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BACKGROUND: Lipedema is an abnormal accumulation of subcutaneous fat that usually affects the lower extremities. Inflammation due to adipose tissue may negatively affect body structure and functions. OBJECTIVE: This case-control study aimed to assess lower extremity muscle strength, endurance and function, functional exercise capacity, pressure pain threshold, and edema in women with lipedema and compare with healthy women. METHODS: Women with lipedema and healthy women of similar age and body mass index (BMI) were included in the study. Lower extremity muscle strength, muscle endurance, functionality, functional exercise capacity, pressure pain threshold, and edema (local tissue water) were assessed with digital dynamometer, 30-Second Sit to Stand Test (30-SSTS), Lower Extremity Functional Scale (LEFS), 6 Minute Walk Test (6MWT), manual algometer and skin moisture meter, respectively. RESULTS: Twenty-four women with lipedema (mean age: 47.9 ± 1.8 years, median BMI: 30.62 (19.03-41.20) kg/m2) and 20 healthy women (mean age: 47.2 ± 12.1 years, median BMI: 28.12 (23.23-39.66) kg/m2) participated in the study. Muscle strength for all assessing lower extremity muscles, 30-SSTS repetition number, LEFS score, pressure pain threshold of all assessing regions, percent of predicted 6MWT distance (p < .001) and 6MWT distance (p = .001) were significantly lower in women with lipedema compared to healthy controls. No significant difference was in terms of local tissue water percentage (p > .050). CONCLUSION: Lower extremity muscle strength, muscle endurance, functionality, functional exercise capacity and pressure pain threshold decrease in women with lipedema. It is recommended that these changes be taken into account when developing rehabilitation strategies.