Compression stockings
Encyclopedia
Compression stockings and socks are specialised hosiery items designed to increase blood circulation. Their main theraputic purpose is to provide graduated pressure on the lower leg and foot and, in some cases, the thigh, to alleviate circulatory problems such as edema
, phlebitis
and thrombosis
.
Unlike traditional dress or athletic stockings and socks, compression stockings use stronger elastics to create significant pressure on the legs, ankles and feet. Compression stockings are tightest at the ankles, gradually become less constrictive towards the knees and thighs. By compressing the surface veins, arteries and muscles, the circulating blood is forced through narrower circulatory channels. As a result, the arterial pressure is increased which causes more blood to return to the heart and less blood to pool in the feet.
There are two types of compression stockings: Gradient and Anti-embolism.
Doctors will typically recommend these stockings for those who are prone to blood clots, lower limb edema, and blood pooling in the legs and feet from prolonged periods of sitting or inactivity.
They are worn by those who are ambulatory in most cases, where they assist the calf muscles to perform their pumping action more efficiently to return blood to the heart. In some cases, they are worn by those at increased risk of circulatory problems, such as diabetics, whose legs are prone to excessive swelling. A common indicator for the prescription of such stockings is chronic peripheral venous insufficiency, caused by incompetent perforator veins. Low pressure compression stockings are available without prescription in most countries, and may be purchased at a pharmacy or medical supply store. Stockings with a higher pressure gradient, say, above 25-30mmHg, may require a prescription from a doctor.
There are several crucial cautionary steps that need to be taken before using compression stocking:
Vascular doctors & nurses may use special pads to insure uniform higher pressure around the circumference of the ankle (to smooth out the irregular cross-sectional profile.)
Self-prescription is reasonably safe assuming that the compression gradient is 15-20 mmHg, the ABI (for both legs) is >1.0 and that the stockings fit correctly. "Firm" gradient stockings (20-30 mmHg and 30-40 mmHg) should generally be worn only on medical advice.
Although current research reports mixed results of compression socks on athletic performance , anecdotal evidence from athletes have reported to benefit from such stockings.
Like gradient compression stockings, anti-embolism stockings deliver a distributed amount of compression at the ankle and up the leg. This compression, when combined with the muscle pump effect of the calf, aids in circulating blood and lymph fluid through the legs (in non-ambulatory patients).
Compression wear has also been adopted by the sports science industry. Various garments have been developed to improve the efficiency of muscles by stabilising muscles and improving circulation/ lactic acid removal.
Today, compression stockings are available in a wide range of opacities, colors, styles and sizes, making them virtually indistinguishable from regular hosiery or socks.
Compression stockings are offered in different levels of compression. The unit of measure used to classify the pressure of the stockings is mmHg. They are often sold in one of the following pressure ranges:
Support - over-the-counter
With the advice or prescription of a physician or medical professional and proper sizing from a trained fitter:
Compression levels used by some manufacturers for custom made, flat knitted products in the US and Europe:
Edema
Edema or oedema ; both words from the Greek , oídēma "swelling"), formerly known as dropsy or hydropsy, is an abnormal accumulation of fluid beneath the skin or in one or more cavities of the body that produces swelling...
, phlebitis
Phlebitis
Phlebitis is an inflammation of a vein, usually in the legs.When phlebitis is associated with the formation of blood clots , usually in the deep veins of the legs, the condition is called thrombophlebitis...
and thrombosis
Thrombosis
Thrombosis is the formation of a blood clot inside a blood vessel, obstructing the flow of blood through the circulatory system. When a blood vessel is injured, the body uses platelets and fibrin to form a blood clot to prevent blood loss...
.
Unlike traditional dress or athletic stockings and socks, compression stockings use stronger elastics to create significant pressure on the legs, ankles and feet. Compression stockings are tightest at the ankles, gradually become less constrictive towards the knees and thighs. By compressing the surface veins, arteries and muscles, the circulating blood is forced through narrower circulatory channels. As a result, the arterial pressure is increased which causes more blood to return to the heart and less blood to pool in the feet.
There are two types of compression stockings: Gradient and Anti-embolism.
Gradient compression stockings
These stockings are designed to remedy impaired "Musculovenous pump" performance caused by incompetent leg vein valves. They are woven in such a way that the compression level is highest around the ankle and lessens towards the top of the hose.Doctors will typically recommend these stockings for those who are prone to blood clots, lower limb edema, and blood pooling in the legs and feet from prolonged periods of sitting or inactivity.
They are worn by those who are ambulatory in most cases, where they assist the calf muscles to perform their pumping action more efficiently to return blood to the heart. In some cases, they are worn by those at increased risk of circulatory problems, such as diabetics, whose legs are prone to excessive swelling. A common indicator for the prescription of such stockings is chronic peripheral venous insufficiency, caused by incompetent perforator veins. Low pressure compression stockings are available without prescription in most countries, and may be purchased at a pharmacy or medical supply store. Stockings with a higher pressure gradient, say, above 25-30mmHg, may require a prescription from a doctor.
There are several crucial cautionary steps that need to be taken before using compression stocking:
- A patient's ABI (Ankle Brachial Index) must be >1.0 per leg to wear compression stockings, otherwise the stockings may obstruct the patient's arterial flow. The ABI indicates how unobstructed a patient's leg and arm arteries are. Any competent doctor or nurse can measure and calculate a patient's ABI.
- It is crucial that compression stockings are properly sized. The compression should gradually reduce from the highest compression at the smallest part of the ankle, until a 70% reduction of pressure just below the knee.
Vascular doctors & nurses may use special pads to insure uniform higher pressure around the circumference of the ankle (to smooth out the irregular cross-sectional profile.)
Self-prescription is reasonably safe assuming that the compression gradient is 15-20 mmHg, the ABI (for both legs) is >1.0 and that the stockings fit correctly. "Firm" gradient stockings (20-30 mmHg and 30-40 mmHg) should generally be worn only on medical advice.
Although current research reports mixed results of compression socks on athletic performance , anecdotal evidence from athletes have reported to benefit from such stockings.
Anti-embolism compression stockings
These stockings are commonly referred to as T.E.D. hose, which is a registered brand name, although numerous others brands exist. They are used to support the venous and lymphatic drainage of the leg.Like gradient compression stockings, anti-embolism stockings deliver a distributed amount of compression at the ankle and up the leg. This compression, when combined with the muscle pump effect of the calf, aids in circulating blood and lymph fluid through the legs (in non-ambulatory patients).
Compression wear has also been adopted by the sports science industry. Various garments have been developed to improve the efficiency of muscles by stabilising muscles and improving circulation/ lactic acid removal.
Today, compression stockings are available in a wide range of opacities, colors, styles and sizes, making them virtually indistinguishable from regular hosiery or socks.
Indications for use
- LipodermatosclerosisLipodermatosclerosisLipodermatosclerosis is a skin and connective tissue disease. It is a form of lower extremity panniculitis, an inflammation of the layer of fat under the epidermis.- Symptoms :Pain may be the first noticed symptom...
- Chronic peripheral venous insufficiencyChronic venous insufficiencyChronic venous insufficiency or CVI is a medical condition where the veins cannot pump enough oxygen-poor blood back to the heart. It is sometimes referred to as an "impaired musculovenous pump", this is due to damaged or "incompetent" valves as may occur after deep vein thrombosis or phlebitis...
- Varicose veinsVaricose veinsVaricose veins are veins that have become enlarged and tortuous. The term commonly refers to the veins on the leg, although varicose veins can occur elsewhere. Veins have leaflet valves to prevent blood from flowing backwards . Leg muscles pump the veins to return blood to the heart, against the...
- EdemaEdemaEdema or oedema ; both words from the Greek , oídēma "swelling"), formerly known as dropsy or hydropsy, is an abnormal accumulation of fluid beneath the skin or in one or more cavities of the body that produces swelling...
(swelling) - LymphedemaLymphedemaLymphedema , also known as lymphatic obstruction, is a condition of localized fluid retention and tissue swelling caused by a compromised lymphatic system....
- Prevention of Deep vein thrombosisDeep vein thrombosisDeep vein thrombosis is the formation of a blood clot in a deep vein. Deep vein thrombosis commonly affects the leg veins or the deep veins of the pelvis. Occasionally the veins of the arm are affected...
(DVT) and the post-thrombotic syndrome (PTS) following DVT- Clinical trial results published in 2009 failed to support the use of low compression, anti-embolism stockings to prevent DVT with stroke victims in a non-ambulatory, hospital setting.
Compression classes
Compression stockings are constructed using elastic fibers or rubber. These fibers help compress the limb, aiding in circulation.Compression stockings are offered in different levels of compression. The unit of measure used to classify the pressure of the stockings is mmHg. They are often sold in one of the following pressure ranges:
Support - over-the-counter
- 10-15 mmHg
- 15-20 mmHg
With the advice or prescription of a physician or medical professional and proper sizing from a trained fitter:
- 20-30 mmHg
- 30-40 mmHg
- 40-50 mmHg
- 50+ mmHg
Compression levels used by some manufacturers for custom made, flat knitted products in the US and Europe:
- 18-21 mmHg
- 23-32 mmHg
- 34-46 mmHg
- >50 mmHg
Commonly used terms for compression stockings
- Anti-embolism - Worn when non-ambulatory or post-surgical to help prevent pooling of blood in the legs that could lead to a venous thrombosisVenous thrombosisA venous thrombosis is a blood clot that forms within a vein. A venous thrombosis is a blood clot that forms within a vein. A venous thrombosis is a blood clot that forms within a vein. (Thrombosis is a medical term for blood clotting (Haemostasis) occurring in the wrong place, i.e...
.
- Custom - uniquely made for a specific individual.
- Circular Knit - Seamless stockings that offer greater aesthetic appeal.
- Flat Knit - Stockings made with a seam that can be constructed in virtually any shape or size. Most often used in higher compression classes.
- Silver - Stockings constructed using special silver textile fibers. Silver offers natural anti-microbial protection.
- Lymphedema - compression stockings used to manage edemaEdemaEdema or oedema ; both words from the Greek , oídēma "swelling"), formerly known as dropsy or hydropsy, is an abnormal accumulation of fluid beneath the skin or in one or more cavities of the body that produces swelling...
resulting from the onset of LymphedemaLymphedemaLymphedema , also known as lymphatic obstruction, is a condition of localized fluid retention and tissue swelling caused by a compromised lymphatic system....
- Support - mild compression stockings sold over-the-counter and without a physician's prescription
See also
- Compression sportswearCompression sportswearCompression sportswear is clothing usually worn by athletes. They may be shorts, tights or underwear. They are form-fitting garments and when worn cover the athlete's waist to mid or lower thigh...
- Diabetic sockDiabetic sockA diabetic sock is a non-binding sock which is designed for those who need or want a sock that does not constrict the foot and/or leg. Typically sufferers of diabetes are the most common audience for this type of sock. Diabetes raises the blood sugar level, which can increase the risk of foot...
, which provides the opposite features - Graduated CompressionGraduated CompressionGraduated compression applies a precise amount of pressure greatest at the ankle and gradually decreases that pressure toward the top of the stocking. Proper graduated compression helps to improve circulation and assist in preventing swelling and tired, achy legs and feet. Improper graduated...
, which provides graduated compression, with applications in elite sport