A Complete Guide to Compression Hosiery
Compression stockings and socks can be confusing to understand: what are the different types, what are they used for, which should I choose and how do I wear them? This guide will answer those questions and help you navigate the options. Please remember that this is a guide only and is not meant to be medical advice. If you have concerns about leg health, please consult your healthcare professional.
What is Compression Hosiery?
Compression stockings are medically designed to improve circulation, and relieve the symptoms of edema, vein diseases and other leg discomforts. and guard against further progression of such venous disorders. Compression hosiery has much higher content of elastic fibers like Lycra® and spandex than other stockings or socks and can be made from a variety of materials, including cotton and microfiber.
There are two main types of compression hosiery: uniform and graduated. Uniform compression, as the name states, offers the same amount of compression to all parts of the leg. According to studies, including one in the British Journal of Surgery, graduated compression hosiery is much more effective in treating vein diseases. Graduated compression is tightest at the ankle and pressure gradually decreases as it moves up the leg. When circulation is impaired, blood tends to pool in the lower extremities, causing circulation problems. The graduated compression helps move blood through veins towards the heart. Graduated Compression is measured in millimeters of mercury and ranges from light support in 8-15 mmHg up to 30-40 mmHg and above. The higher the number the greater the support.
Compression hosiery is available in several styles, including socks, stockings, knee-highs, thigh-highs and pantyhose for both men and women.
What is compression hosiery used for?
Graduated compression hosiery is used to improve circulation and aid in leg health. When circulation is constricted, it can cause all kinds of vein disorders and other circulation conditions. Some of these disorders can be extremely serious.
Edema is swelling that occurs when fluid builds up in tissue. It happens most frequently in feet, ankles and legs and can be caused by injury or illness: something as simple as a sprained ankle or as serious as heart disease. Edema is also a common result of diabetes. According to the Cleveland Clinic, other causes include some medications, allergies, standing or sitting too long and pregnancy. Graduated compression stockings prevent or slow fluids from pooling in legs and ankles.
Lymphedema is a swelling in an arm or leg that’s caused when the flow of lymph fluids is blocked and fluids can’t drain well. The lymphatic system is a crucial element of the circulatory and immune systems. Along with swelling, the limb may ache and feel heavy. There may be restricted range of motion or recurring infections as well.
Nearly half of adults in the U.S. suffer from some sort of vein condition-- from the unsightly and uncomfortable to the life threatening.
Varicose veins are swollen, twisted veins just below the skin’s surface. A paper in the U.S. National Library of Medicine explains that varicose veins are often more of a cosmetic problem than a medical one. But they can cause pain and swelling. Varicose veins can be caused by standing for long periods of time, obesity or pregnancy and tend to be genetic. Spider veins are a less pronounced version of varicose veins and can be a result of injury, a change in hormones, pregnancy, genetics, alcohol use and sun exposure. While not usually serious, they can be unattractive and uncomfortable.
Phlebitis is an inflammation of a vein. Superficial phlebitis may be painful, but is not life threatening. It’s often associated with varicose veins or caused by an IV. It can also develop during pregnancy or in people who are bed-ridden.
There are several serious vein diseases that can be treated or slowed with the use of compression stockings. Graduated compression hosiery is used after surgery to help prevent Deep Vein Thrombosis. (DVT) is a blood clot that typically forms in a deep vein in the leg. The blood clot can travel through the bloodstream to the lung, leading to a Pulmonary Embolism, which can be fatal. In fact, according to PreventDVT, “Complications from DVT blood clots kill up to 300,000 people in the U.S. each year — more than AIDS and breast cancer combined.”
Compression stockings increase venous blood flow and help blood valves work efficiently. This improves circulation and helps move fluid back into blood vessels. Compression keeps blood flowing smoothly and reduces swelling and leg pain.
Other Medical Uses of Compression Stockings
Pregnancy can also cause vein conditions. One their website, The American College of Phlebology explains that during pregnancy, the combination of increased blood volume and hormones can contribute to a weakening of the vein walls. In most cases, these issues can be improved with compression hosiery and will disappear after pregnancy.
Who else can benefit from compression hosiery?
If you have experienced tired, aching legs, compression stockings may bring relief. People who spend all day standing or sitting, like nurses, hair stylists, factory workers, wait staff and truck drivers may find compression hose useful. Some athletes swear by compression socks or compression leg sleeves to reduce muscle fatigue. Air travellers find compression hose relieves leg discomfort caused by inactivity and cramped seating. In general, for anyone who wants to improve circulation, compression stockings are the first step towards leg health.
When NOT to use compressions stockings
As beneficial as compression can be, it should not be used by people with certain conditions, including severe uncontrolled congestive heart failure and advanced arterial disease. Compression pushes blood away from the leg and may not be recommended for smokers and anyone with a decreased blood supply to the legs. Poor blood flow in arteries is different from vein conditions and compression hosiery is usually not advised. Those with diabetes, neuropathy, skin infections and allergies should check with a healthcare professional. In fact, it is always wise to consult a physician before using compression therapy.
The Vascular Disease Foundation offers an in-depth overview on vein diseases and conditions that can benefit from compression therapy.
Choosing the right stocking
While you’ll probably see uniform compression hosiery in stores, most health professionals agree that graduated compression is more beneficial. Graduated compression is measured by the level of tightness, known as compression strength. For graduated compression, the unit of measure is millimeters of Mercury (mmHg, the same standard your doctor uses when taking your blood pressure).You may see it described with numbers ranging from 8 mmHg (light mild compression) through 30-40 mmHg and higher (medical weight).
Aside from medical considerations, it’s not unusual to be concerned about how these stockings look; we all have images in our heads of ultra-thick opaque hosiery that would never be mistaken for a fashion choice. Thanks to newer materials and knitting technologies, today’s compression hose pays more attention to the style savvy.
Choosing the correct size
Compression stockings are sized a few different ways: by height and weight or by several leg measurements. Some compression socks, for both men and women, are sized by shoe size. In most cases, it’s important to take some accurate measurements before ordering. Wearing the correct size will maximize both the benefits and your comfort.
Follow these steps to get the measurements you’ll need:
- If your legs tend to be swollen, measure when swelling is at a minimum, usually first thing in the morning.
- Measure your ankle circumference at the narrowest part of your ankle, usually right above the anklebone.
- Measure calf circumference at the fullest part of your calf.
- You’ll need calf length, which is measured from where your heel touches the floor to the bend in the back of the knee the knee.
- For thigh highs or pantyhose, measure your thigh circumference at its fullest part
- Last, measure the length of your thigh from where your heel touches the floor to the gluteal fold.
- If you’re planning to buy compression pantyhose, you’ll also need to measure your hips, at their widest part.
Various styles and brands have different sizing so it’s important to check the size chart and any sizing instructions before purchasing.
Wearing Compression Stockings
Putting on compression hose is not quite like slipping into a pair of socks or pulling up your pantyhose. The elasticity and resistance of the material can make it hard to handle and some styles can actually be difficult to put on.
We recommend NOT rolling and bunching the stocking before putting it on, but creating a heel pocket instead. With this method, follow these steps:
- Turn the stocking inside out by putting your hand inside the stocking, grasping the heel and pulling it inside out
- Slide your foot into the ‘pocket’ so that your toes are positioned correctly
- Then pull the stocking up and over your foot to position heel correctly
- Pull stocking up, smoothing the wrinkles as you go
Below is a video that demonstration of heel pocket method.
There are a few things that may make it easier to put on compression stockings:
- If you use cream or lotion on your legs, be sure it has dried first. It is not recommended that you use lotion with silicone bands.
- Baby powder or talc may help stockings glide over skin.
- If you wearing a ring, remove it to prevent snagging on the fabric.
- Rubber gloves, will make it easier to get a grip on the material, move the fabric up your legs and smooth out bumps and wrinkles.
- Many find a stocking donner helpful. A donner is a device that a helps to keep the hosiery in place and partially open, making it easier to insert your foot into the stocking.
- Don’t just pull at the top band to put the stockings on—this can damage the fabric. Work the fabric gently up the leg and carefully smooth any wrinkles
Things to look for:
- Make sure that the foot of the stocking is placed correctly on your foot. The foot shape should be the same as the shape of your bare foot.
- If you’re wearing knee-highs, be careful that the band isn’t buckling behind the knee, since this can cut off circulation.
- Never fold over your compression hose as this can cause reverse compression.
The U.S. National Library of Medicine has more useful tips on wearing compression stockings. Your compression stocking or sock should be worn daily, all day, and removed at bedtime, unless your doctor has advised you otherwise. Removing compression hose isn’t quite as difficult as putting them on, but do slide them down your leg slowly. You can see a good overview of donning and removing stockings in material prepared by the University of Wisconsin Hospitals and Clinics Authority.
You should contact your doctor or other healthcare professional if:
- There is increased pain, swelling or numbness while wearing compression hose.
- If you see redness or open skin on your feet or legs
- If compression hose feels too uncomfortable, you may need a different type, but don’t discontinue wear without talking to your doctor.
Wearing Compression Hosiery for Travel
There is a potential, although slight, risk of developing a deep vein thrombosis during long plane flights. This even has a name, ‘economy class syndrome.’ The key is to increase blood flow and compression hose can help with that. The Independent Traveler has some useful steps to help you avoid the threat of DVT or other leg health problems that can arise during flights:
- Moving and stretching encourage blood flow, so take some time periodically to walk up and down the aisle.
- Wear clothing that doesn’t bind.
- Drink plenty of hydrating fluids before the flight and avoid diuretics like coffee and other caffeinated drinks.
Compression hosiery has been shown to reduce the risk of DVT caused by air travel, according to the Nation Health Service, UK. You should wear the stockings for the duration of the flight. And as always, consult with your doctor first.