Garment choices for lipoedema
Lipoedema is an abnormal build-up of fat in the legs and sometimes arms. Susan Butcher highlighted several cases where the correct garment use helped lipoedema patients in treating the symptoms.
The first case she showed was a lipedema patient fitted into thigh-high with waist attachment. There is a measuring issue with the actual groin piece where the thigh piece is not actually going up to the groin, or the panty line where it should be, but also the slippage that is happening with the garment is slipping down and then causing a massive pressure area through the ankle, and this is always something to face with these lipoedema patients, so this is a circular knit garment. It is not the most appropriate garment for a lipoedema patient. It is not the most appropriate garment for a lipoedema patient.
The second case shows a patient to highlight the problems that evolve when putting patients into below-knee garments for lipoedema. So, the same problem is happening at the ankle; this is a circular knit garment that is biting around the ankle joint. More importantly, it is the problems that are developing around the knee. So over time, we would continually have knee swelling issues, as there would be more fat depositing on the inner sides of the knee. If this were the case, we should look at putting this patient into a flat knit garment to prevent further problems that would occur down the track. So, in the end, we got the patient into a flat-knit garment.
The third case has the same problem, but instead of being at the knees, it is at the saddlebag thigh area, so the garments have been worn for a substantial amount of time, it has formed a shape where the garments go up to, but over the day it is slipping down into the ankle creases again this is a circular knit garment. It is leaving that saddlebag area, forming more fat deposits. Hence, we place the patient into a custom-made flat knit garment, and the saddle bag starts to change over about three-four weeks. It is starting to form a better shape.
The fourth is an advanced case of lipoedema, and the patient was wearing an inappropriate stocking when she went to the clinic. So, they put her into a Compreflex wrap to try and get some shape and continuity back into the limb. Then they could put her into appropriate flat knit garments more suitable for her knees.
Susan also mentioned that they do face many challenges when placing patients who are larger sized into suitable garments; they have compliance issues and that comfort level for the patient. There is another garment that is not medical compression; it works on a micro-massage effect, and it is a complete garment that goes up underneath the bust and ends there at the toes. It comfortably goes over all the skin folds without cutting in and that comfortable level there over the ankle due to the cuffing. This is just another way they can utilize another type of garment to help fit these more challenging patients.
Another patient came in a legging that was medical grade compression. It is just a different style of compression that we could use. However, unfortunately, the legging only went to the ankle. It made the indentations left around the ankle through the garment use. Hence, she says that when she wears it for only half an hour or more, she starts to get a throbbing ache around the ankle. So again, even though the lipedema is not extensive here, it still must be carefully thought about what garment to put this patient.
The measuring of garments becomes complicated, especially for these odd-shaped limbs. In the shown image for a patient in the presentation, they have carefully mapped out all the measurement areas that they want to do in this limb, and specifically challenging is at the ankle where there is much cuffing, so they are not doing the traditional measuring at the ankle they are bringing that measurement point up 10 centimeters just above the ankle line where it usually would be to accommodate someone with cuffing, so it is not an easy exercise to measure someone who has got lipoedema.
Finally, Susan highlighted the effects of a garment; when they do get it right and put a patient, especially a lipoedema patient, into the most appropriate garment is essential to use a comfortable and well-fitting garment. In this case, the patient reported reduced pain and more mobility, which helps with all her daily functions. She wears this garment every day also. Susan likes to mention that all the garments seen in the presentation are outstanding products, so it is not the product that is a problem; it is just how the products are being put on or chosen for these patients.
In summary, the best garments for lipoedema patients would be flat knit or custom-made garments. Suppose they were type 2, only going down to the knee. In that case, we could get away with that circular knit garment because we would not be worried about the cuffing at the ankles. However, most of the time, using the go-to would be a pantyhose style either in a flat knit or a custom-made.