Reg presented to clinic with lymphoedema tarda of the entire right leg. No truncal oedema was detected. The lymphoedema had developed suddenly 25 years previously, at which time the possibility of DVT was investigated and discounted. Reg's lymphoedema had deteriorated steadily since its onset. Reg's right-leg volume was 98% greater than that of his left leg: the distal segment was 153% greater, and the proximal 58% (in leg volume comparisons, the total leg volume percentage difference is not an average of distal and proximal percentage differences).
Clinical examination showed skin folds, fibrosed tissues, positive Stemmer's sign and squared toes, but Reg did not report any pain. In 25 years, Reg had not received any treatment for his condition.
Reg's main concerns about the lymphoedema were his inability to wear off-the-peg trousers and his need to buy larger shoes for his right foot. His right calf measurements were 20 cm larger then his left, and his mid-thigh measurements 10 cm greater.
Reg was given 14 sessions of DLT over a 3-week period. This achieved a volume reduction of 2500ml in the right leg. The total difference was reduced to 57% (102% for the distal segment and 30% for the proximal segment).
On the final day of DLT, Reg was fitted with a fully-knitted stocking with waist attachment, which he was advised to wear day and night. A maintenance programme was also devised.
Two weeks later, the volume difference had increased to 71%. Reg's trunk and leg were then treated with MLD twice weekly for 2 weeks followed by 3 days' DLT. This reduced the volume difference to 64%. A CircAid legging was fitted to the lower right leg with a foot wrap. Reg was encouraged to comply with the maintenance programme of skin care, SLD and pumping exercises while wearing the legging.
Reg stopped wearing the foot wrap within a week because he found that it did not fit comfortably in his shoes. He then wore the legging daily with class 3 hosiery for 15 months. His right-leg measurements decreased slowly to being 57% greater in volume than his non-affected leg.
The limb volume charts for the distal and proximal segments show how the fluid in Reg's leg shifted initially to the proximal segment and eventually drained away with SLD and exercise.
Fifteen months after fitting with a CircAid legging, Reg resisted a suggestion by the therapist that he should try hosiery alone. He stated that the firm support of the legging was very comfortable and he would be prepared to purchase the garment privately if it was not supplied by the clinic.