Lipedema presents as abnormal, symmetrical accumulations of painful nodules of fat on the legs, anywhere from buttocks to ankles and especially on the inside of the thighs, although there are several places where it develops, and these are termed the types of lipedema. This excess fat causes affected patients to develop a characteristic gait. To avoid the legs rubbing together and damaging the skin, patients tend to spread the feet while walking.
Patients notice an increase in the size of the legs and believe that any joint pain they experience is due to accompanying weight gain. As the lipedema nodules continue to accumulate, this pushes the legs further apart, and the misaligned joints become clinically relevant. The improper gait causes a valgus deformity in the knee joints (see above), a “skew-foot” position of the ankle joint (see below), along with pronation of the feet and a shift in the hip joint. There are a few patients who develop a varus gait (see above) due to especially enlarged fat pads in the inside of the knees.
Valgus Gait With Skewed, Pronated Foot
Varus Gait With Pronated Foot
These abnormal gaits create wear on the joints, to the point that hips, knees and ankles are adversely affected, even going as far as to cause meniscal and ligamental tears. Add to that the weight of the lip nodules and lymph fluid caught within the tissues combined with affected joints, and mobility is extremely compromised in the late stages of the disease. Many patients develop an inability to stand or walk for even short periods of time, severely impacting their employment, instrumental activities of daily living (such as communication, food preparation, housekeeping, laundry managing finances or medications, shopping, and transportation), and activities of daily living (dressing, eating, hygiene, etc.). Many patients become disabled and must file for disability.
How Is Function Assessed?
Activities of daily living (ADLs) are a series of basic activities necessary for independent living at home or in the community which are performed on a daily basis.
There are nine areas of ADLs used in occupational therapy:
Instrumental activities of daily living are similar to ADLs. These actions are important to being able to live independently but are not necessarily required on a daily basis. IADLs are not as noticeable as ADLs when it comes to loss of functioning, but functional ability for IADLs is generally lost before ADLs. IADLs can help better determine the level of assistance needed by an elderly or disabled person. IADLs include:
The Katz Index of Independence in Activities of Daily Living is a good means to assess functional status as a measurement of a patient’s ability to perform activities of daily living independently.
A functional capacity evaluation (FCE) evaluates a patient’s capacity to perform work activities related to his or her participation in employment. The FCE process compares the health status and body functions and structures to the demands of the job and the work environment. An FCE’s primary purpose is to evaluate an ability to participate in work, although other instrumental activities of daily living that support work performance may also be evaluated. FCEs are usually conducted by occupational therapists, based on their education and training.
The FCE may be used to determine:
The components of the FCE will vary based on the purpose of the assessment. The FCE typically begins with a client interview, medical record review, and musculoskeletal screening. Functional testing may include graded material-handling activities such as lifting, carrying, pushing and pulling, and positional tolerance activities such as sitting, standing, walking, balancing, reaching, stooping, kneeling, crouching, crawling, object manipulation, fingering, hand grasping and hand manipulation. Pain monitoring is frequently performed during the FCE to document patient-reported levels of pain during various activities as well as to manage pain. The FCE may also include evaluation of an individual’s hand dexterity, hand coordination, endurance, and other job-specific functions.
The FCE report includes an overall physical demand level, a summary of job-specific physical abilities, a summary of performance consistency and overall voluntary effort, job match information, adaptations to enhance performance, and treatment recommendations if requested. FCEs are done on a one-on-one basis and may range in length from 4 to 6 hours. The FCE may take place over 2 consecutive days.
Functional Capacity Evaluation. (n.d.). American Occupational Therapy Association.
Stutz, J., & Wald, S. (2011, Jan). Liposuction of lipedema to prevent later joint complications. Vasomed, 23, 2-6.
Learn More
Activities Of Daily Living Continuing Education Activity | National Library Of Medicine
Functional Capacity Exams And Balance Testing PODCAST | Brooks Rehabilitation
Liposuction of Lipedema to Prevent Later Joint Complications PDF | Dr. Josef Stutz
How Lipedema Can Cause Mobility Issues | Dr. Thomas Wright
Lower Extremity Functioning Scale PDF | Emory Healthcare
Occupational Therapy Practice Framework: Domain And Process PDF | Dr. Carrie Schmitt
Occupations And Everyday Activities | American Occupational Therapy Association
The Physical and Emotional Effects of Lipedema VIDEO | Dr. Josef Stutz
What To Know About ADLs And IADLS | Very Well Health
