What You Need to Know About Compression Socks Before You Buy

Vein specialist Eugene Ichinose, M.D., is a firm believer in compression socks – not only for patients but also for himself. 

He once stood on a chair during a presentation to model the compression socks he wears to help improve circulation as he stands throughout day. Compression socks work by promoting improved blood flow in your legs. The compression of the socks gently pushes blood flow up the leg, helping to prevent swelling and even blood clots. If you have noticed your legs swelling or the appearance of varicose veins, for example, you may wonder if compression socks would be a good idea. Many people can benefit from compression socks after surgery, during pregnancy or as legs become achy, swollen or heavy feeling. 

Before heading out to the store or browsing online, there are some things you should consider to make sure you are getting the maximum benefit from compression socks.

First, all compression socks are not created equal. 

“The quality of the material, the sizing, the durability and the amount of compression or pressure the garment provides all culminate in the final product,” Dr. Ichinose said. “Some very economical support hose are not sized by careful measurement of your leg. They are labeled small, medium and large, however the amount of compression provided is not known.”

Dr. Ichinose recommends that patients know two important things before selecting compression socks: the amount of compression and the size needed. Your health care provider will advise the compression level you need and measure your leg to ensure you are fitted in a proper compression sock.

However, you can also measure yourself for compression socks. In the morning before swelling occurs, measure the circumference of your ankle (around your ankle), the circumference of your calf and the length of your calf (from the knee to the heel sitting with your legs at a 90-degree angle). Use the sizing guide on the compression sock packaging to find the right fit for you. If you have any questions about the compression level right for you, talk to your health care provider. Compression levels range from mild compression to extra firm compression:

  • Mild compression (15-20mmHg): Prevention and relief of minor to moderate varicose veins, relief of tired aching legs, relief of minor swelling of feet and legs.
  • Moderate compression (20-30mmHg): Prevention and relief of moderate to severe varicose veins, treatment of moderate to severe lymphatic edema and management of active ulcers or post thrombotic syndrome.
  • Firm compression (30-40mmHg): Ulcer management, post-thrombotic syndrome.

“The amount of compression provided by a pair of socks will vary depending on the size of the leg in relationship to the size of the garment,” Dr. Ichinose said. “Patients commonly complain that the compression socks cut into their leg. Usually, it is because a large leg was placed in a garment too small for the leg.”

When considering price, Dr. Ichinose said it is best to consider the quality first. 

“Many socks are chosen based on economics,” he said. “However, they give up quality material and workmanship to be economical. Unfortunately, many times you get what you pay for. There are four main companies that have been providing compression socks for decades: Juzo, Sigvaris, Medi and Jobst. These companies have made medical-grade compression socks for decades. The quality and workmanship make them high-grade.”

Before self-prescribing compression socks, Dr. Ichinose said they are not recommended for some patients. 

“If you have peripheral vascular disease affecting your lower extremities, you should not wear compression socks,” he said. “The pressure provided by compression socks may make ischemic disease worse. Diabetic patients can be at increased risk of complications, since neuropathy prevents them from feeling the changes in their feet.” 

Dr. Ichinose tells his patients to pay close attention to the color of their toes and report any differences in the color of their toes from the foot or leg to your health care provider. 

“Also, watch for bunching of the hose,” he said. “This may make a tourniquet effect, which may interfere with circulation. Document the color, sensation, swelling and temperature of the toes before putting on the compression socks. Open-toe hose/socks may make monitoring more practical.”

Sometimes, swelling accumulates above the sock. The leg can be so edematous (swollen) that once the sock is on, it will squeeze fluid out of the tissue to above the sock. When the circumference of the leg covered by the sock is reduced, the squeeze becomes less and the remaining fluid in the leg remains. To reduce swelling in this case, take the swollen leg and wrap it with mild to moderate pressure. Over time, the fluid will move out of the tissue and the wraps will loosen. Then, rewrap the leg with mild to moderate pressure. Again, fluid will move out of the tissue and the wraps will loosen. Continue the process until the swelling has resolved. Measure your thigh, knee, ankle and find a pair of compression socks to maintain the condition of the leg.

According to Dr. Ichinose, there are several other factors to consider before using compression socks.

  • Patients should carefully monitor for evidence of worsening blood flow to the foot.
  • Patients with fragile skin may experience a tear in the skin with high-compression socks.
  • If the patient does not have the hand strength or mobility to put on the socks, they should have assistance (a compression sock assistance device from compression sock companies like Jobst and Sigvaris can be found on Amazon).

A second option could be to purchase Velcro compression stockings by Juzo. The length of the stocking can vary, but knee-high should be sufficient. When the sock extends over the knee, care should be taken to avoid developing wrinkles behind the knee as this can cause irritation to the skin. When using thigh-high hosiery, using “roll on“ adhesive product is helpful to prevent the hose from sliding down the thigh. 

Open-toe, zippered or Velcro products may be more tolerated with patients who have foot deformities such as bunions, rheumatoid arthritis or diabetes.

Dr. Eugene Ichinose, Dr. Robert Smith and Dr. Stanley K. Zimmerman lead the Oklahoma Heart Institute Center for the Treatment of Venous Disease, treating patients with peripheral venous disease including varicose veins, deep vein thrombosis and venous insufficiency. To schedule an appointment, please call 918-592-0999 or click here.