Compression (Support) Stockings

Compression Therapy

The use of compression in the form of either stockings and/or wraps is one of the more commonly used forms of therapy in conservative treatment.  If your vascular specialist recommends treatment of your varicose veins should conservative therapy be a failure to improve your symptoms, all insurance companies, including Medicare, have very specific criteria which include documented use of compression.  Each insurance company, including Medicare, has specific criteria in regard to the strength of stockings and length of stockings (whether they are thigh-high stockings or below-the-knee), as well as the length of time for trial.

To help you better understand how compression stockings can be of benefit, we offer the following detailed information.  In some cases, compression therapy may be sufficient to control your symptoms.  In other some more severe cases, compression stockings may also be recommended for continuing use even after endovenous laser, sclerotherapy or microphlebectomy.

The Vascular Center of Wichita Falls will work with you in meeting the specific criteria your particular insurance company requires. 

For very mild symptoms that will not require treatment, you may want to start out using regular support pantyhose or support stockings that end just above the calf and below the knee.  You may find that these help swelling and aching considerably.  They are also less expensive than the special support stockings a doctor prescribes.  If you are the average person, you may be able to buy support stockings from department stores or Wal-Mart, but they are designed to fit only the average person.  The stockings that are not prescription are made of lighter weight elastic and the compression may be equal all the way up the leg.  It is best that the pressure is graduated, which means the pressure gradually decreases as you go up the stocking (leg).

Those that you find at some stores that say mild, moderate or strong compression and if you have a standard diameter ankle, standard calf, standard thigh and a standard length leg, the use of these will help.  However, if you look around the store and everyone is not the same height, same weight and the same shape of their legs, then these may not be for you.  Thigh-high stockings of this type may not be a good choice as they can be harder to keep up without a garter belt and may slide down and bunch up interfering with adequate blood flow and will actually worsen your problems and especially varicose vein problems.  If your thighs are heavy, you can probably only wear below-the-knee support stockings or support pantyhose.

Compression stockings may also be available with open or closed toes. These open-toe stockings may be preferred by those who need more breathe ability (particularly if they have a fungal infection on their toes) or by those with arthritic or clawed toes.  Open-toe stockings may also be of benefit to those with long feet compared to the length of their calves and to people who wish to wear a sock over the stocking.

What Compression Levels Mean

The compression level indicates how much support the compression stockings will provide from the lowest level to the highest level provided.  For example, a typical compression level for travel is 15-20 mm of mercury.  This means 20 mm at the ankle and 15 mm of mercury at the upper level so that it helps move blood and fluid up the leg.

Following are the Classes of compression and the symptoms for which that level of compression is recommended.

Note that the unit of measurement of “millimeters (mm) of mercury (Hg)” is also how blood pressure is measured.

Less than 15 mmHg (Over-the-Counter)

  • For daily comfort
  • Heavy, fatigued, tired legs
  • Mild swelling of ankles after long periods of standing or sitting
  • Tired, achy and swollen feet and ankles during travel
  • Sensitive feet from symptoms of diabetes

Medical Strength Compression

The following should be recommended and prescribed by your vascular specialist.  It is important to know that you have adequate arterial flow before beginning the use of medical grade compression and particularly with high-grade compression as you may block off your arterial flow to your toes.  A vascular specialist will be able to determine this after appropriate non-invasive vascular studies.

Following are the more commonly used levels of compression in the United States. The Class of stocking of 1, 2, 3 or 4 varies around the world, and it is best to use only the numbers indicating mmHg for level of compression rather than Class.  Even the Class set by insurance companies and that set their criteria by Class, are not uniform with the breakdown in these of mmHg (mm of mercury).

15-20 mmHg (Class 1)

  • Heavy, fatigued, tired legs
  • Mild swelling of ankles during pregnancy
  • Mild swelling of ankles after long periods of standing or sitting
  • Tired, achy and swollen feet and ankles during travel
  • Minor varicosities

20-30 mmHg (Class 2)

  • Heavy, fatigued, tired, aching legs
  • Mild varicosities during pregnancy
  • Mild to moderate varicosities (swelling)
  • During recovery period post-sclerotherapy, endovenous laser, radiofrequency ablation or surgery for other vein procedures
  • Swelling in the leg due to inactivity

30-40 mmHg (Class 3)

  • Moderate to severe varicosities with mild edema during pregnancy
  • Mild to severe edema
  • Post-fracture (20-30 mm of mercury may be adequate), post-traumatic edema
  • After sclerotherapy or endovenous laser or radiofrequency ablation or phlebectomy of larger veins or vein stripping to maintain treatment success
  • Venous ulcers, active or to prevent recurrent ulcers
  • Acute deep vein thrombosis (DVT)  if pain allows this much compression.  If not, as soon as the pain subsides.  If there is too much pain, you may use less compression until you are comfortable with this degree of compression.
  • Post-thrombotic syndrome (The valves may be scarred down and nonfunctional and the veins may be blocked because of an old acute deep vein thrombosis.)
  • Mild primary lymphedema after decongestant therapy to maintain reduction, secondary lymphedema

40-50 mmHg (Class 4)

  • Severe varicosities and edema
  • Venous ulcers
  • Moderate to severe lymphedema

In special situations, to achieve these levels of compression in someone with rheumatoid hands, bad elbows, bad shoulders, bad heart, bad back, we will stack two very low-grade compression stockings on the same leg.  Usually we will use:

  • 8 to 16 mm of mercury gradient below-the-knee support stocking
  • 8 to 16 mm of mercury gradient above-the-knee support stocking over the below-the-knee stocking

With this combination, usually the below-the-knee stocking will not slide down with the above-the-knee stocking over it.  This will achieve the levels of compression needed to help you.  Other combinations can be stacked as well to achieve the total desired compression needed.  Do not stack stockings without seeing your vascular specialist.  You must have adequate arterial flow to your feet to wear these combinations.

In summary, these pressures help counteract the abnormal ambulatory venous pressures but many times they do not completely overcome the abnormality.  If you have really bad problems, you can link to a detailed breakdown and further information, which recommendation is made for you to review that.

Special features of some support stockings

Latex allergy

If you are allergic to latex, Juzo brand makes a support stocking without any latex in them.

Open Toes

Compression stockings are also available with open or closed toes.  Open-toe stockings may be preferred by those who need more breathability, particularly if you have a fungal infection in your toes or if you have arthritic or clawed toes.  Open-toed stockings may be beneficial to those with long feet compared with the length of their calves and for people who wish to wear socks over their stockings.

Silver Impregnated

For those with ulceration or recurring superficial infection, there are silver impregnated stockings to help control the infection.


Compression stockings that are 30 to 40 mmHg gradient support can be ordered with a zipper up the back or up the side of your leg but are not as aesthetic and they are more expensive.  The zipper makes it easier to get these on your leg if you have complicating health problems.  Stockings with less compression than 30 to 40 mmHg are not available with a zipper.


Some stocking companies make a thigh-high stocking with a band up the side of the leg that goes to a waistband to help keep them up. 

For Men Only—At Last

Ames Walker now has available pantyhose (waist-high leotards) that are 20 to 30 mmHg and are styled with a fly front.  (Not even Joe Nameth’s had a fly in the front!)

Being Measured

You must be measured for compression stockings.  Your legs are different length from the ankles to the calves, from the ankles to the knees, from the ankles to the thighs, and from the ankles to the waist.  Not only are your legs different sizes around, but they are all different lengths and all stockings must be fit appropriately.  Stockings that roll down are like wearing a garter belt.

You must be measured early in the morning before your legs start to swell.  If they do not go down by morning, you should then either stay off your legs with them properly elevated for two to three days or your doctor should apply compression wraps to your legs for two or three days while staying off your legs before you are measured.  Your compression stockings must be measured for the desired size you want your ankles to be.  If your legs are large and swollen when you are measured, you will never have adequate compression to control the swelling to achieve the desired size for the proper health of your legs.

Again, you must be measured for stockings early in the morning before your legs start to swell as this will be the size you want to maintain.

The first time you buy support stockings you should see a specialist in measuring stockings–you may find that you are the average person.  


Rubber Gloves

The use of rubber gloves of either the dishwashing type or disposable gloves bought from the pharmacy (these are available latex free) will prevent the stockings from slipping through your fingers and make getting them up easier.  This also will keep you from running your fingernails through the stockings and getting runners.

Stocking Donner/Doffer

Talk with your vascular specialist about obtaining a stocking donner if you have difficulty getting your compression stockings started over your foot.  This will help you or your family member to get them over the foot and then all that remains is pulling them up the leg.

Stocking doffers (to help you get stockings off your leg) are also available but so far have not been as successful as the donner in assisting the patient.  The best doffer is a family member or good friend.  Talk with your vascular specialist if getting them off is also difficult.

Ordering Online

Some stockings can be ordered online cheaper if you have already had experience in wearing them and have been measured by a stocking specialist and you have learned how to measure your own legs.  We make no recommendations but simply offer the following web site addresses for you to begin a search.  These sites offer many brands and some have free shipping.

AmesWalker:  They also have the support pantyhose for men with a fly front 20 to 30 mm of mercury gradient support waist-high leotard.

Medical Stockings Online:

For Your Legs:

Consider This

If you have serious varicose vein symptoms and are considering support stockings, be sure not to buy stockings that are too tight or are uncomfortable and too difficult to get on because you may not wear them.  No patient has ever reported that their support stockings were effective while residing in their dresser drawer.  With this in mind, it is important to note that support stockings do have disadvantages in that

  • They are hot.  If they are too hot, you may desire to use only below-the-knee support stockings in the summertime.  Support pantyhose are better in Alaska than in Texas.
  • They can be uncomfortable when worn all day
  • They are expensive
  • They may be difficult for older adults, overweight people, and those with arthritis or other physical limitations to put on.  Again, stacking lesser compression stockings helps.  A stocking donner will help you get them over your feet or a family member or nurse to get them over your feet.  Once they are over your feet, they are easier to pull up.

So give serious consideration to the amount of discomfort and inconvenience of support stockings compared with the possibility that they may help keep your problems from getting worse and may help you avoid surgery or major complications such as ulcers on your ankles that will not heal. 


We hope the information on these pages is both informative and helpful, but it is intended for education only.  Please do note that no web site, no matter how much information is shared, can replace a consultation with your doctor and a vascular specialist.  Medical technology and treatment are continually improving and evolving so before making any decision on treatment, it is always advisable to see your doctor first for a comprehensive evaluation of your vascular disease and other medical conditions.

At the Vascular Center of Wichita Falls, we work closely with your other physicians.  If you have concerns about your arteries or veins, contact us.  A referral is not necessary to make an appointment.