Compression stockings are specialized garments designed to manage various circulatory issues by applying external pressure to the lower limbs. They exert a graduated squeeze, with the greatest pressure at the ankle and gradually decreasing further up the leg toward the knee or thigh. This mechanism assists the veins in pushing blood back toward the heart and prevents the pooling of blood (venous stasis). When used correctly, this consistent pressure effectively reduces swelling, lessens the heavy or aching feeling in the legs, and lowers the chance of developing blood clots like deep vein thrombosis (DVT).
Recognizing Signs of Improper Fit
One of the most immediate indicators of excessive pressure is the presence of deep indentations, or marks, left on the skin after the stocking is removed. These marks are particularly concerning if they appear behind the knee or at the ankle, suggesting a localized pressure point that is too tight. Improper fit can happen if the size is incorrect or the stocking is applied improperly.
The wearer may experience pain or discomfort that goes beyond the normal snugness expected of a compression garment. This pain often signals that the fabric is applying too much force, potentially constricting local blood vessels rather than supporting them. Furthermore, observe for changes in sensation, such as tingling, numbness, or a feeling of “pins and needles” (paresthesia) in the foot or toes.
Visible changes in skin color indicate that circulation is being impaired. If the skin becomes pale, blue, or a mottled purple color, the pressure is likely too high and is restricting blood flow. The stockings should feel supportive and firm, but if the act of putting them on or taking them off becomes an extreme struggle, the garment may simply be too small for the limb measurements.
Medical Consequences of Excessive Compression
When the garment is too tight, especially at the top band or a bunched area, it can create a localized “tourniquet effect.” This effect restricts the flow of blood and can cause blood to pool behind the point of constriction.
Excessive pressure can severely impair the skin’s integrity, leading to chafing, blistering, and even the formation of pressure ulcers or open wounds. This risk is heightened if the wearer has underlying conditions that affect skin sensitivity, such as diabetes. Prolonged, extreme tightness can exacerbate existing poor circulation or nerve issues, known as peripheral neuropathy.
In situations where a person has pre-existing peripheral arterial disease, a too-tight compression stocking can worsen the lack of oxygen supply to the tissues (ischemia). Instead of improving circulation, the restriction can compress smaller blood vessels, further limiting the oxygenated blood reaching the surface tissues. If any of these concerning symptoms appear, immediate removal of the stocking is necessary to prevent further harm.
Strategies for Correct Sizing and Use
Accurate measurement and selection of the appropriate garment are necessary to avoid excessive tightness. It is beneficial to measure the leg circumferences first thing in the morning before any daily swelling has occurred. For knee-high stockings, the ankle at its narrowest point and the calf at its widest point must be measured to ensure a proper fit.
Compression levels are standardized and measured in millimeters of mercury (mmHg), ranging from mild support (e.g., 8–15 mmHg) to stronger, medical-grade levels (e.g., 20–30 mmHg or higher). For higher compression ratings, professional consultation with a healthcare provider is necessary to determine the correct pressure for a specific medical condition.
Proper application maintains the graduated pressure profile of the stocking. The garment should be pulled on smoothly without bunching, wrinkling, or rolling the top edge down. Rolling the top of a stocking creates a concentrated band of pressure that mimics the damaging tourniquet effect, regardless of the garment’s correct size.