Tag Archives: venous insufficiency

Lymphedema Post Script 2010: Meet John Mulligan, RMT/CLT-LANA


Following is some basic information I wish I had known years ago.  Meet John.  Following is his response to my email asking if he had anything to add to an article he wrote in 2007.  The url is at the end and his comments are fresh this morning, Thursday, 30 December 2010.

“ …  I had a look at your blog of December 22 and you raise an important question: when is lymphedema not lymphedema?

There are two kinds of lymphedema; primary and secondary. Primary lymphedema is something you are born with and secondary is something you acquire. One common cause of secondary lymphedema is the surgical removal of lymph nodes due to cancer.

How can we differentiate lymphedema from other types of swelling? Lymphedema, whether primary or secondary, usually occurs in one limb. The foot or hand of that limb is often involved. If both legs or arms are swelling they are usually different from one another; one is “worse” than the other.

If lower extremity (leg) edema is bilateral (occurring on both sides) and symmetrical (same on both sides) and the feet are involved it is more likely to be edema than lymphedema. This swelling can be caused by pulmonary edema or congestive heart conditions. It is a backing up of fluid throughout the system, so to speak. If there are ulcers occurring as well it is more likely that venous insufficiency is part of the picture, where the blood flow from the legs back to the heart is not working properly. If cardiac or pulmonary insufficiency is part of the problem then compression bandaging could make things worse.

If the problem is chronic venous insufficiency then the bandaging and compression garments will help the ulcers to heal and will help the muscle pump in the calf return the blood supply to the heart properly.

With a wider awareness of lymphedema comes the question of accurate diagnosis. A simple hallmark of lymphedema diagnosis, especially in the legs, is the Stemmer sign; can you pick up the skin of one of your toes with two fingers, pinching the skin? If you cannot then it is more likely that you have lymphedema; if you can pick up a fold of skin on your toe, it is less likely to be lymphedema. Please keep in mind that this is a simple clinical test and not foolproof.

It is important to understand that swollen legs or feet that are associated with COPD are more likely to be something other than lymphedema. A complicating factor is that sometimes these conditions can stress the lymphatic system, causing a mixed lymphedema.

Please see this web page for some information on differential diagnosis of lymphedema:


John Mulligan, RMT/CLT-LANA: Lymphedema Therapy, Education & Consulting

T: (905-687-1828| F: (905) 687-8224 | John@LymphedemaTherapist.com


More later… Sharon O’Hara