Compression stockings are a vital medical device that can significantly improve circulation, prevent serious complications, and enhance quality of life for many people. Despite their importance, they're often misunderstood or used incorrectly, which can reduce their effectiveness or even cause harm. This comprehensive guide explains everything you need to know about compression stockings, from their medical purpose to proper application and care.

Understanding Compression Stockings

What Are Compression Stockings?

Definition and Design: Compression stockings are specially designed hosiery that applies graduated pressure to the legs and feet. They're made from elastic materials that provide controlled compression, with the highest pressure at the ankle that gradually decreases up the leg. This graduated compression helps improve blood flow back to the heart.

How They Work:

• Graduated pressure: Strongest at ankle (100%), decreasing up the leg

• Venous return: Help push blood back towards the heart

• Valve support: Assist one-way valves in leg veins

• Muscle pump enhancement: Support the natural muscle pump action

• Swelling reduction: Prevent fluid accumulation in tissues

Types of Compression:

• Anti-embolism stockings: For bedridden patients

• Graduated compression stockings: For active individuals

• Medical compression hosiery: Prescribed for specific conditions

• Support hosiery: Lower compression for general comfort

Medical Purpose and Benefits

Primary Medical Functions:

• Improve circulation: Enhance blood flow from legs back to heart

• Prevent blood clots: Reduce risk of deep vein thrombosis (DVT)

• Reduce swelling: Prevent and treat oedema

• Support veins: Help damaged or weak vein valves function better

• Symptom relief: Alleviate pain, heaviness, and fatigue in legs

Specific Health Benefits:

• Venous insufficiency: Support for damaged vein valves

• Varicose veins: Reduce symptoms and prevent progression

• Post-surgical recovery: Prevent complications after operations

• Pregnancy support: Manage increased blood volume effects

• Occupational health: Support for prolonged standing or sitting

Who Needs Compression Stockings?

Medical Conditions

Venous Disorders:

• Chronic venous insufficiency: When vein valves don't work properly

• Varicose veins: Enlarged, twisted veins

• Spider veins: Small, damaged veins near skin surface

• Post-thrombotic syndrome: After previous blood clots

• Venous ulcers: Wounds caused by poor circulation

Blood Clot Prevention:

• Deep vein thrombosis (DVT) history: Previous blood clots

• Pulmonary embolism risk: High risk of clots travelling to lungs

• Post-surgical patients: Especially orthopaedic and abdominal surgery

• Immobility periods: Bed rest or limited movement

• Long-distance travel: Flights over 4 hours

Other Medical Indications:

• Lymphoedema: Swelling from lymphatic system problems

• Diabetes complications: Poor circulation in legs

• Heart failure: Fluid retention and circulation issues

• Pregnancy complications: Severe swelling or circulation problems

• Occupational requirements: Healthcare workers, pilots

Risk Factors

Age-Related Factors:

• Over 60 years: Increased risk of circulation problems

• Reduced mobility: Less active lifestyle

• Multiple medications: Some drugs affect circulation

• Chronic conditions: Diabetes, heart disease, arthritis

• Previous injuries: Leg fractures or surgeries

Lifestyle Factors:

• Prolonged standing: Teachers, retail workers, healthcare staff

• Prolonged sitting: Office workers, drivers, frequent flyers

• Obesity: Extra weight affecting circulation

• Smoking: Damages blood vessels

• Sedentary lifestyle: Lack of regular exercise

Types and Compression Levels

Compression Levels Explained

Compression Measurement: Compression is measured in millimetres of mercury (mmHg), the same unit used for blood pressure. The higher the number, the stronger the compression.

Level 1: Light Compression (8-15 mmHg):

• Purpose: General comfort and mild support

• Users: Healthy individuals with tired, aching legs

• Activities: Long periods of standing or sitting

• Availability: Over-the-counter purchase

• Benefits: Prevents minor swelling, improves comfort

Level 2: Moderate Compression (15-20 mmHg):

• Purpose: Prevention and mild treatment

• Users: Early varicose veins, minor swelling

• Activities: Travel, pregnancy, occupational use

• Availability: Over-the-counter or prescribed

• Benefits: Prevents progression of minor vein problems

Level 3: Firm Compression (20-30 mmHg):

• Purpose: Treatment of established conditions

• Users: Moderate varicose veins, post-surgical recovery

• Conditions: DVT prevention, chronic venous insufficiency

• Availability: Usually requires prescription

• Benefits: Significant symptom improvement

Level 4: Extra Firm Compression (30-40 mmHg):

• Purpose: Severe venous conditions

• Users: Severe varicose veins, post-thrombotic syndrome

• Conditions: Chronic venous insufficiency, lymphoedema

• Availability: Prescription required

• Benefits: Maximum therapeutic effect

Level 5: Maximum Compression (40-50 mmHg+):

• Purpose: Severe lymphoedema and venous disorders

• Users: Complex medical conditions

• Supervision: Specialist medical oversight required

• Availability: Specialist prescription only

• Benefits: Treatment of severe, chronic conditions

Styles and Lengths

Knee-High Stockings:

• Coverage: Foot to just below knee

• Uses: Most common type for general circulation

• Benefits: Easy to put on, suitable for most conditions

• Ideal for: Varicose veins, mild swelling, prevention

• Considerations: May roll down if not properly fitted

Thigh-High Stockings:

• Coverage: Foot to upper thigh

• Uses: More extensive venous problems

• Benefits: Better coverage for thigh veins

• Ideal for: Extensive varicose veins, post-surgical use

• Considerations: May be difficult to keep in place

Pantyhose Style:

• Coverage: Full leg and waist coverage

• Uses: Pregnancy, extensive venous disease

• Benefits: Stay in place well, comprehensive coverage

• Ideal for: Pregnancy, bilateral leg problems

• Considerations: More difficult to put on

Open-Toe vs Closed-Toe:

• Open-toe: Better for foot problems, easier fitting

• Closed-toe: Complete coverage, better appearance

• Choice factors: Foot health, shoe fitting, personal preference

• Medical considerations: Toe circulation, wound care needs

Proper Application Techniques

Before Putting On Stockings

Preparation Steps:

• Morning application: Put on first thing after waking

• Clean, dry legs: Wash and thoroughly dry legs and feet

• Moisturise carefully: Use non-greasy lotion, allow to absorb

• Check for problems: Inspect legs for cuts, sores, or irritation

• Gather supplies: Stockings, gloves (if needed), application aids

Timing Considerations:

• Best time: Early morning when legs are least swollen

• Avoid: After standing, walking, or bathing when legs may be swollen

• Consistency: Same time each day for routine

• Pre-activity: Before getting out of bed if possible

• Medical advice: Follow specific timing instructions from healthcare provider

Step-by-Step Application

Traditional Method:

1. Turn stocking inside out to the heel

2. Place foot into toe section ensuring proper heel placement

3. Gradually roll stocking up leg, smoothing as you go

4. Avoid pulling from top which can damage the stocking

5. Check for wrinkles and smooth out any bunching

6. Ensure proper positioning at knee or thigh level

Detailed Application Process:

• Sit on edge of bed or stable chair

• Insert hand into stocking and grasp heel section

• Turn stocking inside out until you reach the heel

• Slip foot into stocking ensuring toes are properly positioned

• Check heel placement - heel of stocking should match your heel

• Gradually unroll stocking up the leg using both hands

• Smooth out wrinkles as you progress up the leg

• Avoid overstretching the material

Common Mistakes to Avoid:

• Pulling from the top can tear the stocking

• Rushing the process leads to improper fit

• Ignoring wrinkles can cause pressure points

• Wrong size selection affects effectiveness

• Putting on over swollen legs reduces effectiveness

Application Aids and Tools

Stocking Aids:

• Sock aids: Metal or plastic frames that hold stocking open

• Stocking donners: Devices that help pull stockings up

• Rubber gloves: Provide better grip without snagging

• Talcum powder: Helps stockings slide on more easily

• Silk stocking liners: Make application easier

For Limited Mobility:

• Long-handled shoe horns adapted for stockings

• Dressing sticks with hooks for pulling up stockings

• Elastic shoelaces to avoid bending for shoes

• Compression stocking applicators for independence

• Professional application by carers when needed

Daily Wear and Care

Wearing Schedule

Daily Routine:

• Put on: First thing in the morning

• Wear duration: All day until bedtime

• Remove: Before going to bed at night

• Consistency: Every day as prescribed

• Activity levels: Wear during all daily activities

Special Circumstances:

• Exercise: Usually safe to wear during moderate exercise

• Swimming: Remove before swimming, reapply after

• Sleeping: Generally not worn overnight unless specifically prescribed

• Travel: Especially important during long journeys

• Hot weather: May need adjustment for comfort

Monitoring and Adjustment

Daily Checks:

• Circulation: Ensure toes remain pink and warm

• Comfort: No excessive pain or numbness

• Position: Stockings haven't rolled or bunched

• Skin condition: No red marks, sores, or irritation

• Effectiveness: Legs feel better with stockings on

Warning Signs to Watch:

• Numbness or tingling in toes

• Blue or purple discolouration of toes

• Severe pain or cramping

• Red marks that don't fade after removal

• Skin breakdown or sores

When to Remove Immediately:

• Signs of impaired circulation

• Severe discomfort or pain

• Skin irritation or breakdown

• Swelling above the stocking

• Any concerning symptoms

Proper Removal

Evening Removal Process:

• Sit comfortably on bed or chair

• Roll down gradually from top to bottom

• Don't pull or yank which can damage stocking

• Turn inside out as you remove

• Inspect legs for any marks or irritation

• Allow legs to rest overnight without compression

After Removal Care:

• Inspect skin for any problems

• Moisturise legs with appropriate lotion

• Elevate legs if swelling is present

• Note any changes in leg condition

• Prepare for next day application

Care and Maintenance

Daily Care

After Each Use:

• Hand wash in lukewarm water with mild detergent

• Rinse thoroughly to remove all soap residue

• Gently squeeze water out - don't wring or twist

• Lay flat to dry away from direct heat or sunlight

• Have spare pairs to wear while others are drying

Washing Instructions:

• Water temperature: Lukewarm, never hot

• Detergent: Mild, non-biological washing powder

• Method: Hand washing preferred, gentle machine cycle acceptable

• Fabric softener: Avoid as it can reduce elasticity

• Bleach: Never use bleach or harsh chemicals

Storage and Replacement

Proper Storage:

• Lay flat in drawer or fold gently

• Avoid hanging which can stretch the material

• Keep away from sharp objects

• Store in cool, dry place

• Separate from other hosiery to prevent snagging

When to Replace:

• Loss of elasticity: Stockings become loose or baggy

• Visible wear: Holes, runs, or thinning material

• Reduced effectiveness: Legs feel less supported

• Time frame: Typically every 3-6 months with daily use

• Professional assessment: Regular review with healthcare provider

Signs of Wear:

• Stockings slide down frequently

• Material feels loose or stretched

• Visible thinning or holes

• Reduced compression effectiveness

• Discomfort or poor fit

Potential Problems and Solutions

Common Issues

Difficulty Putting On:

• Solution: Use application aids or seek help

• Prevention: Apply when legs are least swollen

• Technique: Take time, don't rush the process

• Professional help: Occupational therapist assessment

• Alternative options: Different style or compression level

Stockings Rolling Down:

• Causes: Wrong size, loss of elasticity, leg shape

• Solutions: Proper sizing, replacement, adhesive strips

• Prevention: Correct application technique

• Professional advice: Fitting assessment

• Alternative styles: Different length or style

Skin Irritation:

• Causes: Allergic reaction, too tight, poor hygiene

• Solutions: Hypoallergenic materials, proper sizing, good skin care

• Prevention: Daily skin inspection, appropriate moisturising

• Medical attention: If irritation persists

• Alternative options: Different materials or brands

Serious Complications

Circulation Problems:

• Symptoms: Cold, numb, or discoloured toes

• Action: Remove stockings immediately

• Medical attention: Contact healthcare provider

• Prevention: Proper sizing and regular monitoring

• Follow-up: Professional assessment of compression level

Skin Breakdown:

• Symptoms: Sores, wounds, or severe irritation

• Action: Stop wearing stockings, seek medical advice

• Treatment: Wound care and healing before resuming

• Prevention: Daily skin inspection and proper hygiene

• Professional care: May need specialist wound care

Special Considerations

Diabetes and Compression Stockings

Diabetic Considerations:

• Circulation problems: Diabetes affects blood flow

• Nerve damage: Reduced sensation in feet

• Skin vulnerability: Slower healing, infection risk

• Professional supervision: Medical oversight essential

• Regular monitoring: Frequent foot and leg checks

Safety Measures:

• Daily inspection: Check feet and legs carefully

• Proper fitting: Professional measurement is essential

• Gradual introduction: Start with lower compression

• Medical monitoring: Regular healthcare provider reviews

• Emergency awareness: Know when to seek immediate help

Pregnancy and Compression Stockings

Pregnancy Benefits:

• Prevent varicose veins during pregnancy

• Reduce leg swelling from increased blood volume

• Improve comfort during prolonged standing

• Support circulation as baby grows

• Post-delivery recovery support

Pregnancy Considerations:

• Growing belly: May need pantyhose style

• Changing leg size: Regular size reassessment

• Comfort adjustments: May need different compression levels

• Medical supervision: Obstetric approval recommended

• Post-delivery: Continued use may be beneficial

Elderly and Mobility Considerations

Age-Related Challenges:

• Reduced flexibility: Difficulty bending to apply stockings

• Arthritis: Joint pain affecting application

• Vision problems: Difficulty seeing the proper placement

• Cognitive changes: May forget to wear or remove

• Skin fragility: Increased risk of skin damage