Clinical innovation: wider collaboration on lymphoedema research is needed — footwear and gait analysis
Dr Rhian Noble-Jones, Lynne Rowley, Chris Rowley. Wounds International 2017 | Vol 8 Issue 1
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Clinical innovation: wider collaboration on lymphoedema research is needed — footwear and gait analysis
Dr Rhian Noble-Jones, Lynne Rowley, Chris Rowley. Wounds International 2017 | Vol 8 Issue 1
Extending teams that research and manage lymphoedema to include orthotists and podiatrists may extend our understanding of the condition and component parts of treatment. New technology, some of which is low cost, enables an increasing range of data and outcome measures. This article highlights the reality of a shortage of studies involving gait analysis and a lack of consideration of the impact of inappropriate footwear on exercise as a key component of lymphoedema management.
Main findings
- Podiatrists and orthotists have a role to play as part of the multidisciplinary team in the management of lymphoedema.
- The increase in mass in a body segment due to the presence of lymphoedema results in an increase in the forces needed to achieve locomotion (force = mass x acceleration). There is strong evidence linking an increase in body mass index (BMI) to an increase in knee osteoarthritis further investigation is required regarding whether there is a link between severity of lower limb lymphoedema and knee osteoarthritis.
- Lymphoedema in the lower limb can alter the centre of mass. Changing the centre of mass in a limb segment alters the moment about that joint, requiring the muscles to increase the force to control the body segment compared with the non-affected limb.
- Lymphoedema in the lower limb can restrict range of movement (ROM). Restricted ROM results in compensation at other joints or gait deviations. A common gait pattern is antalgic gait and a shortened stride length with the stride length shorter than the stance phase. This can lead to structural and functional abnormalities in the hip, knee and ankle joints combined with muscle weakness. These factors result in altered biomechanics during gait.
- A heavy oedematous arm can also affect balance and gait. Simple observation can establish that a swollen arm has the potential to significantly redistribute weight/balance affecting the biomechanics of other muscles and joints and therein gait.
- Kinesiotaping has a role to play in improving gait dorsiflexion range of movement, cadence, stride length, step length and stance phase.
- Collaborative research is necessary to explore the effect of lymphoedema and its management on gait and its subsequent sequelae.
