Compression Stockings: A Guide?>

Compression Stockings: A Guide

by Jeanine Barone

Compression socks or stockings can be found on the legs of a wide swath of the population, from pilots, flight attendants, runners, and nurses to pregnant women, people recovering from surgery, and people otherwise at risk for blood clots in their legs. Just as varied as the people wearing them are the stockings’ materials and prices, with a pair selling anywhere from $10 to well over $100. Outside of medical uses, can the average person benefit from wearing compression stockings? Are there risks to wearing them? What do the pressure ratings on the packages mean? Here, a quick guide to this sometimes confusing category of products.

Who should wear compression stockings?

The clearest benefit is for people with certain leg problems or at risk for blood clots in the legs, known as deep vein thrombosis (DVT). Many factors can increase the risk of these clots, including prolonged bed rest (such as after surgery), sitting for long periods (such as on a plane), use of birth control pills or hormone replacement therapy, pregnancy, family history of DVT, inflammatory bowel disease, and certain genetic clotting disorders. Compression stockings are also sometimes used in people who have an acute DVT, to prevent a group of symptoms known as post-thrombotic syndrome that includes leg pain and swelling. But the American College of Chest Physicians says there’s insufficient evidence to support using the stockings for this purpose.

Other groups that can benefit from wearing compression stockings include people with varicose veins, leg ulcers (referred to specifically as venous leg ulcers), or leg swelling (edema), as well as those with circulatory problems. People who spend a lot of time on their feet may feel that the stockings improve comfort, even if they don’t have a clear health benefit in those cases.

How do they work?

Blood in your veins has to work against gravity to flow back to the heart. Anything that impedes that flow—such as circulation problems, lack of movement (especially after an injury or surgery), or weakness in the walls of the veins of the legs (referred to as venous insufficiency)—results in blood pooling in the veins of the lower legs or feet, leading to leg swelling, achiness, and leg fatigue; it could also predispose you to a venous clot. By squeezing the leg tissues and walls of the veins, compression stockings can help blood in the veins return to the heart. They can also improve the flow of the fluid(called lymph) that bathes the cells in the legs. Improving the flow of lymph can help reduce tissue swelling. The stockings may improve comfort in some healthy wearers even if they don’t have a discernible health benefit. For example, improving the flow of blood and lymph may make legs feel less tired in some people. Though runners and other athletes sometimes wear compression stockings to improve athletic performance or prevent injury (see inset below), there’s little evidence that they help in this way.

Compression stockings are beneficial, however, only if the are worn properly—and evidence suggests that this is often not the case. In a 2008study in the American Journal of Nursing, among 142 hospitalized people who were told to wear compression stockings after surgery to prevent DVT, 26 percent were given the wrong size and 29 percent were not wearing them correctly—for example, the socks were worn wrinkled. That could lead to new or worse problems, since bunching or wrinkling can exert excess pressure on the skin. In addition, patients reported finding the socks or stockings uncomfortable, especially if they were thigh-high as opposed to knee-high.

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Are there people who shouldn’t wear compression stockings?

Typically, the stockings are safe and wearing them results in few or no complications, provided they’re worn smoothly against the leg, without any folds. But some groups of people should avoid them, including those with peripheral neuropathy or any other condition that impacts skin sensation; a history of a peripheral arterial bypass grafting; peripheral artery disease; skin infection; dermatitis with oozing or fragile skin; massive leg swelling; or pulmonary edema from congestive heart failure. Each of these conditions presents a different series of risks. For example, for people with peripheral artery disease, stockings can worsen oxygen delivery in arteries with impaired blood flow. People who have sensory problems, such as those with peripheral neuropathy, may not feel when a compression stocking is too tight, which could impede circulation. And certain skin conditions or infections may worsen with a compression stocking covering and pressing on the area.

In general, if you have any medical condition, talk with your health care professional before using compression stockings to see if you’re a good candidate for them.

Where are compression stockings sold?

You can buy compression stockings online, in pharmacies, and at medical supply shops. Prices vary widely depending on many factors, including whether it’s a name brand, the quality of the fabric (such as the smoothness and softness, breathability, and ability to wick away moisture), whether it’s a custom fit, opaque or sheer (solely a fashion concern), open or closed toed, made with latex or latex-free, and, of course, the length, strength of the compression, and what purpose the stocking is geared toward (for example, leg ulcer relief). If you have a medical condition and your healthcare provider has recommended compression stockings, ask what type you should look for.

How do you determine the right size and height?

There is no universal standard for sizing, so using a tape measure is key. You’ll need to take measurements at several parts of your leg, such as the circumference of your ankle, calf, and thigh and the distance from your knee or thigh to the floor. (Exactly which of those measurements you’ll need will depend on the length of stocking—knee-high, thigh-high, or tights.) This website provides guidance on how to take measurements.

How high the stockings should go on your leg depends on your reasons for wearing them. Knee-highs are easier to wear and generally more comfortable than wearing thigh-highs. If you are wearing the socks for a non-medical reason, such as running or standing up for long hours on the job, it makes sense to start with a knee-high pair. If you’re wearing the stockings for a medical condition, your physician will determine what’s best for you. Thigh-high stockings are sometimes recommended over knee-high stockings for preventing DVT post-surgery, but evidence isn’t clear as to whether this height is more effective at preventing clots.

If you find the stockings are difficult to get on, it may help to put them on before getting out of bed (before any swelling develops), according to the Vascular Disease Foundation, as well as to avoid moisturizing your legs right before slipping them on. You can also try applying a little cornstarch on your legs, which will dry up excess moisture that causes friction.

What do the compression ratings mean?

Compression stockings come in four or five main levels of compression, which refer to the amount of pressure (measured in millimeters of mercury, or mmHg) applied to the leg. The higher the number, the greater the compression. As a general rule, mild or very light compression (under 15 mmHg) is for healthy people, such as pregnant women who have tired or fatigued legs from sitting or standing all day. Moderate compression (15 to 20 mmHg) can prevent DVT in airline passengers or help with minor leg swelling.

Higher compression levels (20 to 30 mmHg, 30 to 40 mmHg, or more than 40 mmHg), sometimes referred to as “medical-grade,” are for medical uses such as varicose veins, edema, and preventing blood clots post-surgery. These higher compression stockings are often graduated, meaning they are tighter at the bottom (foot and ankle) and looser at the top. This helps prevent them from cutting off circulation rather than helping it. Although medical-grade stockings are cheaper to buy online, it's a good idea to get at least your first pair at a medical supply shop with a professional fitter. This will ensure that you get the right fit, plus learn how to put them on properly. (Lighter-compression stockings for non-medical uses are OK to buy online.)

How long should the stockings be worn?

There is no one answer for this. It depends on the reasons for wearing them in the first place. If it’s because of issues related to the veins, the stockings can be worn all day, and taken off when you go to bed or when you’re at home relaxing with your legs up. If you’re wearing them post-surgery, typically it’s recommended they be worn if you’ll be standing or sitting for long periods.

Bottom line: If you have a medical condition, talk with your doctor about whether you might benefit from compression stockings and what type might be best for you. If you’re healthy and want to try using them because of a long flight, a job that requires lots of standing, or another non-medical reason, you can experiment to see what’s most comfortable and works best for you, starting with a low compression level.