Wearing compression stockings will likely be the most important part of managing your leg swelling, regardless of the cause. Compression stockings can help improve vein function, improve conditions of the skin (e.g., venous stasis dermatitis and lipodermatosclerosis, reduce symptoms of heaviness, itching, and pain, and also help to prevent and treat venous leg ulcers.
How do compression stockings work? Compression stockings reduce how much excess fluid leaks from the blood capillaries into the tissues and cause swelling. They also support the leg veins and help the venous blood to flow back to the heart more efficiently, and they help the leg muscles to compress the veins more effectively (calf muscle pump), which also improves blood flow back to the heart. Reducing leg swelling can also reduce inflammation of the tissues and hardening of the skin. Together, these actions improve the overall health of your swollen leg.
Medical compression stockings. Compression stockings are knit in a way that allows them to stretch. When the compression stocking is pulled on the leg, its elasticity causes it to exert pressure, or compression, on the leg. Medical grade compression stockings are knit so that the greatest compression is at the ankle. The compression is then graduated, or reduced so that it becomes progressively less toward the top of the stocking. For example, a compression stocking that is labeled as “20-30 mmHg” of compression, applies this range of pressure at the ankle and then provides significantly less pressure at the top of the stocking. The pressure gradient on the leg created by the compression stocking helps the venous blood in the leg to flow in the correct direction toward the heart. Another important feature of medical-grade compression stockings is their stiffness, which is also incorporated into the stocking during the knitting process. The stiffness is a measure of how much resistance the stocking provides to a leg that is attempting to swell. The support provided to the leg by a compression stocking can “relax” as the day goes on (i.e., garment fatigue). This results in loss of optimal edema control by evening when edema is usually worst for most people. A stiffer compression stocking may provide better day-long edema control.
Choosing a compression stocking. Ideally, a compression stocking should provide a low, comfortable pressure on the leg at rest, but a strong pressure during standing and walking to control swelling. There are many compression stocking choices. Cheaper compression stockings purchased at discount retail stores may provide their labeled leg compression right out of the box, but may not be able to consistently provide this compression all day long, or over multiple months. Better quality, medical-grade, compression stockings usually cost more but have advantages of a better fit, and better-sustained edema control. Your physician or therapist can assist you in choosing an appropriate compression stocking.