Comprehensive Guide to Compression Stockings for Venous Diseases

Aug 16, 2023

Dr Tan Yih Kai

Compression stockings are designed to provide external, consistent, and graduated pressure in the legs, helping blood to flow back to the heart. They are able to improve varicose vein-related symptoms such as pain, the sensation of heaviness, swelling, and night cramps. Compression stockings exert higher pressure at the ankle and lower pressure gradually towards the knee and thigh to ensure blood in the veins is pushed upwards towards the heart.

Classes of Compression Stockings

Compression stockings are classified according to the compression pressure applied by the garment at the ankle level. There are four compression classes. The higher the class, the stronger the compression.

Compression ClassPressure in mmHgIndications
I18–21Prevention of DVT

Mild varicosities, eg spider veins

II23–32Varicose veins

Mild oedema

III34–46Ulcer treatment

Post-thrombotic syndrome

IV> 49Severe lymphaedema

Types of Compression Stockings

  1. Knee length
  2. Thigh length
  3. Pantyhose

Measurement for Compression Stockings

The sizes of compression stockings will be determined based on the measurements of the ankle, calf, and thigh circumferences. A good fit is essential to ensuring the pressure exerted by the compression stockings is evenly distributed. There is no universally accepted sizing method for compression stockings. Measurements need to be taken according to the sizing system of the respective brand of stockings.

Compression stockings are generally safe to wear. However, all compression stockings with a compression pressure greater than 20 mmHg need to be prescribed by doctors. This is because if compression stockings are applied to legs with impaired arterial circulation, they will worsen the ischaemia, which may lead to tissue necrosis or gangrene.

Furthermore, poorly fitted compression stockings can cause more discomfort and pain. Undersized stockings will leave marks on the skin and, at worst, cause skin necrosis. Oversized stockings will cause the stockings to continue sliding down from the top, resulting in ineffective compression.

Compression stockings should be worn during the day and removed before going to bed. The stockings should be put back on again first thing in the morning. This is when the leg swelling is minimal, allowing stockings to go up the legs easier. It is advisable to wear stockings for 4-6 weeks after varicose vein surgery.

Medical grade compression stockings that are worn and washed daily should maintain their compression effect for about six months. It is advisable to change the stockings every 6 months. Remember that, a pair of worn-out and non-stretchy socks will lose their medical benefits in preventing deep vein thrombosis (DVT), leg swelling, leg ulcers, or venous insufficiency.

It is ok to wear compression stockings overnight, but it is generally not necessary.  Please discuss this with your doctor before doing so. In an upright position, compression stockings provide a constant amount of pressure to the venous circulation system to fight gravity and pump the blood back to the heart. However, when lying down flat in a horizontal position, veins are not subject to gravity pull, and the blood will flow naturally back to the heart. Therefore, the benefit from the compression stockings is minimal. Furthermore, wearing compression stockings at night may apply unnecessary pressure to the ankle, reducing blood supply to the leg, especially in those who already have poor arterial circulation.

Putting compression stockings on and taking them off can be challenging, especially for the elderly and those with arthritis. There are a variety of tools available on the market to help with putting on and taking off compression stockings. These include:

Do compression stockings contain latex?

Most brands of compression stockings are latex-free. Please ask your doctor to ensure that the compression stockings that you are getting are latex-free.

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