- by Fast Surgical
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- Apr 25 2017
Compression Stockings: A Guide
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.
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. They’re also popular among some athletes, such as runners and basketball players.
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 that bathes the cells (referred to as lymph) 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 flow 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.
Moreover, the benefits of compression stockings are dependent on wearing the stockings properly—and evidence suggests that many people don’t. In a study published 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.
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.
Generally speaking, 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.
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