Which bedside finding, if positive, reliably differentiates lymphoedema from lipodema and chronic venous oedema of the foot?

• A Loss of the ankle jerk reflex
• B Pitting oedema that resolves overnight elevation
• C Haemosiderin pigmentation around the ankle
• D Inability to pinch a fold of skin at the base of the second toe (positive Stemmer sign) ✓

Explanation

In lymphoedema, protein-rich fluid in the subcutaneous tissue causes fibrosis and thickening of the skin, so a fold at the base of the second toe cannot be pinched: a positive Stemmer sign. Lipodema spares the foot entirely, and simple gravitational or venous oedema pits freely and pits even at the toes. Pigmentation around the ankle indicates venous hypertension, not lymphatic failure.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.