When and why to use compression socks

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The use of compression to treat circulatory problems has a long history, documented in drawings as early as the Neolithic period (5000-2500 BC).  As doctors made new discoveries about circulatory problems and manufacturing materials improved, medical treatments advanced as well.  Compression socks were developed and are now in widespread use for comfort, prescribed as medical treatment, and worn by athletes to enhance performance.  Contraindications exist, so potential users should consider their health status before making a purchase.  However, if indicated, many benefits can be gained.

Compression socks fit tighter than the typical dress or sports socks found most often in daily use by the general population.  While anti-embolism styles feature evenly distributed compression throughout, gradient styles hug the ankle more snuggly with the support becoming gradually lighter as the socks proceed higher on the leg.

Support stockings, also called support hose, belong to the lightest category of compression socks and can be purchased over the counter.

History

Compression therapy for the lower extremities has been in use since 5,000 BC.  Various means of compression such as splints and wool and linen bandages were used over many years.  Treatment of enlarged leg veins and varicose veins using bandages was chronicled during the Middle Ages.

Dr. William Harvey discovered in 1628 that venous stasis, or slow blood flow in the veins, could be treated with external pressure.  New materials such as silk, cotton, coconut, acrylic, nylon, and polyester came to be used in the manufacture of compression stockings following Dr. Harvey’s discovery.  

Two German Phlebologists, Fisher and Lasker, began using external pressure to treat blood clots in the lower leg late in the 19th century.  Deep vein thrombosis was then treated with the use of compression stockings.

How are compression socks used?

Medical indications

The use of compression socks is frequently prescribed for the relief and prevention of circulatory problems, including those found in patients with edema, chronic venous insufficiency, varicose veins, deep vein thrombosis, lymphedema, phlebitis, lipodermatosclerosis, cellulitis, lower extremity ulcers, and pregnancy, among others.

Work use

Airline pilots and crew wear compression socks to combat the health dangers of taking extended flights lasting seven hours or more.  Passengers have taken a cue from them to avoid the risk of stroke and heart attack.

Nurses, teachers, warehouse workers, and other employees who are on their feet all day can avoid pain and fatigue by wearing compression socks.

Athletic use

Athletes who wear compression socks adhere to the belief that the socks enhance their performance and help them recover faster.  Many studies have been cited saying that the benefit is very small in this context. 

Elmarie Terblanche of Stellenbosch University in South Africa is a sports physiologist who notes that the studies were primarily conducted in the laboratory and had no control subjects.  She challenged prior results by timing runners in the Two Oceans ultramarathon, a grueling outdoor race in her country.  The difference in time between athletes who wore compression socks and those who did not was an impressive 12 minutes faster on average for the former group.

According to Terblanche, the following features need to be present for compression socks to be effective in athletic performance:

  • gradient compression should be used;
  • the socks must fit well; and
  • they should have 22–32 mmHg of pressure.

Terblanche found no differences between various brands of socks. 

The consensus among athletic trainers, physiologists, and others in the field seems to be that if the socks are not too tight or irritating, do not cause blisters, and the athlete feels good using them, then why not?  Even if much of the benefit may be psychological, attitude is one of the most important influencers of performance outcomes such as the ability to maintain a competitive mindset and finish an event.

Risks

There are contraindications to using compression socks depending on the health of the individual.  Medical conditions in which caution is required include advanced peripheral obstructive arterial disease, heart failure, septic phlebitis, oozing dermatitis, and advanced peripheral neuropathy.

Proper fit

In order to use compression stockings safely, a person’s ankle brachial pressure index  (ABPI) should be greater than 1.0 in each leg.  The ABPI can be measured by a qualified medical provider.  The stockings must also be of the correct size and pressure.

To be effective, compression stockings should lie smoothly on the leg.  Any bunches, ridges, or rolls in the fabric will cause tighter pressure beneath the uneven area.

The ankle-brachial index test is a method used to assess for peripheral artery disease (PAD).  PAD occurs when the arteries have narrowed, reducing blood flow to the limbs.  Leg pain when walking is a common symptom of PAD.  This condition also increases heart attack and stroke risk.  It is estimated that 10 percent of people over age 55 suffer from peripheral artery disease.

During the ankle-brachial index test, the blood pressure at the ankle is compared with the blood pressure at the arm.  An ankle-brachial index number below 1.0 can indicate the presence of peripheral artery disease.

Risk factors for peripheral arterial disease include:

  • a history of smoking and/or other tobacco use;
  • diabetes;
  • high blood pressure;
  • high cholesterol; and
  • restricted blood flow (atherosclerosis) elsewhere in the body.

To reduce the risk of peripheral artery disease:

  • stop smoking and/or using other tobacco products;
  • exercise; and
  • eat a healthy diet.

Styles of compression socks

Compression socks can be found in knee high, thigh high, tights, and panty hose styles.  In addition, they are available in wide calf sizes.  One style zips onto the leg like a jacket.  Some socks, called leg sleeves, are made to resemble a sheath and have no toe section.

Construction

The degree of compression in the socks varies according to the manufacturing process.  Some socks feature firmer compression than others.  Over-the-counter compression socks feature pressures of 10-15 or 15-20 mmHg.  Stockings in the range of 20-30 mmHg to 50+ mmHg require both a prescription and a professional fitting.

Custom-made compression stockings range from 18-21 mg to greater than 50 mmHg.  These are usually flat-knit, with the seam allowing for manufacture in any size and shape.

Circular-knit compression stockings are seamless.

Gradient compression stockings use stronger compression at the ankle, which gradually becomes lighter as the stocking proceeds up the leg.  This measured change allows blood to be pumped from the ankle toward the heart efficiently while also discouraging blood from pooling at the ankle.

Waist-hung compression garments provide additional treatment options.  With the waistband providing stability, compression can be applied to one leg or one hip, for example.

Colors and patterns

There is no reason to think that all compression socks belong to your grandparents’ era.  A quick online search will reveal that lighter compression strengths are available in colors encompassing the entire spectrum.  Striped and print patterns can be found easily.  With a variety of lengths to be had, a style can be found to fit many needs.

Important considerations

The amount of compression is individual to each person’s requirements.  To determine the proper fit, it is crucial to consult with a doctor or a medical supply store.  A trained provider will measure your legs and make a recommendation.

Your doctor will advise you as to how many hours per day and days per week to wear the socks.  If s/he overlooks this important step, the patient or caregiver should ask.  If the socks become uncomfortable, contact your doctor.  It is important not to stop wearing compression socks prescribed by a doctor unless s/he advises you to do so.

Compression socks can be worn underneath a second pair of socks.

The socks can be difficult to put on.  Helpful tips include:

  • applying silicone lotion to the legs first, then letting it dry;
  • using a dusting of talcum powder, baby powder, or cornstarch to the legs first;
  • wearing rubber gloves;
  • using a stocking donner, available in medical supply stores, catalogs, and online;
  • rolling the sock down toward the toe first, inserting the foot into the toe, then unrolling the sock slowly to ensure a smooth fit;

Where to purchase compression socks

Compression socks are widely available in many department stores, pharmacies (Walgreens, CVS, Rite Aid, Pathmark, etc.), medical supply stores, catalogs, and online (accessible via search engine or Amazon).  The pressure specifications for such a purchase should be carefully considered.

Caring for compression socks

If the socks are to be worn every day, it is helpful to own at least two pair.  The pairs can be alternated; one to wash and one to wear.  Hand washing and air drying may be recommended by the manufacturer to increase the life of the garment.

Conclusion

Compression socks are medically useful for patients with varicose veins, lower extremity ulcers, thrombosis and other circulatory problems.  They can also provide insurance against stroke and heart attack on long-distance flights lasting more than seven hours.  Athletes such as long-distance runners often use them to enhance their performance, whether that is an improvement in the way they feel psychologically, a reduction in foot and leg cramps, or an improvement in their race times.  With advancements made in manufacturing since the 1950’s, especially, there are a great many styles now available.  The process of finding one that meets your needs has never been easier.

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