Chronic oedema Resources

Chronic oedema of the lower limb arises when the balance between capillary filtration, venous return, and lymphatic drainage is disrupted. Venous hypertension, most often resulting from venous reflux or obstruction, increases capillary pressure and fluid extravasation into the interstitial space (Eberhardt and Raffetto, 2014). Sustained oedema impairs oxygen and nutrient diffusion, promotes inflammation, and contributes to skin changes such as lipodermatosclerosis, hyperpigmentation, and ultimately ulceration (Moffatt et al, 2017). The development of venous leg ulcers is therefore closely linked to the chronic cycle of venous hypertension, oedema, and tissue breakdown, with healing often delayed by persistent swelling and recurrent episodes of cellulitis (Guest et al, 2020).

Lymphoedema is a chronic, progressive condition caused by impaired lymphatic drainage, leading to swelling, skin changes and increased risk of infection. Although specialist services provide targeted treatment, many patients are first seen in community settings where generalist practitioners may have limited knowledge or training in lymphatic care. This article offers a practical overview to support non-specialist healthcare professionals in recognising and managing lymphoedema. It outlines prevalence, risk factors and common presentations, highlights key assessment and differential diagnosis points, and reviews core management principles, including compression therapy, skin care, exercise and patient education. The psychosocial impact of lymphoedema and the importance of timely referral to specialist services are also discussed. Early recognition, consistent advice and person-centred support can improve outcomes and quality of life, while collaborative working ensures safe longterm care.

The vast majority of wound care is undertaken by community nurses (Dhoonmoon, 2023), with £941 million attributed to venous leg ulcer care and a further £836 million spent on unspecified leg ulcer management (Guest et al, 2017). If signs and symptoms can be 
recognised and a diagnosis made, a plan of care can be drawn up and treatment implemented quickly and efficiently to reduce costs escalating further. More important though, the patient’s condition will improve quickly and deterioration in quality of life can be avoided. Nursing staff are currently encouraging patients to take a more active role in their own care, guiding them in how to look after their own long-term conditions, which can promote long lasting healing and independence.

This clinical series aims to demystify and simplify approaches to assessment and
management of chronic oedema in the community, including the promotion of selfcare,
to improve efficiency and the delivery of evidence-based care for patients with
chronic oedema. Part 4 looks at chronic oedema management, beginning with skin
care and exercise (Wound Care People, 2019).

This clinical series aims to demystify and simplify approaches to assessment and management of chronic oedema in the community, including the promotion of selfcare, to improve efficiency and the delivery of evidence-based care for patients with chronic oedema. Part 3 looks at how to assess chronic oedema using the six Ss, discussing the final three — skin, size and shape.

Chronic oedema is a challenging clinical problem (Figure 1), which will continue to increase and for which most healthcare professionals receive little formal training (Sneddon, 2019). This omission in training can lead to a lack of awareness, confidence and specialist knowledge regarding chronic oedema (Allen and Morgan, 2021).

This clinical series aims to demystify and simplify approaches to assessment and management of chronic oedema in the community, including the promotion of self-care, with the aim of improving efficiency and delivering the best evidence-based care for patients with chronic oedema. Part 1 explains what chronic oedema is, its prevalence, causes and appearance.

Reading the story of Anne’s journey with chronic oedema in a recent issue of JCN was quite disturbing (Rubio, 2021). That someone could have needlessly suffered for so long offers a wake-up call to us all, especially as it is, sadly, a fairly common story. Chronic oedema and lymphoedema are not well understood among many healthcare professionals, so the conditions often go untreated until a patient develops serious complications.

Awareness of the incidence of chronic oedema in the UK, and the consequences of inadequate management has grown over the last 10 years. Moffatt et al (2019) identified that over 50% of patients cared for by community nurses had an element of chronic oedema. A failure to identify and manage chronic oedema can result in the disease progressing to more advanced stages, which are more costly for patients and healthcare services to manage (Wound Care People, 2019). This article tells the story of Anne and her journey with chronic oedema. Her story exposes many inadequacies ranging from prevention to diagnosis, management, and prevention of harm. These culminated in a hospital admission and lengthy rehabilitation calculated to have cost in the region of £35,000. The use of an evidence-based care pathway is advocated and the potential impact which its use might have had for Anne at a number stages in her journey are explored. The combination of Anne’s story, and the financial analysis of the outcome and other potential outcomes had a care pathway been followed, make a powerful argument for change.