Lipedema

Lipedema is the abnormal accumulation of adipose tissue affecting the legs, hips, thigh – the lower half of the body. It is a congenital condition and occurs in stages and its appearance becomes more obvious with age.

Areas affected by Lipedema can be more sensitive to pain and bruising. This is NOT LYMPHEDEMA, which is the abnormal accumulation of lymph fluid. The key to distinguishing between Lipedema and lymphedema (typically) is that LIPedema DOES NOT involve the foot, in and of itself. It will if there is superimposed LYMphedema.

Lipedema affects almost exclusively females, and it is estimated that 10% of women have this condition in some form. It is generally an inherited disorder that is felt to have a hormonal component. The few men we have seen in our practice with this disorder also have additional hormonal imbalances.

Lipedema is felt to have a hormonal relationship. The fat cells are different from the fat cells in the trunk of the body and they are very resistant to diet and exercise. After years of the condition, it can affect the lymphatics of the leg with resultant lymphedema and swelling of the feet.

Often, patients’ chief complaint is of swelling and enlargement of tissue around the ankle NOT the foot. On careful questioning, the “swelling” may not change much as the day progresses, and it may not subside overnight. Ultrasound evaluation at the ankle later in the day will not show fluid in the tissue. If there is coexisting vein and/or lymphatic disease, there can be swelling with the finding of fluid in the tissue. These are easy to diagnose with diagnostic tests such as a duplex and / or lymphoscintigraphy.

Lipedema by itself can create column-like ankles. Sometimes the fatty tissue of the legs is tender and patients may complain of easy bruising. History of the patient will reveal poor-to-no results with diet and exercise from the hips down, although the upper body responds.