Compression stockings

Many people are prescribed compression stockings, also known as support stockings, for a variety of conditions. Compression stockings help improve the circulation (blood flow) in your legs and also reduce swelling.

How do compression stockings work?

Compression stockings gently squeeze the veins and muscles of the leg. Compression is firmest at the ankle, and gradually reduces up the leg. The graduated compression helps blood flow from the lower legs towards the heart. The stockings also help move fluid up the leg, so it doesn’t collect around the ankle.

Depending on why you need them, they may be worn on both legs or just one leg.

Conditions treated with compression stockings

Compression stockings may be used in the treatment or prevention of the following conditions:

Varicose veins

Compression stockings are often recommended as the first treatment for varicose veins. The stockings help prevent blood from pooling in the veins and relieve pain and swelling in the legs.

People who have had surgery or other treatments for their varicose veins may need to wear compression stockings afterwards. This is to prevent the varicose veins developing again, and is especially important if you will be standing for any period of time.

Compression stockings may also help prevent the development of varicose veins in people who are at increased risk.

Venous leg ulcers

Ulcers that develop in people with problems with their leg veins are called venous ulcers. Previous blood clots or varicose veins can cause venous ulcers on the lower legs, usually around the ankles. Compression stockings can be used to help heal these venous ulcers, as well as to prevent new ulcers from forming.

Blood clots in the legs

Your doctor may recommend you wear compression stockings to prevent DVTs (blood clots in the deep veins of the legs) if you are at increased risk. Compression stockings are frequently used to prevent clots in people having major surgery and those being treated in hospital for any reason. Professionally-fitted compression stockings are also sometimes recommended for preventing DVTs and leg swelling in people who are travelling long distances, usually by plane.

For people who have been diagnosed with DVT, fitted compression stockings can help treat and prevent a common complication called post-thrombotic syndrome that causes ongoing leg pain, swelling, and skin changes in the legs.

Lymphoedema

The use of specially-fitted compression stockings (or sleeves) is an important component of the treatment of lymphoedema - a condition where lymphatic fluid (lymph) accumulates in the body’s tissues, causing swelling (oedema). The compression stockings help maintain limb size and shape, and are often used following a period of intensive lymphoedema therapy.

Types of compression stockings

Compression stockings are available in different sizes, colours and lengths (knee-high, thigh-high and waist-high). There are also different classes based on the amount of compression they provide. The length and level of compression needed will vary depending on your condition.

Compression stockings are not suitable for everyone or for all purposes, so never wear someone else's compression stockings. Your doctor or pharmacist will ensure that you are prescribed and given the correct type and the correct size.

Being measured for compression stockings

To be fitted with the correct size stocking you will need to be measured by your doctor, physiotherapist or pharmacist.

An open-toe stocking is not recommended for people with bunions, or very broad or fat feet, because the band across the foot may become restrictive and uncomfortable. In some cases, an ultrasound of the arteries in the legs will be performed before fitting the compression stockings. This is may be particularly important if you have known or suspected arterial disease.

Support stockings should be replaced regularly (about every 6 months), as the elasticity of the fabric will loosen over time and may not provide the required compression. You should have your legs re-measured when having your stockings replaced. Measurements are best taken as early as possible in the morning.

How to put on compression stockings

Compression stockings should be put on or changed first thing in the morning when your legs have the least amount of swelling.

The stocking fabric should be evenly distributed over the leg, with no wrinkles, and not pulled over tightly at the top. Make sure the seams are straight and ensure that your heel is in the correct position. You should never fold over the band at the top of the stocking as this will constrict leg circulation.

If you have trouble pulling the stockings up, try wearing rubber gloves to help you move the stockings up your legs. You could also try applying moisturiser or talcum powder to the leg to help the stocking to move more smoothly over your leg. (Let the moisturiser dry before putting on the stocking.)

If your toes start to tingle while wearing compression stockings, you should remove the stockings and consult your doctor or pharmacist. Do not cut or modify the stocking fabric as this will alter the compression.

Wearing compression stockings

Depending on the reason you wear them, graduated compression stockings may not need to be worn at night - check with your doctor.

Talk to your doctor if you are having difficulty wearing your stockings. This is not uncommon, and can be due to a number of factors including the comfort of the stockings, especially during hotter months and other conditions like arthritis that may make it difficult for you to put on the stockings.

Side effects of compression stockings

Graduated compression stockings are designed to be firm, and may take some getting used to. However, any symptoms that may result from the stockings being too tight should be reported to your doctor straight away.

You should let your doctor know and remove the stockings if you experience any:

  • pain or tightness in your legs;
  • numbness or tingling in the toes, feet or legs; or
  • change in the colour of your toes, especially if they become pale or blue.

Compression stockings may not be suitable for people with problems with the arterial blood supply or nerves in their legs. They should generally not be used in people with severe peripheral vascular disease or peripheral neuropathy.

Looking after your compression stockings

Refer to the manufacturer’s information for laundry details. After washing, dry your stockings away from direct heat. Do not dry your stockings in a clothes dryer.

To prevent fingernails and jewellery snagging the stockings, try wearing rubber gloves when putting on your support stockings.Trimming rough nails on the hands and feet will also help prevent snagging.

References

1. Venous thromboembolism: treatment (published March 2018). In: eTG complete. Melbourne: Therapeutic Guidelines Limited; 2018 Jul. https://tgldcdp.tg.org.au/ (accessed Nov 2018).
2. Wound therapies: compression (published November 2011). In: eTG complete. Melbourne: Therapeutic Guidelines Limited; 2018 Jul. https://tgldcdp.tg.org.au/ (accessed Nov 2018).
3. Venous leg ulcer (published November 2011; amended October 2015). In: eTG complete. Melbourne: Therapeutic Guidelines Limited; 2018 Jul. https://tgldcdp.tg.org.au/ (accessed Nov 2018).
4. Venous thromboembolism: prophylaxis (published March 2018). In: eTG complete. Melbourne: Therapeutic Guidelines Limited; 2018 Jul. https://tgldcdp.tg.org.au/ (accessed Nov 2018).
5. Australasian Lymphology Association. Position Statement: The use of compression garments in the management of lymphoedema (March 2012). http://www.lymphoedema.org.au/public/7/files/Position%20Statements/ALA%20Poistion%20Statement%20on%20Compression%20Garments.pdf (accessed Nov 2018).
6. Clarke MJ, Broderick C, Hopewell S, Juszczak E, Eisinga A. Compression stockings for preventing deep vein thrombosis in airline passengers. Cochrane Database of Systematic Reviews 2016, Issue 9. Art. No.: CD004002. DOI: 10.1002/14651858.CD004002.pub3. https://www.cochrane.org/CD004002/PVD_compression-stockings-preventing-deep-vein-thrombosis-dvt-airline-passengers (accessed Nov 2018).
7. Appelen D, van Loo E, Prins MH, Neumann MHAM, Kolbach DN. Compression therapy for prevention of post-thrombotic syndrome. Cochrane Database of Systematic Reviews 2017, Issue 9. Art. No.: CD004174. DOI: 10.1002/14651858.CD004174.pub3. https://www.cochrane.org/CD004174/PVD_compression-therapy-prevention-post-thrombotic-syndrome (accessed Nov 2018).
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