Lipedema: understanding, recognizing, and managing a chronic disease of adipose tissue

Lipedema: understanding, recognizing, and managing a chronic disease of adipose tissue

General introduction
Lipedema is a chronic and progressive disorder of adipose tissue that mainly affects women and presents with an abnormal, symmetrical accumulation of fat, especially in the lower limbs and sometimes in the arms. Often mistaken for obesity, fluid retention, or lymphedema, lipedema has well-defined clinical features that impact pain, mobility, and quality of life.
Early recognition of lipedema is essential to slow disease progression, reduce symptoms, and improve limb function. A multidisciplinary approach combining compression therapy, physical activity, and specialist monitoring represents the most effective long-term management strategy.

Definition and characteristics of lipedema
Lipedema is a pathological alteration of subcutaneous adipose tissue characterized by an increase in fat cells associated with capillary fragility and a tendency toward edema. Fat distribution is symmetrical and typically affects the thighs, knees, buttocks, and calves, while the feet and hands are generally spared.

Main features of lipedema include:

• Symmetrical fat accumulation in the lower limbs.

• Sensation of heaviness and tightness.

• Spontaneous pain or pain on palpation.

• Easy bruising.

• Progressive worsening over time.

Lipedema does not respond significantly to diet or exercise, which distinguishes it from common obesity.

Causes and classification
The exact causes of lipedema are not yet fully defined, but genetic and hormonal factors are considered central. The condition often appears during periods of hormonal change such as puberty, pregnancy, and menopause, and a family history is frequently observed.

Lipedema is classified according to disease stage:

1. Early stage: smooth skin, soft adipose tissue, mild edema.

2. Intermediate stage: more nodular tissue, persistent swelling, more evident pain.

3. Advanced stage: limb deformity, fibrosis, and possible lymphatic involvement (lipo-lymphedema).

Progression varies but is generally slow and continuous if untreated.

Symptoms and impact on quality of life
Lipedema is not only an aesthetic condition but a disorder that can compromise physical and functional well-being. Common symptoms include:

• Diffuse pain and skin tenderness.

• Sensation of heaviness and limb fatigue.

• Swelling that worsens during the day.

• Reduced mobility and walking endurance.

• Difficulty maintaining balanced posture.

As the disease progresses, lipedema may contribute to joint problems, gait alterations, and significant psychological impact, especially due to poor response to diet and physical activity.

Diagnosis of lipedema
Diagnosis is mainly clinical and based on observation of fat distribution, symptom evaluation, and medical history. There is no single diagnostic test, but some investigations help distinguish lipedema from other conditions.

The diagnostic pathway may include:

• Specialist clinical examination.

• Assessment of adipose tissue consistency and sensitivity.

• Soft tissue ultrasound.

• Lymphoscintigraphy in cases of suspected lymphatic involvement.

Early diagnosis allows effective therapeutic strategies and helps limit progression.

Available treatments

Conservative therapy
Management of lipedema is primarily based on conservative treatments aimed at reducing edema, pain, and disease progression. The main pillars are:

• Compression therapy with medical elastic garments.

• Manual lymphatic drainage.

• Regular low-impact physical activity.

• Weight control and active lifestyle.

Elastic compression plays a central role by improving venous and lymphatic return, reducing swelling, and relieving heaviness.
The orthopedic technician contributes to lipedema management through the selection and customization of appropriate compression devices, considering body morphology, disease stage, and functional needs. A well-fitted compression device improves comfort, therapeutic effectiveness, and treatment adherence.

Surgical treatment
In selected cases, liposuction specifically designed for lipedema may be indicated. This technique aims to remove pathological adipose tissue and improve mobility. However, surgery does not replace conservative therapy and still requires ongoing compression use.

Rehabilitation and physical activity
Exercise is essential to maintain joint mobility, promote circulation, and reduce the risk of worsening. Low-impact activities such as walking, swimming, water aerobics, and cycling are recommended, as they support drainage without overloading the joints.

Progression and outlook
Lipedema is a chronic condition, but early and consistent management can significantly slow its progression. Research is focused on new diagnostic techniques, improved compression therapies, and more targeted surgical approaches.
Long-term monitoring, patient education, and adherence to treatment are key factors in maintaining clinical stability and quality of life.

Conclusions
Lipedema is a complex and often underdiagnosed condition requiring a comprehensive and personalized approach. Recognizing symptoms, intervening early, and adopting multidisciplinary management helps reduce pain, swelling, and functional limitations. Compression therapy, physical activity, and specialist support are the foundations of lipedema care, helping preserve mobility, independence, and long-term well-being.