Heat is the enemy of leg well-being. Just when people start to expose their legs more, they encounter the consequences of high temperatures impacting circulation. The result? Swelling, heaviness, and pain that, according to estimates, affect one in two women in the summer. And unfortunately, it’s not just a cosmetic problem: the accumulation of fluids can compromise the proper oxygenation of tissues, leading to redness, eczema, dermatitis, ulcers, and infections. 

Swollen and Painful Legs:

Corrado Campisi, President of the World Congress of Lymphology, which will be held in Genoa from September 11 to 15, discusses the problem and suggests strategies for care and prevention. 

A Women’s Issue Men are not immune, though they tend to ignore and underestimate the problem. However, women are definitely more vulnerable. “When we talk about swollen legs and circulation, the thought goes directly to blood, which flows through the arteries and veins of our body with the push of the heart,” explains Campisi, a professor of Plastic Surgery at the University of Catania and co-founder of the Campisi Clinic.

“But besides the major ‘highways’ of the blood circulatory system, there’s also a complex network represented by the lymphatic system that transports proteins, fluids, and lipids. This system, made up of lymphatic vessels and nodes, allows lymph to be drained in body tissues, at every point of our organism, before flowing into the blood circulatory stream. Malfunctioning of this network can lead to abnormal swelling of the hands, arms, or legs. Sometimes so extensive they seem like ‘elephant’ limbs.” 

Discovering Lymphedema There are two main forms of lymphedema: “primary,” due to congenital malformations of the lymphatic system vessels, and “secondary,” due to external adverse events that alter the normal function of the lymphatic system, such as lymph node removal and radiotherapy, both anticipated in oncological treatments. It is estimated that there are 350 million people with lymphedema worldwide, 2 million in Italy alone, with about 40,000 new cases each year. 

“When the lymphatic circulation of our legs has anomalies,” explains Campisi, “there is an accumulation of fluids in the tissues and when this state, as often happens, is associated with insufficiency of the venous circulation of the limbs, the picture gets complicated.” In summer, walking or even wearing shoes can be difficult. “The fluids that cannot be drained can become so dense, due to the high protein content, that it can compromise the proper oxygenation of the tissues, predisposing them to redness, eczema, dermatitis, ulcers, and infections,” adds the specialist. 

Recognizing the Problem Initially, a doctor needs just one finger to identify the problem. “The pressure exerted by the finger on an ankle or leg – Campisi recounts – can verify that, for a few seconds, a sort of dimple forms, a clear sign of lymphatic dysfunction. Clinical observation should then be combined with an EcoColorDoppler for the study of the venous circle and a lymphoscintigraphy to check for lymphatic congestion.” 

As for the symptoms, they can be subtle and hard to detect in summer: the most common are heavy legs and swollen ankles, which are often considered ‘normal’ and therefore negligible. “What should not be ignored is the difficulty with which the legs deflate: if no benefit is obtained by raising them and refreshing them with jets of cold water, it is advisable to consult a specialist,” he recommends. 

Leg-Saving Interventions As for remedies, they range from lifestyle changes, like avoiding smoking or standing still for a long time, to the use of elastic stockings, which exert a graduated compressive thrust draining fluids from the ankle upwards. Then there’s pharmacological therapy with benzopyrones, antibiotics, antifungals, diethylcarbamazine, diuretics, and manual lymphatic drainage with a specialized physiotherapist, mechanical drainage such as pressotherapy, or the use of multilayer bandages and gymnastic exercises. 

More recently, microsurgery has been used, which acts directly on the cause, thereby preventing recurrences. “Surgical procedures are multiple: from lymphaticovenous bypasses, which – explains the specialist – aim to create a peripheral physiological discharge to solve the obstruction, to autologous transplantation of lymphatic tissue or lymph nodes with the aim of creating a new lymphatic drainage system in the affected limb, up to true liposuctions guided by lymphatic navigation.” 

Campisi has devised a new technique of “ultrasound liposuction,” which uses sound waves to “dissolve” lymphatic congestion and facilitate the surgical procedure. However, the ‘black’ period for the legs has just begun. That’s why experts have developed a targeted decalogue: 


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