Compression stockings

Published by Bupa's Health Information Team, February 2011.

This factsheet is for people who wear compression stockings, or who would like information about them.

Compression stockings help maintain circulation in the leg veins and reduce leg swelling. They are used to treat leg ulcers and varicose veins, and to help reduce the risk of blood clots forming in the veins of the legs (deep vein thrombosis, DVT).

About compression stockings

Compression stockings (also called graduated compression stockings) can be used to prevent as well as treat a number of conditions that affect the circulation in your body.

• DVT. This is a blood clot in a deep vein, usually in the leg. If the blood clot breaks loose, it can travel to your lungs and block a blood vessel there (this is known as a pulmonary embolism).
• Varicose veins. These are swollen veins that lie under your skin (superficial veins) that look lumpy and dark blue or purple through your skin. They usually affect your legs, particularly your calf and sometimes your thigh, and are caused by damaged valves in your veins.
• Venous leg ulcers. These are areas of skin loss (lesions) usually near your ankle. They are caused by problems with the valves in your leg veins.
• Fluid build-up in your legs (oedema). This can be caused by problems with the veins in your legs and can also occur during pregnancy.

How do compression stockings work?

Compression stockings work by putting pressure on the veins in your leg. They are called graduated compression stockings because the pressure is greatest at your ankle and reduces further up your leg. When you walk or exercise your legs, compression stockings help the natural pump mechanism of the muscles in your leg to improve your circulation.

Compression stockings are available in several sizes and lengths. They are also available with different strengths of compression; class one to three. Class one stockings apply the least amount of pressure and class three stockings apply a much higher pressure. Your GP will advise which strength is appropriate for you.

Wearing compression stockings

For them to be effective, you need to wear your stockings constantly during the day. Usually you should take them off before you go to sleep, but your doctor may advise you to wear the stockings at night. Take them off every day to wash your legs and check the condition of your skin.

When checking your skin you need to look out for:

• sore marks at the top of your legs
  
• blisters or discolouration, especially on your heels or ankle bones

If you spot any of these signs, or if you're worried, don't put your stockings back on and talk to your GP.

Take care to prevent your skin becoming dry by applying an emulsifying cream to your legs. Your GP can recommend creams that are appropriate for you.

Wearing compression stockings for surgery

Hospitals often do a pre-operative risk assessment for DVT, which takes into account your health and the type of treatment or surgery you're having. Your surgeon will recommend appropriate preventive measures for you.

Your surgeon may ask you to wear low-pressure compression stockings (also called anti-embolitic, or thrombo-embolus deterrent – TED – stockings) before your surgery and to keep wearing them during your hospital stay. You may need to have an injection of an anticlotting medicine called heparin as well as, or instead of, wearing stockings.

Compression stockings are available in several sizes and lengths. Your nurse will measure your legs and recommend the correct compression stockings for you. He or she will record your stocking size and length but may need to re-measure your legs if they are swollen after surgery.

Your nurse will show you how to put the stockings on and may also give you advice about washing and taking care of your stockings once you're at home.

Your nurse will also teach you foot and ankle exercises that will help to encourage blood flow through your legs.

You may still be at risk of DVT after going home from hospital, depending on your health and the type of treatment or surgery you had. Your surgeon may ask you to keep wearing your stockings at home until you can move around as usual.

Wearing compression stockings for travelling

If you're travelling for a long time, you may be at a slightly higher risk of DVT, especially if you have other risk factors. Wear below-the-knee compression stockings if you're travelling for more than three hours and you:

• are older than 60
  
• are obese (you have a BMI of 30 or more)
• have varicose veins
  
• take hormone replacement therapy (HRT) or the contraceptive pill
• are pregnant or have recently had a baby
  
• have cancer or are having cancer treatment
  
• have had recent surgery or an accident
  
• have a blood condition called thrombophilia
  
• have another condition such as heart failure or lung disease or an infection
  
• have had DVT before, or have a close family member who has

How to put on compression stockings

There are different lengths of compression stockings that fit your leg differently.

• Knee-high stockings – these should sit below your knee.
• Thigh-high stockings – the top of the stocking rests below your buttocks.
• Waist-high tights – the body part of the stockings rests on your waist and the seams run vertically up the front of the garment.

Compression stockings are tighter at the foot than higher up the leg. They are difficult to put on and take off so you may need someone to help you with this. You will need to:

• insert your hand into the stocking as far as the heel pocket and turn the stocking inside out
• carefully slip your foot into the foot portion and ease the stocking over your heel – make sure your heel is centred in the heel pocket
• bring the rest of the stocking over your heel and up around your ankle and calf – don't pull the stocking, instead use the palms of your hands to gently massage the stocking up your leg
• smooth out any creases and never roll down your stockings while wearing them – this can affect how well they work and may restrict blood flow through your legs

To help blood flow in your legs, don't sit or stand still, or lie in bed for long periods. Take regular walks around the house and do gentle foot and ankle exercises when sitting down.

Caring for your compression stockings

You may need to wear your stockings for several weeks so it's important that you take care of them and wash them regularly. Make sure you have a spare set to wear while the others are being washed.

Always ask your GP or nurse for advice and follow the manufacturer's instructions that come with your compression stockings.

Typical care instructions are:

• machine or hand-washing in warm water, at a maximum of 40°C, every two to three days
• not wringing the stockings as this may damage them
• letting them dry naturally as the heat from a tumble dryer may damage the elastic

Video

See our video about compression stockings:

• How do I put on compression stockings?

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.