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Frequently Asked Questions

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  About Compression    Caring for Your Graduated Support Hose
  Wearing Graduated Support Stockings   Compression Stockings and Serious Disorders

About Compression
  1. What is graduated compression?
    Graduated compression, or graduated support, delivers a squeezing to the leg that is tightest at the ankle. The amount of squeezing or compression gradually decreases up the leg. This compression, generally expressed in mmHg (millimeters of mercury), provides two main benefits.

    Probably the most beneficial effects of compression are its effects on the capillaries and tissue spaces, though a complete understanding of precisely how compression works remains unknown.

    Compression is believed to increase the pressure in the tissues beneath the skin, thus reducing excess leakage of fluid from the capillaries and increasing absorption of tissue fluid by the capillaries and lymphatic vessels. Compression therefore reduces and helps prevent swelling.

    The physical presence of the stocking also helps control the size (diameter) of superficial veins beneath the stocking. The stocking does not allow these superficial veins to over expand with blood. This action helps prevent "pooling." The venous blood then flows more quickly up the leg towards the heart.

  2. Why should support hose and socks for the legs be gradient?
    Graduated support is specifically important to the legs. When we stand still, the forces of gravity increase the pressure within leg veins. That pressure is greatest at the ankle, and decreases gradually up the leg and body. This pressure depends on the vertical distance of the column of blood from the heart to the foot.

    Approximately 86 mmHg of pressure is inside the veins of the ankle of a 5’7” adult in the quiet standing position. In the vena cava vein just before it enters the heart, the venous pressure is about 2 mmHg. Graduated compression stockings are designed with the pressure greatest at the ankle and decreasing up the leg in order to counter the effects of the higher venous pressures.

  3. What is compression therapy?
    Compression therapy refers to the benefits gained from the use of specialized stockings or bandages in the management of chronic venous disease and lymphedema. Individuals suffering from chronic venous disease (often called insufficiency) have leg complaints of fatigue, heaviness and aching.

    Graduated support stockings remain the standard in the management of chronic venous disease. Graduated compression delivers a squeezing to the leg that is tightest at the ankle. The amount of squeezing or compression gradually decreases up the leg. While the exact mechanism of action of compression remains elusive, compression is believed to provide two primary benefits to individuals suffering from chronic venous insufficiency.

    Perhaps the most important effect is that compression increases the pressure in the tissue under the skin (subcutaneous), thereby helping to reduce and prevent swelling. The compression of this subcutaneous tissue helps move excess fluid (swelling) back into the capillaries (tiniest of the blood vessels), and helps prevent too much fluid from leaking out of these little vessels.

    Secondly, compression reduces the ability of the superficial veins in the leg to expand and overfill with blood, which in turn helps prevent blood in these veins from flowing backward, causing congestion. Congestion in the leg accounts for leg complaints, swelling and skin changes common in persons with venous problems.

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Wearing Graduated Support Stockings
  1. Who benefits from wearing graduated support hose and socks?
    Anyone's legs can feel better while wearing graduated compression stockings and socks, especially those who spend too much time in sedentary sitting or standing positions.

    Graduated compression stockings are of most benefit to individuals with the following leg complaints:

    • Tired, aching, heavy feeling legs
    • Leg swelling
    • Varicose veins
    • Venous insufficiency
    • Post-thrombotic syndrome
    • Healed venous ulcer
    • Active venous ulcer
    • Lymphedema

  2. Are there reasons a person should not wear compression?
    Contraindications, medical conditions in which compression is not recommended, include:

    • Ischemia (e.g. advanced arterial disease) of the legs
    • Uncontrolled congestive heart failure
    • Untreated septic phlebitis of the leg
    • Phlegmasia coerulea dolens

    The wearing of compression should also be used with caution in the presence of:

    • Skin infections
    • Weeping dermatoses
    • Incompatibility to fabric of garment
    • Impaired sensitivity of the limb
    • Immobility (confinement to bed)

    Remember: Consult your physician before wearing compression 20 mmHg and above.

  3. When is the best time of day to measure for compression stockings?
    It is best to measure for graduated support stockings earlier in the day – before swelling builds in the legs. Measurements taken later in the day after swelling is present may result in choosing an overly large stocking size. Many clinics unable to see patients earlier in the day will elevate, bandage or pump the legs for a period of time before measuring in order to reduce any swelling.

  4. How many hours each day should graduated compression stockings be worn?
    The wearing time for graduated support stockings is dependent on both the reason for wearing the compression (indication) and the amount of compression (mmHg). An individual's physician or designee can provide the best guidance for determining these factors.

    Physicians may advise bed-bound patients to wear anti-embolism stockings (16-18 mmHg) to help prevent blood clots from forming in deep leg veins. Immediately following sclerotherapy, physicians may instruct individuals to wear a specific level of compression continuously for a specified number of hours or days, depending on the size of the veins injected. Individuals with lymphedema are advised to follow the wearing schedule recommended by their physician or therapist.

  5. Why are elastic stockings so hard to put on?
    Your physician may tell you that, "if they are not hard to put on, then they cannot be providing the compression needed." But that is probably not the answer you wanted.

    Because graduated compression stockings provide the greatest compression at the ankle, this requires the largest part of the foot – the circumference from the top of the foot around the heel – to pass through the smallest and tightest part of the stocking: the ankle.

    Newer knitting technologies, yarns and finishes produce stockings that are easier to put on than the stockings of old. For those who have diminished arm/ hand strength or impaired mobility, however, there are items that can make the task easier, such as:

  6. When are knee-length socks recommended?
    Knee-length graduated compression stockings are generally recommended to prevent or manage signs and symptoms of chronic venous insufficiency or other causes of lower leg swelling and skin changes. When swelling or varicosities are present above the knee, then a thigh, chaps or pantyhose style may be a more effective choice. Please consult your physician for assistance.

  7. Is there a layering or additive effect of compression? Can I wear one compression stocking on top of the other instead of wearing a higher compression stocking?
    Yes, there is an additive effect with compression stockings. For example, some doctors instruct their patients to wear one level of compression in a pantyhose style and then wear a knee-length compression stocking over the compression pantyhose. Please consult your physician for assistance.

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Caring for your Graduated Support Hose

  1. How should I wash and dry my graduated support stockings?
    Here are some general laundering instructions for your graduated support stockings:

    • Wash in warm water (105 degrees F / 40 degrees C)
    • Do not add bleach
    • Use a delicate fabric detergent
    • Rinse well
    • Air dry

    To help maintain the stockings, they may be hand washed or machine washed on gentle cycle in a mesh bag. The stockings dry quickly if laid flat or hung to air dry. A machine dryer may be used on a low or delicate setting.  
    • Does a run in compression hosiery affect the compression?
      Depending on factors that include the severity and location of runs, it is possible for them to affect the compression of the garment.

      For example, a single small run confined to the upper thigh or panty area will not affect the compression of the lower leg, where the stated ankle pressure is determined. A localized decrease of compression may occur in the area directly under the run. If the run is moderate to severe, improved hemodynamics in the area beneath the run may not occur. As always, if you have concerns about wearing the garment, please consult your medical professional.

      Some graduated compression hosiery products are very sheer and, as with any hosiery product, the sheerer the garment, the more susceptible it is to runs. There are several things that you can do to help ensure a long life for the product.

      • Check your footwear, hands, nails and feet for any rough spots that may damage the garment during donning or wearing.
      • Take care that you do not snag or pick the fabric when donning the garment.
      • Remove jewelry and wear rubber gloves if needed.
      • Avoid walking around without footwear to protect the stocking.

Compression Stockings and Serious Disorders

  1. Does Medicare cover graduated compression stockings?
    Compression stockings are a non-covered service under Medicare B. Medicare will not pay for these items even with a prescription from your doctor. Contact the Medicare office for your region for more information.

  2. Why are graduated compression stockings prescribed after a blood clot (DVT) in the leg?
    Knee-length graduated compression stockings are often prescribed for a patient who has sustained a deep vein thrombosis (
    DVT) or blood clot in the leg. The stockings are helpful in:

    • Controlling the swelling in the leg that occurs with DVT.
    • To help prevent the development of post-thrombotic syndrome that may occur several months after the DVT.

  3. What is post-thrombotic syndrome (PTS)?
    Post Thrombotic Syndrome (PTS) is a collection of subjective complaints and clinical signs following a thrombotic episode. PTS manifests itself with clinical signs of swelling, dilation of the veins around the ankle bones, pigment changes in the skin of the lower leg along with subjective complaints of spontaneous calf pain and/or pain with standing/ walking. The syndrome can present symptoms ranging from mild severity to excruciating or incapacitating pain and swelling.

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Used by permission: BSN

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