Saturday, April 13, 2024

Question about lymphedema patient

Sharidy MacCord

Hello List-

I have a 44 y/o patient that has been dealing with lymphedema for the past 4-5 years in the left leg. She is 5’2″ about 115# and up until the lymphedema she was rather active. Patient has been through a lot, foot ulcer, had surgery to correct alignment of foot. In the midst of all her foot issues patient ended up hyperextending her knee, and over an extended period of time, has stretched out the posterior ligaments etc and without any management stands with an approximate 25 degree hyperextension angle. Patient then was sent to our office. Patient has been to an orthopedic doctor and, as I thought, he feels surgery is not the option (knee repair or replacement). Patient is in lymphedema therapy and has on numerous occasions at our office brought up having an amputation. Currently she is wearing a post op knee orthosis set to stop at 20 degrees short of full extension, both for easy adjustability as she continues to change in volume, ROM control, and in the midst of her waiting to get in to see an orthopedist and tossing around the idea of amputation.

I feel that the patient and her husband have made the decision mentally to have an amputation, BUT physician would like her to have a KAFO and PT for 2-3 months. Any suggestions due to large fluctuations in volume for design of KAFO? Metal obviously for fluctuations, but even metal with large fluctuations isn’t always that simple. Any suggestions, things you have used that worked in the past etc. would be MUCH appreciated.

Also, patients thigh has stabilized more in volume but still large fluctuations in knee and calf section. In the event she does have a transfemoral amputation, what have been your experience with fitting a patient with lymphedema? Did you just use socks to chase volume changes? Did you use pin suspension? Any physicians that specialize in amputation of a lymphedema effected patient?

Much Appreciated,

Sharidy MacCord, CP
Virginia Prosthetics
[email protected]


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