Integrated & Community Services - Lower Limb Lymphoedema and Chronic Oedema Discharge Advice

You have been provided this leaflet today from the Oldham Lymphoedema Service.

This leaflet provides guidance on how to manage low level/well managed oedema.

This leaflet discusses:

• Red Flags and when to remove any compression hosiery/garments
• Caring for your skin
• Leg exercises
• Washing advice for compression hosiery/garments
• Application of compression hosiery/garments
• What to do if you require more compression hosiery/garments

Red Flags

Caution - If you have any of the problems listed below it may be necessary for you to remove the compression garments immediately and contact your GP straightaway. Please see examples below:

• Prolonged numbness or tingling of your toes
• Regular cramp-type pain in your legs/feet
• Bluish discoloration of your toes
• Excessive coldness – check unbandaged foot to see if different colour or temperature to bandaged leg
• Pain (more severe than usual)
• Cellulitis - Infection of the skin and soft tissues, your leg maybe swollen, red, hot to touch, blistered, and painful

If you suspect infection please contact your GP/111 immediately for antibiotics

• Bandages have slipped down your leg (slipped bandages can often cause tight bands around the leg, creating circulation problems and new ulcers)
• Unusual swelling of your toes/knees where the hosiery starts and finishes
• Itching of your leg (more than usual)

Caring for your skin

Washing

• When washing use warm water, pat dry and ensure the spaces between your toes are thoroughly dried

Applying Moisturisers/Emollient

• Use the one recommended by your healthcare professional. Apply to freshly washed skin, in downward strokes, twice daily or more often if the skin is dry
• Avoid placing moisturiser/emollient in-between toes
• Avoid over-the-counter products that may contain harmful ingredients Ask your healthcare professional for advice on the best moisturiser or emollient
• To prevent contamination of bacteria into the emollients please ensure that the dispenser is not damaged, if so discard. When removing emollients from tubs, please ensure that you use a clean utensil to avoid contamination from hands
• Look at your legs Inspect them daily. Contact your GP/Nurse if any redness, irritation, or a break in the skin occurs
• Avoid Scratching your skin, knocking your leg, hot sun, exposure to extreme cold and sitting too close to the fire

 Keep your skin healthy by eating a well-balanced diet consisting of: 

•    Protein - for example meat, fish, dairy produce, soya, pulses (beans, lentils and peas)
•    Vitamin C – for example vegetables and fruit
•    Iron – for example cereal, meat and dark green vegetables
•    Drink plenty of fluids during the day (unless advised otherwise by your GP/nurse)

Leg exercises

Exercise is good for your circulation and general health. If possible, take daily walks but please ensure you wear sensible footwear.

When not resting try to keep as active as you can within your own limitations.

Walking improves your circulation as well as your general health.

Avoid standing in one position for long periods. If this is necessary then move your toes up and down, bend and straighten your knees and shift your weight from foot to foot at regular intervals.

You can also exercise indoors 

1.    Ankle circling in both directions

2.    Toes bend/curl and stretch

3.    Ankle bend and stretch

4.    Marching on the spot

5.    Knee bends whilst sitting

6.    Standing on your tip toes

7.    Elevating legs when sitting out

If possible raise your legs, higher than the level of your heart, using pillows or arm of sofa if possible. Ensure heels are always suspended (floating) clear of the edge of pillows, recliner chairs or footstools.

Washing advice for compression hosiery/garments  

Compression hosiery/garments can be put in the washing machine however fabric softener cannot be used. When drying hosiery, they do not like direct heat and therefore tumble dryers and radiators should be avoided. These can damage the fibers within the hosiery which reduces the effectiveness of the compression hosiery.

How to apply compression hosiery/garments

All compression hosiery/garments should be smooth when applied. Below the knee hosiery should come just below the knee. There should be no creases in the hosiery when they are on the leg. If hosiery is digging in, then please seek further advice as hosiery is incorrectly applied or of an incorrect fit if this occurs.

What do I do if I need more hosiery/garments?

You can contact your GP as we have requested and have this added to your prescription. Or if you would prefer you can self- purchase from companies via their websites such as Daylong who are a hosiery distributor www.Daylong.co.uk, or direct from the company such as Jobst, Duomed, Activia and Medi. Compression hosiery, below knee, thigh length and tights in Class one, has an average life span of 6 months when worn regularly.

It is important to renew hosiery/garments when loose, too tight, or at regular intervals every 6-12 months as overtime hosiery loses its elasticity and becomes less effective.

Useful Numbers 

Daylong: 0115 8508850

Your Health Oldham: 0161 960 0255

Age UK Oldham: 0161 622 9266

Millercare: 0161 785 9898

Single Point of Access (SPOA): 0161 357 5190

Oldham Community Tissue Viability and Lymphoedema service- please email oldhamtissueviability@nca.nhs.uk or contact the service by ringing the SPOA number above and ask for a message to be sent to the team and we will get back to you as soon as we can.

What compression hosiery/garments have I been provided with today?

After assessment today we have suggested you be managed in the below compression hosiery:

Brand: ………………………………………………………
Class: ………………………………………………………..
Size: ……………….......................................................... 
Colour: ……………………………………………………...
Style: ………………………………………………………...

These can be provided from your GP or please refer to page 6 to see hosiery providers. If you have any problems or concerns, please contact your GP to discuss.

Remember if you feel your hosiery/garments are no longer the right size, as they are too tight, or your leg has increased in size please contact your local pharmacy to be remeasured before requesting a repeat prescription.