Lipoedema

A long-term condition affecting the distribution of fatty tissue

What is lipoedema?

Lipoedema is a chronic condition that causes an abnormal and usually symmetrical build-up of fatty tissue, most commonly around the:

  • Hips

  • Buttocks

  • Thighs

  • Lower legs

The arms can also be affected.

Unlike ordinary weight gain, the affected tissue can be painful or tender and may bruise very easily. Lipoedema can also cause a feeling of heaviness and, as it progresses, may affect mobility and everyday activities.

Lipoedema is much more common in women and only rarely occurs in men.

What does lipoedema look like?

Lipoedema usually affects both sides of the body relatively evenly.

Common features include:

  • Legs that appear disproportionately large compared with the upper body

  • Enlargement of the hips, thighs and lower legs

  • A noticeable difference between the size of the waist and legs

  • Soft, cool-feeling fatty tissue

  • Dimpling or an “orange-peel” texture to the skin

  • Pain or tenderness when the tissue is pressed

  • A feeling of heaviness

  • Easy bruising

  • Increasing difficulty with walking or mobility in more advanced cases

The appearance and severity vary greatly between individuals.

What happens to the feet?

This is one of the particularly useful clues.

In classic lipoedema, the feet are usually spared.

The fatty tissue may extend down the leg as far as the ankle and then stop relatively abruptly, sometimes creating a visible cuff or step around the ankle.

Similarly, when the arms are affected, the hands are usually spared.

This is different from lymphoedema, where swelling commonly extends onto the foot and into the toes.

However, conditions can overlap, so foot sparing alone cannot confirm or exclude a diagnosis.

Is lipoedema the same as obesity?

No.

Lipoedema and obesity are separate conditions, although a person can have both at the same time.

Lipoedema causes a characteristic distribution of abnormal fatty tissue, and the affected areas may remain disproportionately enlarged even when someone loses weight.

NICE notes that lipoedema-associated fat is usually resistant to diet modification and exercise.

That does not mean healthy eating, exercise or weight management are pointless.

Maintaining a healthy weight can:

  • Support mobility

  • Reduce additional mechanical load on the joints

  • Improve general cardiovascular health

  • Prevent ordinary weight gain from adding further volume to the affected limbs

But somebody with lipoedema should not simply be told that the condition exists because they are overweight.

The NHS specifically states that lipoedema is not caused by being overweight and can occur in people who are otherwise a healthy weight.

Is lipoedema the same as lymphoedema?

No.

Despite the similar names, they are different conditions.

Lipoedema primarily involves an abnormal distribution of fatty tissue.

Lymphoedema results from impaired drainage of lymphatic fluid.

Some useful differences are:

Lipoedema tends to:

  • Affect both legs symmetrically

  • Spare the feet

  • Cause tenderness or pain

  • Cause easy bruising

  • Produce disproportionate enlargement of the lower body

Lymphoedema may:

  • Affect one limb or both

  • Extend into the foot and toes

  • Produce obvious fluid swelling

  • Initially leave a dent when pressed

  • Cause thickening and hardening of the skin over time

However, the two conditions can coexist.

Can lipoedema eventually cause lymphoedema?

Yes, in some people.

As lipoedema becomes more advanced, the increased volume and changes within the tissues can place additional strain on the lymphatic system.

Secondary lymphatic impairment can then develop alongside lipoedema. This combination is sometimes referred to as lipo-lymphoedema.

At this stage, the feet may also begin to swell, making the distinction from uncomplicated lipoedema less obvious.

What causes lipoedema?

The exact cause is still not fully understood.

There appears to be an association with hormonal change, as symptoms may first appear or become more noticeable around:

  • Puberty

  • Pregnancy

  • Menopause

  • Hormonal contraception

There may also be a genetic component because lipoedema can run in families.

Research is continuing into the mechanisms behind the condition.

Does lipoedema always get worse?

Not necessarily.

Lipoedema affects people very differently. Some people have relatively mild disease that changes little for many years, while others experience progressive enlargement, pain and mobility difficulties.

Changes in weight, hormonal events and other health factors may influence symptoms.

It is therefore better to assess and manage the individual rather than assuming that everyone will follow the same progression.

How is lipoedema diagnosed?

There is currently no single blood test or scan that diagnoses lipoedema.

Diagnosis is primarily based on:

  • Your medical history

  • The pattern and distribution of tissue

  • Whether both limbs are affected

  • Whether the feet or hands are spared

  • Pain and tenderness

  • Easy bruising

  • Other clinical features

Other causes of leg enlargement or swelling may also need to be considered, including:

  • Obesity

  • Lymphoedema

  • Chronic venous insufficiency

  • Generalised oedema

  • Medication-related swelling

  • Heart, kidney or liver disease

The NHS recommends speaking to your GP if you have symptoms suggestive of lipoedema. Referral to an appropriate specialist may then be considered.

How is lipoedema treated?

There is currently no simple cure, so treatment focuses on controlling symptoms, maintaining function and supporting quality of life.

Management may include:

Physical activity

Regular movement helps maintain:

  • Muscle strength

  • Joint movement

  • Cardiovascular fitness

  • Mobility

Activities that place less load through painful joints, such as swimming or cycling, may be easier for some people.

The best form of activity is one that can be performed comfortably and maintained regularly.

Weight management

Losing weight does not selectively remove lipoedema tissue.

However, where somebody also has excess non-lipoedema body fat, appropriate weight management can still reduce overall load on the legs and improve general health.

Compression

Specialist compression garments may help some people by:

  • Reducing discomfort

  • Supporting the tissues

  • Helping control additional fluid accumulation

  • Improving mobility

Compression does not remove the abnormal fatty tissue itself.

Compression should ideally be assessed and fitted by somebody appropriately trained, particularly where there are other vascular or swelling problems.

Skin care

Good skin care helps maintain the natural protective barrier of the skin.

Regular moisturising can help prevent dryness, cracking and irritation, particularly where skin folds or friction are present.

Psychological support

Lipoedema can have a substantial impact on body image, confidence and quality of life.

Unfortunately, people may also have spent years being told that the appearance of their legs is simply due to weight.

Counselling, psychological support or CBT may be helpful where the condition is affecting emotional wellbeing. The NHS includes psychological support among the management options for lipoedema.

What about liposuction?

Specialist liposuction can be considered in some people with severe lipoedema.

This is not the same as ordinary cosmetic liposuction.

The aim is to remove abnormal fatty tissue while minimising damage to blood vessels and lymphatic structures. The procedure may reduce limb bulk and aim to improve pain, mobility and function.

More than one operation may be required.

NICE has specific HealthTech guidance covering liposuction for chronic lipoedema. That guidance was last reviewed in August 2025, and NICE has said it will review it again when further trial evidence becomes available.

Access to specialist liposuction for lipoedema through the NHS is limited and depends upon individual circumstances and local services.

Can massage remove lipoedema fat?

No.

Manual lymphatic drainage (MLD) is sometimes used as part of conservative management, particularly where there is an additional fluid component, but it does not remove lipoedema-associated fatty tissue.

NICE similarly notes that compression and manual lymphatic drainage may be used conservatively but do not remove the abnormal fat itself.

Why can lipoedema make feet uncomfortable even if the feet are spared?

Even when the foot itself is not affected by lipoedema tissue, changes higher in the leg can alter:

  • Walking pattern

  • Lower-limb loading

  • Balance

  • Foot posture

  • Joint stresses

  • Footwear fit

Larger or heavier limbs can also make reaching the feet for ordinary nail and skin care considerably more difficult.

Pressure from footwear around the ankle may become particularly troublesome where there is a pronounced cuff.

When should I seek medical advice?

Speak to your GP if you have:

  • Symmetrical enlargement of both legs that seems disproportionate to the rest of your body

  • Painful or tender fatty tissue

  • Frequent unexplained bruising

  • Progressive difficulty with mobility

  • Increasing swelling

  • Symptoms that are affecting your daily life

A proper assessment can help distinguish lipoedema from other causes of leg enlargement and swelling.

When is it urgent?

Lipoedema itself is a chronic condition and does not normally cause a sudden hot, red or acutely swollen leg.

Seek urgent medical assessment if:

  • One leg suddenly becomes significantly more swollen than the other

  • A leg becomes hot, red or very painful

  • You develop fever, chills or feel acutely unwell

These symptoms may indicate another condition such as cellulitis or DVT and should not simply be attributed to lipoedema.

The NHS specifically advises urgent assessment when a person with suspected lipoedema develops hot, painful swelling with flu-like symptoms because this may represent cellulitis.

Lipoedema and your podiatry care

Although lipoedema primarily affects fatty tissue rather than the foot itself, it can have important consequences for lower-limb and foot health.

At Blackfords Footcare, we may identify features suggestive of lipoedema during examination of the feet and lower limbs.

We can also help with associated foot problems such as:

  • Difficulty reaching and caring for the feet

  • Painful corns or callus

  • Nail-care difficulties

  • Footwear problems

  • Altered pressure and gait

  • Skin damage caused by rubbing or pressure

  • Fungal skin or nail infections

Where appropriate, we can assess the vascular, neurological and musculoskeletal health of the feet and lower limbs to identify other factors which may be contributing to your symptoms.

We do not diagnose or provide specialist treatment for lipoedema itself, but where the pattern of changes raises concern, we can explain our findings and recommend appropriate onward medical assessment.

Lipoedema is a recognised medical condition. It is different from obesity and different from lymphoedema, although these conditions can occur alongside one another.