Compression stockings (CS) are specialized garments designed to apply graduated pressure to the limbs, supporting venous blood flow back toward the heart. This mechanical assistance helps manage swelling and reduces the risk of blood clots like deep vein thrombosis (DVT). While these stockings are a beneficial therapeutic tool for many conditions, their application is not universal. In certain medical situations, wearing compression stockings can be counterproductive or even worsen an existing condition.
Severe Arterial Disease and Circulation Blockages
The primary function of compression stockings is to aid the body’s venous system, but this pressure can become harmful if the arterial system is already compromised. Compression is strictly contraindicated for individuals diagnosed with severe Peripheral Artery Disease (PAD) because the arteries carrying oxygenated blood to the tissues are narrowed and restricted. Applying external pressure to a limb already suffering from reduced arterial inflow can further diminish the blood supply.
If the blood flow to the limb is significantly impaired, the pressure from the stocking can starve the tissues of oxygen and nutrients. This can rapidly lead to tissue damage, skin necrosis, or the formation of ulcers. Healthcare providers often use a measurement called the Ankle-Brachial Index (ABI) to assess the severity of PAD; a low ABI value, typically below 0.5, indicates severe arterial blockage where compression should be entirely avoided.
Compression must also be used cautiously in cases of uncontrolled congestive heart failure (CHF), particularly when it results in massive edema. While mild compression may be used for edema management, strong compression can potentially shift a large volume of fluid back into the central circulation too quickly. For a heart that is already struggling to pump efficiently, this sudden increase in fluid load can overwhelm the heart and lead to cardiac decompensation.
Active Skin Infections and Open Wounds
Compression stockings should not be worn over areas of the skin that are actively infected, broken, or weeping fluid. Conditions like active cellulitis or acute dermatitis cause inflammation and fluid buildup that compression can exacerbate. The mechanical pressure from the garment can trap moisture, increase irritation, and create a warm, occlusive environment favorable for bacterial growth and the spread of infection.
The practice of wearing compression over open venous ulcers or wounds is also discouraged until the wound has been properly treated and dressed. Compression can interfere with the necessary air circulation required for healing and may cause the stocking material to adhere to the fragile tissue. Improper use over a delicate skin barrier can also cause chafing, bruising, or new skin breaks, which then serve as entry points for infection.
Recognizing and Avoiding Improper Fit
Improper fit is a common issue that can transform a therapeutic garment into a harmful device. Compression stockings are designed with a specific pressure gradient, being tightest at the ankle and gradually decreasing pressure further up the leg. If the stocking is too tight overall or bunches up, it can create a localized “tourniquet effect,” which reverses the intended benefit and actively blocks blood flow, both venous and arterial.
A stocking that is too long or that rolls down at the top creates a constrictive band that can cause significant circulation problems at that localized point. This binding can restrict the flow of blood and may increase the risk of skin damage and pressure sores beneath the tight edge. Therapeutic-grade compression stockings, which have higher pressure levels, require professional measurement of the limb circumference at multiple points to ensure the correct pressure profile is applied.
Using off-the-shelf sizes for medical conditions can lead to either insufficient compression, which is ineffective, or excessive compression, which is dangerous. When the garment is too tight, it can mimic the symptoms of arterial disease by restricting flow and causing discomfort. Furthermore, if a person experiences weight gain or significant changes in edema, their current size may no longer be appropriate and require a new fitting to prevent complications.
Warning Signs Requiring Immediate Removal
The appearance of acute symptoms while wearing compression stockings signals that the therapy may be causing harm and requires immediate removal and medical consultation. Sudden or severe pain that develops after putting the stocking on indicates that the pressure is likely too high or the fit is incorrect.
Changes in sensation, such as new or increasing numbness, tingling, or a burning feeling in the toes or foot, can indicate nerve compression or compromised circulation. The skin below the top edge of the stocking should maintain its normal color and temperature. Any noticeable discoloration, such as a pale, bluish, or mottled appearance, or if the toes feel suddenly cold to the touch, suggests that arterial flow is being restricted.
An immediate increase in swelling just above the stocking’s top edge is another urgent warning sign, indicating that the garment is creating a fluid dam rather than promoting fluid return. If any of these symptoms occur, the stocking should be taken off immediately and a healthcare provider contacted to reassess the need for compression and to check for potential complications.