Stemmer's sign is positive in 82 per cent of those affected: this means that it is impossible to raise a skin fold in the area of the base of toes or fingers.
In contrast to primary lymphoedema, the swelling in secondary lymphoedema decreases from the trunk downwards. The backs of the hands and feet are not swollen and there are no square toes.

Summary of signs of lymphoedema

• Positive Stemmer's sign
• Asymmetric swelling
• Deepened natural skin folds, especially at the basal joints
• Often swelling on the backs of the feet and hands
• Skin smooth and tight