Compression Stockings FAQ In St. Louis

The best way to improve venous and lymphatic circulation is with graduated compression. That is compression that is strongest at the foot and ankle and then lessens as you go up the leg. Mild compression garments like UnderArmour actually help to slightly improve venous and lymphatic circulation. To be helpful, the compression needs to be enough to be greater than forces that are wanting to slow venous return but not greater than the pressure in arterial circulation. If the pressure of a stocking or clothing garment is greater than the arterial circulation, that would cut off circulation. This is generally much higher than any stocking or clothing is made for and therefore in almost all cases compression stockings help circulation.

Essentially everyone benefits from wearing compression stockings. As our society has become increasingly industrialized, our amount of walking has diminished. Walking activates the foot and calf muscles, which in turn are the major pumps for emptying venous circulation and any excess fluid. Compression stockings assist the effectiveness of leg circulation pumps. The key element for the effectiveness is proper professional fitting and instruction regarding the care and use of these garments. The most helpful “device” to help put these hose on are snug fitting textured rubber gloves. The hose are meant to be evenly applied by “milking” them up with the palm of the hands.

This method is superior to pulling them up by the top end. In the latter case, it is possible to rip or create a hole in the stocking, and they may have a tendency to displace unless evenly applied. Some devices that may help you get started putting on the stocking are a metal “butler” that the stocking is placed on first and then the foot is placed in the stocking. A “stocking donner” is a silk sleeve that goes over the foot first, then lines up the stocking to slip over the foot. There are also light support stockings that are applied first, then the heavier compression stocking can slide over more easily.

In general, and especially if a pulmonary embolism resulted from a lower extremity venous thrombosis, the more the hose are worn the better. The indications which help modify this general statement are many, including other risk factors, the possible damage a previous venous thrombosis has caused, tendency to leg swelling, and others.

Stockings come in a variety of strengths, styles, and colors. They should be strong but not very tight. If you have weak hands or arthritis, getting these stockings on may be difficult, but there are devices to make putting them on easier. Please search answers in this section for a description of options for donning assistance.

Compression hose come in various strengths and should be prescribed by your physician. Your doctor will either supply you with hose or give you a prescription to be used in a medical supply store. Over-the-counter hose offer less compression than the prescription ones and may not be adequate. Prices vary from $50-$125.

Compression stockings are a simple, inexpensive way to treat varicose veins. They are designed to reduce the pooling that occurs in spider and varicose veins, and helps shunt blood back up the leg towards the heart. Wearing compression stockings won’t eliminate varicose veins, but they will help to alleviate symptoms such as aching, heaviness, and swelling. They can also reduce the risk of developing blood clots.

Before beginning varicose vein treatments, the use of compression stockings is recommended. These may help relieve some of the symptoms and move blood more efficiently through your legs. These stockings have been proven to help with the treatment of varicose veins. If they do not relieve symptoms sufficiently, treatment may be required. Many insurances cover vein treatment if it is symptomatic and methods such as compression stockings have failed.

In addition to colors and style differences, which are readily apparent, most compression stockings sold at regular drug stores are up to 15mmHg, which is considered insufficient compression after sclerotherapy (especially for varicose veins). The best compression stockings pressures are graduated 20-30mmHg for spider veins and small varicose veins, and 30-40mmHg for large varicose veins, which are used for a few days to a couple of weeks after treatments. Medical supply stores carry these stockings as well as all vein specialist offices. Generally, prices are usually lower at the doctor’s office for the same type of stockings, as compared to medical supply stores.

Knee-high stockings type/gauge/size etc.? I want to purchase knee-high stockings.

You can get these from your local medical supply store. For most treatments, because the involved veins are on the full length of the leg, one must use either a thigh-high or pantyhose version. Knee high would only be appropriate if the involved veins are limited to below knee. Once treatment is completed, and if stockings are needed on a more prolonged basis, because of the nature of one’s occupation or activities, then knee high might be appropriate at that time. The hose are sold by degree of compression, such as 15-18mmHg pressure, up to 40-50mmHg.

You might need a prescription for the tighter hose. If you have no varicose vein or venous insufficiency issues, then the lesser compression stockings will likely be very comfortable for you, and you can check out the website of the major manufacturers (medi, Jobst, Sigvaris) to find locations where you can get them. Many of the over the counter stockings sold at department and drug stores are not graduated.

Immediately. If you are putting the stocking on first thing in the morning before you have been standing, they should prevent the swelling on the first day. The compression hose should have graduated compression so that the ankle receives the most support and should improve at least as much as your calf. It is important that the stocking is working and fitted properly. I would recommend that you talk with your doctor/vein specialist to make sure the stockings are the correct strength for the problem you are treating.

No, the daily use of compression stockings, particularly for an individual whose occupation or activities require standing or sitting for prolonged periods, can only help your legs. The only time there might be a concern would be in an individual who has significant arterial disease, in which case the stocking might reduce already limited arterial blood flow in the limb. A venous specialist will be able to evaluate you and determine if their use is appropriate in your case.

You can wear stockings on both as a matter of fashion.

Compression stockings after a venous procedure almost always improve healing and act as an analgesic by the compression. Your Phlebologist should advise you best, as the nature of the procedure may help to provide this answer for you.  It is also almost always beneficial for venous health even without a procedure, so many Phlebologists may recommend converting from a thigh high with a higher degree of compression to a “maintenance” knee high type. There are many brands, models, and colors available these days. The key is proper fitting, supportive guidance, and professional instruction regarding application and care.

During the first trimester, hormones are released that cause veins to relax and after pregnancy they become smaller but often are still enlarged. It has been shown that with an increased number of pregnancies, the risk of varicose veins increases. Therefore, compression stockings during pregnancy may help. Unfortunately, we don’t know for sure, but it will at least help control the symptoms and manage swelling in the legs.

I am experiencing extreme pain in both calf muscles and have egg size swelling on each outer leg. My GP has recently told me to just go to the drugstore and buy support hose because I have symptoms of varicose veins. What are my options?

Extreme pain is always a concern. Venous insufficiency usually does not cause extreme pain, especially in a symmertic fashion in your calves. This combined with swelling on both sides of your outer leg is also a concern. When is the pain better or worse, how long have you had it, are there associated skin changes? Either way, given the limited information you provided I would recommend a more complete evaluation which would include an ultrasound before you go out and buy support hose. After an evaluation was completed and no other problems were found, support stockings could be tried and may give some relief, but they will not treat the underlying cause.

There are several devices that can help with compression. The most common are stockings which come with different levels of compression. There are also wraps that can be applied on regular basis. For patients with significant swelling problems in the leg there are also compression pumps and compression braces. Several devices are available to help with applying compression stockings. There is a stocking butler which allows you to step into the stocking. There are also are stocking donners which help guide the stockings on.

It completely depends on what type of treatment you are having and where the involved veins are. For most treatments, because the involved veins are on the full length of the leg, one must use either a thigh-high, or pantyhose version. Knee high would only be appropriate if the involved veins are limited to below the knee. Once treatment is completed, and if stockings are needed on a more prolonged basis because of the nature of one’s occupation or activities, then knee high might be appropriate at that time.

I want to purchase knee-high compression stockings. How do you know which type/gauge/size etc, of over the counter stocking to buy?

You can get these from your local medical supply store. The hose are sold by degree of compression, such as 15 – 18 mmHg pressure, up to 40 – 50 mmHg. You might need a prescription for the tighter hose. If you have no varicose vein or venous insufficiency issues, then the lesser compression stockings will likely be very comfortable for you, and you can check out the websites of the major manufacturers (Medi, Jobst, Sigvaris) to find locations where you can get them.

Most compression stockings sold at regular drug stores are up to 15mmHg pressure which is considered insufficient compression after sclerotherapy (especially for varicose veins). Best compression stockings pressures are graduated 20-30mmHg for spider veins and small varicose veins, and 30-40-mmHg for large varicose veins, which are used for a few days to a couple of weeks after treatments. Medical supply stores carry these stockings as well as all vein specialist offices. Generally, price is usually lower at the doctor’s office for the same type of stockings, as compared to medical supply stores.

My compression stockings really hurt the back of my knees I cannot get my compression stocking to not have wrinkles. These wrinkles gather around the back of my knee and really hurt. How do I overcome that? 

The keys to proper usage of compression stockings are that they fit properly and that they are worn. It seems that they do not fit you properly. They could be too long. I would recommend a custom fit stocking or perhaps another brand. Please discuss your options with your doctor to ensure a proper fit.

One of my knee high hose has a run in the foot up into the lower ankle. Can wearing this be dangerous? My doctor advised to wear the hose for fluid retention. If it is not safe, can I wear just one leg until my new hose arrives tomorrow? 

No it is not dangerous to wear just one hose, or wear one with a run in it. Use kitchen gloves or latex gloves to put them on as this will allow you to pull the hose away from the skin of the leg rather than poking your fingernail through the hose.

The best treatment for leg cramps is to try to find the cause and treat that. Unfortunately, this is not always easy to do. Venous reflux can be a cause and should be evaluated. If this is negative and no other obvious causes are found, such as medications, thyroid issues, or medical problems, then symptomatic treatment is indicated. Compression stockings may help to increase the venous return. A trial of this is worthwhile but it may not help.

You should wear the stocking as ordered. The purpose of the stocking is to improve the venous return and prevents clots from forming. One of the major complications of orthopedic surgery is deep vein thrombosis and it can occur in either leg.

There have been several studies that compression stocking help prevent blood clots from forming when you are immobilized, as occurs on a long flight. The compression socks sold at drug stores, if they fit right and are at least 20mmHg pressure, will likely work.

I have been running lately and while I run, my left foot gets tingly and wants to fall asleep and then throughout the day from my knee down to my toes it tingles off and on. I believe compression stockings will help. 

What you describe may be a neurological problem like a pinched nerve, it could also be related to venous symptoms. I would consider seeing a doctor about your symptoms, however, you could certainly try a compression stocking to see if it helps.

I have to wear a compression sock because I had a DVT and the valve in the vein that runs behind my knee is broken. I am still young and would like this fixed so I don’t have to wear the sock. Is there a procedure to fix this?

I strongly recommend that you continue to wear the compression stockings per your physician’s recommendation, since this has been shown to decrease the chance of “post thrombotic syndrome.” Additionally, you really need to know which “valve is broken.” A complete ultrasound is needed. If you do not have any DVT anymore and you have superficial venous reflux, that could be treated and you could get improvement of your symptoms (assuming you have them).