the patient. Once you identify the typical distribution of fat, you know that this is the diagnosis. One useful clue is to look at the feet. Patients might have a considerable amount of fact in their legs, but their feet will remain unaffected. This is very different from lymphedema. In lymphedema there is a typical “dorsal hump” over the foot and the toes are usually swollen as well. But in lipedema the feet remain “skinny”.
Lipedema Leg Pain Treatment
For most people, there is not much to do about lipedema. So the goal ends up being to avoid unnecessary treatments. I have seen people receiving chronic diuretics that do not really help them, but might cause complications. I have also seen people have unnecessary procedures and use all sorts of wraps and compression stockings, that will not help them. In fact, many people complain of sensitive skin. Compression stockings actually feel uncomfortable for them. Many people also complain about easy bruising.
Having said that, over the years there have been reports of specialized liposuction. The idea is to remove the fat by sucking it out. The medical literature is biased toward positive reports of this technique. But in practice, we see more failure and complications than successful procedures. For this reason I tend to be conservative in offering procedures. When I do think a procedure makes sense, I send my patients to surgeons who specialize in this procedure specifically in lipedema. I have been told that they use special suction catheters and that they achieve better results.
Future Therapeutics will Address the Root Cause
On the horizon, we might be seeing systemic therapies. The idea would be to target the root cause for the fat to accumulate where it does. In the meantime, there are guidelines that we can follow to try to offer best quality of care. If you read these guidelines you will see that most of the recommendations are based on low-level data. So there is still much to do to understand this condition and to improve our care for patients.
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