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Complete Decongestive Physical Therapy in a Patient With Secondary Lymphedema Due to Orthopedic Trauma and Surgery of the Lower Extremity

Meryl D. Cohen

Abstract

Background and Purpose This case report describes a patient who developed lower-extremity lymphedema secondary to orthopedic trauma and surgery and reports the response to complete decongestive physical therapy (CDP), with 8 treatment sessions over 3 months.

Case Description The patient was a 56-year-old man who sustained a right ankle displaced fibular fracture, underwent open reduction internal fixation surgery 12 days later, and developed lymphedema 4 months postinjury. The patient's impairments of the right lower extremity included increased girth, decreased ankle range of motion, and increased pain. Due to these impairments and the inability to fit into normal footwear, the patient limited activities such as ambulating long distances and climbing stairs. This limited activity restricted him from participating in his normal lifestyle activities such as walking his dog in the community and performing all necessary work duties.

Outcomes Using the truncated cone formula to measure limb volume, the limb volume of the right (involved) lower extremity decreased 368 mL as a result of CDP. The percentage of difference in limb volume between the right and left lower extremities at the initial examination was 9%, and it was reduced to less than 1% at discharge. He was independent with his home program in order to maintain the results of therapy.

Discussion Physical therapist management of secondary lymphedema due to orthopedic trauma and surgery of the lower extremity was effective in decreasing circumferential girth measurements and decreasing limb volume, thereby improving gait and allowing the patient to fit into his work and leisure shoes. The patient reported improvement in his ability to perform all work activities, and he returned to his prior level of participation in the community.

Footnotes

  • The author thanks Ms Carolyn Padial, PT, Ms Gina Sauro, PT, DPT, Ms. Delia Gorga, PhD, OTR/L, FAOTA, and Dr Michael O'Dell for their support.

  • Received March 21, 2010.
  • Accepted June 19, 2011.
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