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Compression Stockings

Updated: Dec 12, 2022

Compression stockings vary in terms of the extent of the leg covered, the amount of compression offered, and the materials used. Read more...

 

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Photo: Techei

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What are compression stockings?


Compression stockings vary in terms of the extent of the leg covered, the amount of compression offered, and the materials used. The goal of compression garments is to apply external relatively uniform pressure to provide a number of benefits. These benefits include:

  • Improving venous return

  • Reducing leg swelling or edema

  • Improve lymphatic drainage

  • Help treat and prevent leg ulcers

  • Reduce the risk of an orthostatic event

  • Prevent blood clots and reduce the risk and symptoms associated with varicose veins.

There are ‘valves’ in our veins meant to assist with venous flow and return. When these valves weaken with age, pressure, and/or a genetic predisposition, external compression can assist their function.



What types of compression stockings are there?


When most people hear compression stockings they think of tight, uncomfortable garments that are really difficult to put on leave alone wear for extended periods of time! There are actually different types of compression available.

  • Graduated compression stockings are medical-grade compression. They apply the most compression at the foot and ankle with a gradual decrease in the amount of compression applied as the garment extends up the leg. They are meant for patients that need to be mobile while still addressing venous insufficiency. They can be very difficult to pull on although there are some devices available that can help pull them on.


  • Anti-embolism stockings are very similar to graduated compression stockings and can function in a similar manner. However, these are really meant for immobile patients.



  • Nonmedical support hosiery can be found at many drugstores and even clothing stores. The compression is uniform and intended for daily use although the degrees of compression are much less than the other two types.



How much compression do these stockings provide?


The compression offered by compression stockings is measured in millimeters of mercury (mm Hg). This is the same unit of measure used to measure your blood pressure.


The amount of compression offered by graduated compression stockings is as follows:



Who are good candidates for wearing compression stockings?


There are a number of indications for compression stockings including but not limited to...

  • Feeling of heaviness or fatigue in the legs

  • Varicose veins with evidence of spider and reticular veins

  • Pregnancy-associated varicose veins with or without leg swelling

  • Leg swelling/ edema

  • DVT prophylaxis

  • Thrombophlebitis

  • Post-sclerotherapy and/or leg vein procedure

  • Treat or prevent leg ulcers

  • Postoperative leg swelling

  • Venous congestion caused by immobility or prolonged standing

Should I only be prescribed compression stockings by a doctor, or can anyone choose to wear compression stockings purchased over the counter?



If you are in need of graduated compression stockings or anti-embolism stockings, these are by prescription only. They need to be fitted appropriately and ensure the length is correct to address the underlying issue. Over-the-counter options are not as compressive and are safe to be used by most people.



What are the right and wrong ways to wear compression stockings?

Compression stockings are meant to be worn most of the time. They can be taken off while showering or bathing and while sleeping. Given the compression offered, they can often be worn under clothing.

The most important aspect of compression stockings to understand is that they work by applying pressure which means they will hug or squeeze the skin tightly. This means they must fit appropriately by the circumference of your legs and height. I routinely see patients with chafing where the compression ends from the garment "digging" into the skin. This can lead to risks of pain, skin breakdown, discomfort, and cellulitis.


What about compression socks?



A day does not go by that I do not come across the impact of circulation-related skin changes on the legs of patients during routine skin exams. Many people are familiar with obvious circulation-related findings such as varicose veins. Swelling or edema, orange-brown discoloration, cayenne pepper-like spots, thickening of the skin, and even potential blisters and ulcers can all signify subtle and sometimes obvious changes in circulation or chronic venous insufficiency. The theory behind compression socks is that external pressure applied by stockings or leggings can assist circulation.


Compression through socks and stockings is the result of pressure between the textile and the skin. The interface pressure achieved by the socks is a result of the elastic component of the textile is woven together with either cotton, nylon, or polyester. The construction of the textile allows for uniform pressure to be applied by taking into consideration the changes in the circumference of the leg.


The challenge that most of my patients face with regard to compression socks is a practical one- they can be so difficult to pull on and off. I have learned over the years that as beneficial as medical-grade or high-level compression socks and stockings can be, they simply cannot work if they are not worn. For this reason, I am increasingly recommending to my patients starting at a much younger age to consider the benefits of mild compression.


Drugstores and department stores that sell compression socks generally have compression in the range of about 8-15 mm Hg or 15-20 mmHg. ‘Prescription’ strength or high-level compression is generally 20-30 or 30-40mm Hg.


When choosing a pair of compression socks please consider :

  • The grade of compression

  • The height of the sock

  • Your ability to take it on and off

  • Any underlying health concerns as discussed with your physician

  • Any concerns about skin integrity that can be irritated or worsened from taking on and off the sock or stockings



I tend to recommend for early evidence of venous insufficiency the 8 to 15 mmHg or 15-20 mm Hg. Try to find an item that extends to under the knee. If it is shorter, the elastic band can be like a ‘dam’ blocking fluid past the elastic band while worsening edema proximal to the band. I have seen patients deal with significant chafing and even blisters and skin breakdown from the fluid accumulation under the skin.


Always be mindful of nonhealing wounds or sores and bring these to the attention of your Dermatologist to help manage them.



How should compression socks or stockings fit?


Here are some basic guidelines to follow along with checking with your doctor to verify the right fit and size for you.

  1. The foot should be included in the garment. Compression works by applying even pressure from beginning to end almost like they are milking the blood to move through the vasculature. I have seen patients cut off the 'foot' portion of the stockings due to the tightness around their ankles or fit in their shoes. When this happens the remainder of the compression acts like a dam with a "build-up" on either end of the stocking.

  2. Know your measurements. Different brands use varying measurement scales to determine size. Know your measurements ahead of time to make sizing easier. Choosing the right size is critical to the best results and best comfort.

  3. Sizes may change. Sizing is based on your current measurements. With the routine use of compression stockings, the circumference of your calf and ankle may decrease with less fluid accumulated in the soft tissues over time. Reassess your measurements every month to verify you are still using the right size.

Can compression stockings be washed and reused? When should compression stockings be thrown out and replaced?


Compression stockings can and should be washed and reused. This helps the elasticity regain its shape in addition to keeping them clean. Ideally, they should be replaced at least every 6 months. They gradually lose their elasticity and effectiveness over time from repeat use.

How much can someone expect to pay for compression stockings?


Medical-grade compression stockings generally cost around $100 per pair. OTC support hosiery varies widely in terms of cost but can be as low as $10 per pair.



Any other thoughts, tips, or suggestions on this topic?


There are some potential contraindications to wearing compression stockings to be aware of.

  • Peripheral arterial disease

  • Peripheral neuropathy

  • Allergy to stockings

  • Excessive leg swelling or pulmonary edema from congestive cardiac failure

  • Fragile skin

  • Cellulitis

  • Recent surgery with a skin graft or stitches

  • Rashes that are inflamed, oozing

  • Leg deformities that make it difficult to fit appropriately

Follow your progress with your doctor routinely for the best results and to reduce the incidence of side effects.





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