The most common chronic swelling that we see at the Lymphedema clinic is in the feet, ankles and calves. Your doctor may have recommended that you wear compression garments. Or maybe they used different terms like support hose, compression socks, TED hose, support stockings or compression stockings. They usually mean the same thing. It can be confusing to know what to choose. Unfortunately we have found that most of the store bought compression socks fail. We have seen the most common reasons for failure, and most can be overcome. Here’s what we have learned over the years.
1. Get the right measurements
The first and common mistake we see, is that the stocking was fitted when the leg /ankle/ foot was swollen. Measurements for sizing should be taken when there is no swelling. Compression garments are supposed to keep the leg from swelling, but does not necessarily reduce swelling. We have three suggestions for how to reduce the swelling before you measure and spend money on a compression sock.
- Check first thing in the morning. Often the swelling goes down at night since the feet are up in the bed. If there is no or minimal edema (swelling) in the morning. Measure the ankle and calf circumference to get the right size.
- If the swelling does not go away at night, find a Lymphedema Therapist that can work with you using bandages to reduce the existing swelling. Then measure to get the right size compression socks.
- If you can’t find a good Lymphedema therapist that uses bandages (not just massage) you can self-treat with a Non-Elastic Velcro closure compression wrap. Click here to see an example.
Measure the narrowest part of the ankle, widest part of the calf and the length from your foot to your knee. Most sizing charts are based on those three measurements. If your proportions are outside of the sizing chart range at any part, you may need to be fitted for a custom made garment.
2. Don’t go cheap
Paying a little more upfront will only hurt once, in the wallet. Cheap stockings may hurt every time you wear them. Here’s the reason. It is essential that the stockings fit well. The main problem with the low priced stockings is the sizing chart. Some stockings only has 3 or 4 sizing options with no variations for calf to ankle proportions or length. That’s a real gamble. If the calf ends up tighter than the ankle it will push the swelling down instead of up, making it worse. Most cheaper socks do not come with a silicone band at the top. Often they will roll at the top and cut in. This may also make the swelling worse. Find a compression sock with many sizing options to get the best possible fit. A good quality knee high sock is usually closer to $100 range.
3. Get strong enough
Many of our patients come in with swollen feet and ankles, wearing stockings that are to weak or too stretchy. Yet they hurt and feel like they are too tight. Consider this. If you were a size 3 in the morning when you put them on, but the stockings are not effectively keeping the swelling down, as the day goes, you may be a size 4 or 5 by the afternoon. Now you’re wearing a size 3 sock on a size 5 leg. That will hurt. If the sock is strong enough, you should not get any more swelling while wearing them and it will hurt less. Most of our patients need 30-40 mmHg pressure to maintain the size throughout the day. The thickness and flexibility of the fabric matters as well. The stiffer and thicker the fabric, the better it holds the size. The pressure and strength needed depends on the severity of the condition.
4. Get silicone top border
Very often, a compression sock without silicone border at the top will roll or fold at the top. This increases the pressure, it will hurt and constrict the flow of lymph, resulting in worse swelling or even pressure sores. We have seen this happen many times. A 5 cm wide silicone border at the top usually solves that problem.
5. Decide open or closed toe
Most of our patients use closed toe compression stockings. That is because open toe socks can often slide back over the foot throughout the day and result in swollen toes and swelling in the front part of the foot. A few patients choose open toe because they want to wear sandals or because of sensitive toes. The compression in the toe portion is usually half or less compared to the rest of the sock, so it should not squeeze if they are fitted right.
6. Decide if you need custom or ready made
If the sock creases and cuts in at the ankle and you have the best possible ready made fit, then you may need custom made.
If you get swelling throughout the day, even when wearing a 30-40 mmHg good quality compression sock. Then you may need a thicker, flat knit fabric that is custom made for you.
If you have a narrow ankle but a large shoe size, the ready made socks can be too short at the foot portion and hurting your toes. There is a ready made sock with a larger foot portion called Mediven for Men but it does not come with a silicone border. It can work if you have a thinner ankle and calf with a larger foot. Otherwise, custom made is the way to go.
7. Figure out how to get the compression stockings on and off
If you can slide them on with your bare hands, they are probably not strong enough to do much good for swelling. Fortunately many brilliant minds have worked on solutions to this common problem. There are many devices that can assist with getting the compression socks on and off. The first thing to try is a pair of good grip gloves to assist you. Most of our patients need more than the gloves. The Doff N Donner is an amazing device and is the most commonly used among our patients. That does require that you can reach your feet though. If your not able to reach your feet you can use the PikStick with the Doff N Donner, or the Steve, or the Ezy As. There are many other options as well. The key is to keep exploring until you find what will work for you. Don’t give up on this! We have worked with over 1000 patients of all ages from 50 to 100 with many health problems like back pain, arthritis, obesity etc. We usually find a solution. Not always without some struggle and failures before we find the right answer.
8. Try a regular wearing schedule.
If you go without them and the leg becomes swollen, the stocking will not fit right. Off course we don’t know your specific situation, but here are some general guidelines for wearing schedule. You need compression the most when the foot and leg is exposed to gravity. That is, when you are sitting, standing or walking. Most of our patients need to put the compression sock on as soon as they get out of bed in the morning, and wear it until bedtime. Each situation is unique though. The only way to know is to try different wearing schedules and monitor if the swelling comes back. Wearing elastic compression socks while sleeping can be very uncomfortable. And, since you are not moving around as much there is a risk to develop pressure sores if you sleep with them on. It is usually not recommended to wear them in bed. If you need compression at night, we recommend Non-elastic garments like the Juzo Wrap or the Farrow wrap.
If the seller allows returns. Now is the time to learn if the stockings you bought are right for you. If there is a problem, exchange for something different. Sometimes you need shorter / longer, upgrade to stronger compression or upgrade to custom made.
So, what compression stocking do I get?
We like to stick with the reputable brands that have all the options mentioned above. Medi, Juzo, Jobst and Sigvaris. We sell all those brands at the clinic but most of our patients get the Medi Plus. The brands are equal in quality and options so our deciding factor has been the 30 day return policy that Medi offers to us. It is important to have a second chance if they do not work out. The Medi Plus has many sizing options, silicone band, open / closed toe, two different lengths and two different calf sizes per ankle size. The fabric is moisture wicking and durable. It works for most of our patients, but there are times when we get the other brands, since each brand has some unique differences.
I hope this helps, but if it feels overwhelming, give us a call.
For more information, watch the videos below.