The patient complains of swelling of the foot, leg, or entire extremity. Lymphedema is usually unilateral and is worse during warm weather, before menstruation, and after prolonged time with the limb in a dependent position. There is usually no discomfort. On examination, the edema is diffuse, causes a typical mound on the dorsum of the foot or hand, and is only partially pitting. There are usually no skin changes or evidence of venous insufficiency.
Secondary lymphedema is often a result of infection, especially dermatophytosis in the foot.
In older persons, it may be due to malignant disease in the pelvis or groin and may follow radiotherapy. Lymphangitic streaks may be seen in the skin, and lymph nodes in the groin are usually enlarged and tender. These features differentiate lymphangitis from acute thrombophlebitis. Obliteration of lymphatic tissue by excision or radiotherapy is another cause. When lymphedema is due to infection, the response to antistreptococcal antibiotics is often rapid.