From long flights to pregnancy and diabetes, many circumstances and conditions can cause pain and swelling in the legs, ankles, and feet. Enter compression socks and stockings — specially designed garments that apply gentle pressure to stimulate circulation and relieve discomfort.
“Compression garments help to prevent the blood pooling in the veins, they prevent fluid pooling in the legs, and they help return the blood in the veins back to the heart,” says Natalia Fendrikova Mahlay, MD, an internal medicine doctor at Cleveland Clinic in Ohio.
Dr. Mahlay says that the arteries are like “supply vessels” and the veins “collectors.” Usually, the veins collect fluid from the periphery and return it to the heart, which circulates it back through the body. But if the veins aren’t functioning properly, fluid can pool. Over time, that can lead to problems such as chronic pain, swelling, cramps, varicose veins, and ulcers, according to Mahlay and Johns Hopkins Medicine.
To prevent such problems and support healthy vein function, a doctor may suggest compression socks or stockings.
Here’s what you need to know about these garments and how they could benefit you.
Mahlay says that some people use the terms “compression socks” and “compression stockings” interchangeably, but technically they’re distinct. Socks are typically closed-toe and don’t rise higher than the knee, whereas stockings come in varying heights, including knee-high and thigh-high, and they may have open or closed toes.
There are three main types of compression socks and stockings. The first two, graduated and anti-embolism, are designed to apply a specific degree of pressure to a particular area, Mahlay says. These usually require a doctor’s prescription and a professional fitting. The third, nonmedical support hosiery, is designed for more all-purpose use. You can purchase these over the counter at most pharmacies.
Most compression garments are made with an elastic, knitted fabric. But some are made with a thicker material, such as wool, to keep feet and legs warm. They come in an array of colors, sizes, and pressure levels.
The most common kind, these fit tighter around the foot and ankle and looser higher up in the leg, Mahlay says. They primarily support the foot and lower leg — where fluids tend to accumulate when you’re sitting or standing for long periods. These are usually knee-high or thigh-high, but pantyhose styles are also available.
Also known as thromboembolism-deterrent (TED) stockings, these garments apply a uniform degree of pressure throughout the garment to maintain circulation, support venous and lymphatic drainage, and prevent blood clots, Mahlay says. Doctors usually prescribe these to people who are bedbound.
Similar to anti-embolism garments, these also provide a consistent degree of pressure throughout, but they are much lighter. While support hose can provide some relief for tired, achy legs and feet, Mahlay says they’re not intended to alleviate or prevent specific medical conditions. “Support socks are basically just a tight sock — it can feel tight on the leg, but they are not as specific as the compression socks and stockings are,” she says.
Mahlay and Karena Wu, DPT, owner and clinical director at ActiveCare Physical Therapy in New York City, say that compression garments can provide a range of potential benefits, including:
A systematic review published in the Canadian Medical Association Journal agrees, with the authors writing that “high-quality evidence supports their use by patients with chronic venous insufficiency, especially those with ulcers.”
Like orthotic footwear, compression garments are most popular among seniors. But Mahlay, Dr. Wu, and the Cleveland Clinic all say that many others can also put them to good use, including those with certain medical conditions, such as:
They can be helpful in everyday situations, too. A previous Cochrane review report, for example, suggests that there’s “high-certainty evidence” that they can reduce symptomless DVT during air travel. And a review published in 2020 in the Open Access Journal of Sports Medicine noted that while there’s not much evidence they can improve athletic performance, they can reduce soreness and assist with recovery after vigorous exercise.
“Compression socks and stockings are useful in people with poor circulation, the elderly, and post-surgically. People also use them during travel to minimize the fluid stagnation in the lower limbs from being sedentary on a flight,” Wu says. “They can also be used on people who have prolonged workouts and those who stand on their feet all day.”
Compression garments aren’t typical socks, and they can take some getting used to. The following tips can help:
If you’re having trouble sliding the stockings up, MedlinePlus recommends applying lotion to your leg and allowing the skin to absorb it before putting on the garment. A bit of baby powder or cornstarch might work, too.
For people with arthritis or other mobility challenges, gripping the sock or stocking can be tricky. In that case, Mahlay and MedlinePlus suggest using a stocking donner, or butler, which is available at many pharmacies and medical supply stores.
MedlinePlus advises washing the stockings daily with a mild soap and water mixture, then rinsing and air-drying them to prevent bacterial buildup. Mahlay and Wu suggest having at least two pairs in rotation.
Jerome Enad, MD, an orthopedic surgeon in Pensacola, Florida, and Mahlay say that there’s no need for most people to wear their compression stockings or socks to bed. Wearing them for too long could produce unpleasant side effects, like skin damage, says Dr. Enad, which is backed up by a previous report published in the British Journal of General Practice. Some compression socks, however, may be appropriate for wearing overnight. “It depends on the specific sock’s purpose,” Enad says. “For example, medical-grade TED hose stockings can be worn continuously for several days, whereas compression socks intended for running marathons would not be appropriate for sleeping.”
Mahlay and Wu advise putting socks on before getting out of bed each day. Otherwise, fluid can accumulate in the leg, making it harder to put the garment on.
Enad, Wu, and Mahlay say that the first factor to consider when choosing compression garments is the intended use, which will determine the pressure level rating. This is measured in mmHG, or millimeters of mercury.
“Lower levels of compression are adequate for running, low to medium for standing at work, and medium to high levels for preventing blood clots,” says Enad.
Mahlay offers the following guidelines:
Mahlay also says to keep in mind that the size is not the same as the pressure — both are important.
“Pay careful attention to the manufacturer’s sizing guide, which usually refers to measurements around the calves, because there might be subtle measuring differences to determine proper sizing, and the wrong size compression socks can be useless or potentially harmful if too tight,” says Enad. Specifically, if they are too tight, it can cut off circulation at the knee crease in the back of your leg.
Enad says that they should feel snug but not tight. “You should still be able to bend your ankle or knee through a full range of motion while wearing them.”
Mahlay suggests carefully considering sock height, too. To enable full mobility and avoid a “tourniquet effect,” she says, knee-high socks should end an inch below the knee, not at the knee crease. The same goes for the toes. An opened-toe garment could cut off circulation if your toes are particularly prone to swelling, she says, so go for closed-toe instead.
Wu and Mahlay suggest being particular about fabrics as well. They recommend breathable, moisture-wicking, seamless materials to prevent skin irritation and bacterial infections. And for those with mobility challenges, a zipper may make the garment easier to put on.
Another good feature to seek out is the American Podiatric Medical Association (APMA) Seal of Acceptance, which indicates that the garment was reviewed and approved by APMA podiatrists.
As for particular brands, Wu recommends Physix Gear Compression Socks for athletics and travel. “They offer moderate compression, a sleek design, arch-to-calf compression, and breathable fabric,” she says.
SB Sox Compression Socks are another of Wu’s favorites. “These have premium compression to help with muscle recovery and removing lactic acid,” she says. “The toe box and heel are reinforced to offer exceptional support.”
Enad also recommends the ProCompression brand for athletes and marathon runners, due to its “firm elastic support and durability.”
Compression garments, which stimulate circulation and reduce swelling, discomfort, and the risk of blood clots, can benefit many people with various medical conditions. But they’re not one-size-fits-all.
If your doctor has prescribed compression garments for a specific medical condition, be sure to have a professional fitting and follow your doctor’s instructions carefully. Although these garments will feel different than typical socks, stockings, or hose, they shouldn’t be uncomfortable. Talk to your healthcare provider if they restrict your movement, feel too tight, or irritate your skin.
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