Effect and use of medical compression stockings

Photo of a woman with compression stockings

Medical compression stockings are an important part of treating post-thrombotic syndrome. They are usually well tolerated. Putting them on and taking them off can feel a little strange at first. It is usually enough to wear the compression stockings on the affected leg.

To make sure blood doesn't build up in the leg veins, it is a good idea to move regularly and exercise your calf muscles. Regularly elevating your legs takes the strain off the veins and relieves the symptoms of post-thrombotic syndrome (PTS).

Wearing compression stockings is an important part of treating PTS. Using them properly and taking good care of them is important to avoid chafing the skin and tearing the stockings.

But it's important to know that over-the-counter compression stockings and socks, like those sold in sports shops, don't meet the requirements of medical compression stockings. That means they aren't suitable for the medical treatment of vein conditions like post-thrombotic syndrome.

Can compression stockings help?

Compression stockings put pressure on the veins, which helps to send blood from the legs back to the heart. That is believed to relieve symptoms and prevent complications like chronic wounds.

There are hardly any studies on the effectiveness of compression stockings for treating post-thrombotic syndrome. But some other studies have shown that they can help with chronic vein weakness and can support the healing of ulcers caused by vein weakness. That is why experts assume that they can also relieve PTS symptoms.

Do compression stockings have any side effects?

Compression stockings can be uncomfortable to wear and can dry the skin out. They can quickly make you sweat in warmer temperatures, and they sometimes cause itching. Itching is often a result of dry skin and can be relieved with lipid-replenishing skin care products. They can sometimes cause chafing, which can turn into blisters, rashes or other skin conditions. Serious side effects are very rare though.

Not everybody copes well with stockings. It takes a little practice putting them on. They are supposed to be a tight fit. If they keep slipping down, they are too loose and will have no effect.

When are compression stockings not suitable?

Compression stockings can make symptoms worse with some associated medical conditions, and can even lead to serious complications like lasting skin damage.

People with other conditions should talk to their doctor before wearing compression stockings. Compression stockings might be unsuitable in the following cases:

  • Circulation problems in the legs (peripheral vascular disease, PVD for short)
  • Diseases which cause nerve damage or feelings of numbness in the legs, such as advanced diabetes or diabetic foot syndrome
  • Acute bacterial infections in the deep skin layers such as erysipelas
  • Severe heart failure

Weeping skin inflammations and rashes, sensory disorders, and arthritis might also be a reason not to use compression stockings.

What types of compression stockings are there?

It is important to use the right size, strength and type of compression stockings. The stockings have to be tight and fit perfectly. If they are too loose, they do not put enough pressure on the leg. If they are too tight, they can cut off the blood flow.

There are also different compression strengths, lengths, and fastening options. Some stockings have an open toe, others are closed. Some have a seam, others don't.

You will be measured for the right size in the medical supply store, generally in the morning when your legs aren't yet swollen.

The pressure strength of compression stockings is measured in units of “millimeters of mercury,” written “mmHg” for short. The higher the number or compression class, the higher the pressure. There are 4 compression classes (CCL).

  • CCL 1: 18 to 21 mmHg
  • CCL 2: 23 to 32 mmHg
  • CCL 3: 34 to 46 mmHg
  • CCL 4: over 49 mmHg

Post-thrombotic syndrome is usually treated with compression class 2 stockings, or class 3 where needed. Knee-high stockings are usually enough.

If a doctor prescribes the stockings, the costs are covered by statutory health insurers, who generally pay for 2 to 4 pairs per year.

How do I put the stockings on properly?

It is usually enough to wear one compression stocking on the affected leg. Put it on in the morning when your leg is least swollen. It takes a little practice to put the stocking on properly. It is best to do it as follows:

  • Sit down on a chair with a good backrest that offers plenty of support.
  • Turn the upper part of the stocking which will go over the lower leg inside out.
  • Put both hands into the foot of the stocking and pull it out to the sides.
  • Slip your toes into the foot and then first pull the stocking up over your foot, then over your heel, and then over your ankle. Check that the stocking fits well so far and doesn't have any creases.
  • Now gradually pull the rest of the stocking up over your lower leg by turning it back the right way around and slowly smoothing it out upwards.

The stocking shouldn't have any creases in it. The seams should go straight up the leg.

These tips can make it easier to put the stockings on and help not to damage them:

  • Make sure your skin is dry: Don't put the stockings on straight after showering. Wait for any skin care products to soak in before putting the stockings on.
  • Take off any rings or bracelets before putting the stockings on.
  • Wear rubber gloves: That makes it easier to get hold of the stocking material and prevents tears. It is easy to tear the material if you get a fingernail caught on one of the stitches.

You can ask for advice in the medical supply store about how best to take care of the compression stockings. Aids are available for people who cannot lean forward very well or who don't have enough strength in their hands. Doctors can prescribe these kinds of aids if they are needed for medical reasons. Nursing services can also be arranged to help with getting the compression stockings on and off.

How should the stockings be washed and cared for?

Taking good care of the compression stockings is not only hygienic, it also means they can be used for longer. It is recommended to wash the stockings after each use if possible.

You can wash the stockings in the evening by hand with a little detergent or shampoo and hang them up to dry overnight. Lots of compression stockings can also be machine washed. But they can't be put in a tumble dryer because the hot air destroys the elastic fibers. Fabric softeners, whiteners, and stain removers would also damage them.

Some materials are not supposed to come into direct contact with skin care products because they can harm the stocking material and make it wear out faster. Check the care instructions for more details.

If properly cared for, compression stockings can be used for about six months. They should then be replaced because the material gets slacker over time and the compression effect gets weaker.

Azirar S, Appelen D, Prins MH et al. Compression therapy for treating post-thrombotic syndrome. Cochrane Database Syst Rev 2019; (9): CD004177.

Makedonov I, Kahn SR, Galanaud JP. Prevention and Management of the Post-Thrombotic Syndrome. J Clin Med 2020; 9(4): 923.

O'Meara S, Cullum N, Nelson EA et al. Compression for venous leg ulcers. Cochrane Database Syst Rev 2012; (11): CD000265.

Rabe E, Földi E, Gerlach H et al. Medizinische Kompressionstherapie der Extremitäten mit Medizinischem Kompressionsstrumpf (MKS), Phlebologischem Kompressionsverband (PKV) und Medizinischen adaptiven Kompressionssystemen (MAK) (S2k-Leitlinie). AWMF-Registernr.: 037-005. 2018.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Created on June 2, 2022

Next planned update: 2025


Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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