CASE STUDY TWO

14/09/25

Dr Aoife McGarvey / Julia Britton

Mr H first saw me with severe and chronic swelling (otherwise known as oedema) of the right lower leg, ankle, foot and toes.

Oedema/swelling in a leg can occur due to damage to the lymphatic system from surgery, trauma or infection. The swelling that occurs is lymphatic fluid sitting in the tissues that isn’t being drained back towards the heart (which is where all our lymphatic fluid ends up!).

Mr H However, had not had surgery or trauma that may have caused the swelling in his right leg. He had what is called Primary Lymphoedema. This is an inherited condition which affects the structure of the lymphatic system. It can be present from birth or show up later in life.

Being an active man who loves swimming in the ocean and walking, the size and heaviness of his leg was causing discomfort and limitations, not only to exercising but what trousers and shoes he could wear. Mr H had widespread pitting oedema, which is where indentations on the skin occur due to lymphatic fluid being built up in the tissues. This is a clinical sign of moderate-severe lymphoedema.

He’d been wearing an off-the-shelf or “ready to wear” knee high compression garment for years, purchased from a healthcare supplier shop. This garment clearly didn’t fit well (Photos 1-3) and caused discomfort if worn for several hours. An ill-fitting compression garment can cause more harm than good. Digging in and garment strangulation can cause circulation and lymphatic drainage impairment, skin breakdown and pain.

Treatment plan

Our first goal of treatment was to reduce the size and volume of his leg, which would thereby reduce discomfort, and improve mobility and the ability to wear trousers and shoes. We discussed some management options and decided to do a few days of compression bandaging of the toes, foot and lower leg.

Mr H had a dramatic improvement in both the size, but the shape of his leg. Our next goal was to maintain this improvement!

We opted to change the compression garment completely. We customised it to Mr H’s specific dimensions, which was then made in Germany. The style was altered to thigh high, fabric to flat knit (often best for severe oedema) and increased the compression class or fabric stiffness to CCL3 (Compression Class 3 which delivers a pressure of 35-45mmHg). This compression garment provided an excellent maintenance of the reduction in his leg volume.

We added a toe cap which fits over the toes and half of the foot extremity to wear under the thigh high garment to maintain the reduction in oedema of his toes.

Results

After 3 sessions Mr H reported a significant improvement to his swelling and comfort. He was finding more comfort wearing shoes and found his leg was fitting more easily into trousers too.

Maintaining an active lifestyle is a key part of improving lymphatic health, so to help Mr H stay active we made a compression plan that would also allow more movement, especially when he is beach walking.

For beach days he wears a knee-high lighter compression garment that is more manageable to get on and off and is cooler for when he’s working a up a sweat with his walking. Together, we have applied for Mr H’s future compression garments to be partially funded through the NSW Government Enable scheme.

This case study highlights how important the right compression can be to helping people maintain the health of their limbs while living with swelling from Lymphoedema.

Compression garments are essential to minimising swelling and improving skin health and long-term outcomes. Compression strategies need to be individualised to suit different people’s needs. Having some flexibility and variability to compression options can allow people to manage their swelling, while still living life to the full.

Thank you Mr H for allowing us to share your story.

*Client consent has been obtained to share these photos and story on social media. This post does not provide clinical suggestions for other client presentations. Physio Living has no declarations or financial affiliations with any garment companies.