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THE EUROPEAN JOURNAL OF
lymphology
and related problems
VOLUME 29 • No. 75 • 2017
INDEXED IN EXCERPTA MEDICA
ORTHOTIC TREATMENT AS THERAPEUTIC SUPPORT FOR LYMPHOEDEMA OF THE LOWER LIMBS
MARTINELLI DORETTA 1, ACCOGLI SUSANNA 1, CAMPISI CORRADINO 2, BOCCARDO FRANCESCO 2
1 Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), San Martino Hospital, University of Genoa, Italy
2 Department of Surgery, Unit of Lymphatic Surgery and Microsurgery, San Martino Hospital, University of Genoa, Italy
E-mail: francesco.boccardo@unige.it
ABSTRACT
The steady increase in the diagnosis of Lymphoedema, in both its primary and secondary forms, places this dysfunction amongst those chronic diseases that are in continual growth amongst the world’s population.
It can be inferred from information published by the WHO that since 1994 the number of people affected by Lymphoedema has increased from 140 million to 300 million.
Currently in Italy an estimated 45,000 new cases are reported each year.
Medical protocols for the treatment of Lymphoedema call for the involvement of various professionals, including a Podiatrist, so as to make connections between the different aspects of the disease and alleviate the symptoms linked to its development.
To date it is still not possible to totally defeat Lymphoedema, but it is certainly possible to keep its aggravating characteristics under control thus simultaneously alleviating the symptomology. Living with this dysfunction is made tolerable with the help of early prevention, pharmacological treatments, conservative therapies and even surgery if required.
The typical development of lymphatic diseases undoubtedly brings about gradual disability in patients. When the lower limbs are affected, the gradual reduction in ability to work and in motor capacity leads to changes in interpersonal and social relationships causing a significant transformation in quality of life. Lymphoedemas caused by orthopaedic disorders are of interest due to the frequency with which they arise, for example:
• Post-traumatic Lymphoedemas caused by a sprained ankle and/or bruising;
• acute Lymphoedemas, secondary to pulled muscles, sprains and torn ligaments. acute tendon injuries, broken bones and following operations;
• Lymphoedemas due to the use of a plaster cast or prolonged immobilisation.
When the disorder is in the lower limbs, the greatest complications encountered, other than a reduction in the immune system typically caused by lymphatic damage, are those due to reduced mobility in the limb, particularly the bending and straightening of it, caused by oedema.
In that case, the most important thing is to keep the affected limb moving.
Working on the basis that the use of foot or toe orthotics or other podiatric rehabilitation techniques impact on the positioning of the foot on the ground as well as on walking, there was the desire to establish the effectiveness of using the orthotic as a therapeutic aid which aims to improve the symptoms and functionality of people affected by lymphatic disorders.
Short-term monitoring plays a fundamental part in ascertaining the effectiveness of the device, as well as in identifying the extent of the results achieved and in ensuring they are maintained over time. It is, however, important to point out that identifying the orthotic treatment best suited to the conditions and symptoms displayed by an individual may ensure an improvement in the current conditions but will not bring about total elimination of the symptoms.
Key Words: Orthotic Treatments of Lymphoedema, Podiatric rehabilitation, Disorder in Lower Limbs, Reduced
mobility by oedema.
INTRODUCTION
The positioning of the foot on the ground when standing and gait are undoubtedly factors which impact on the posture of an individual.
Another fundamental function of the foot is linked to the upwards return of lymph as it is activated by rhythmic compression of the sole of the foot. The propulsion takes place during walking and the fluid is sent back into the blood stream at the height of the subclavian vein. [1-2]
Checking for and treating any possible alteration in the articulation of the ankles, knees or spine, as well as the muscles used for walking, is therefore a form of prevention as such conditions are detrimental to the correct functioning of the arteriovenous and
L ymphatic Circulatory Systems. [3-4-5]
Static analysis and baropodometric tests allow the quality of the positioning of the foot to be analysed, focussing on fundamental factors such as:

Weight distribution on two feet;
The points of highest load;
Postural and barycentric analysis;
The transfer of body weight during the various phases of a step and the contact time of each part of the foot with the ground.
THE EUROPEAN JOURNAL OF LYMPHOLOGY - Vol. XXIX - Nr. 75 - 2017
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