Treatments for varicose veins (III): the secrets of compression stockings

This week I’m explaining the most effective of the conservative treatments; this one that is loved by some and hated by some others, but it is beyond any doubt the most useful as a treatment and also as prevention against the development of varicose veins, their symptoms and their complications: the compression stockings.

To begin with, I will clarify that this is quite a complex topic, more than it seems, because there is not a unique type of stockings: there are stockings of different lengths, different sizes and different compression degrees. Unfortunately, there are also stockings of different qualities, so the best approach is to seek appropriate advice from the specialized doctor.

The stocking acts by compressing the limb unevenly: the maximum compression is exerted at the ankle, and it decreases while ascending in the limb. This pressure gradient favors “milking” the veins, and propels the blood flow upwards. Combining both the external compression with internal compression (the one the leg muscles are doing when walking or doing sport) increases their effectiveness: this is the reason why we advise to walk or to play sport while wearing the compression stockings.

They are VERY EFFECTIVE improving or completely removing the varicose veins symptoms (pain, heaviness, leg tiring, swelling…). They have virtually no side effects (unless a person being allergic to latex or any other of its components; in such a case it’s necessary to find for them a special solution), and very few contraindications (which mean that very few people are advised against using them).

Compression stockings can be used as a standalone treatment, but also as a preventive measure, or even as an auxiliary aid to another treatment, in all of the following conditions:

1. Vein insufficiency and varicose veins.
2. As a complementary treatment after surgery for varicose veins (or other procedures as laser or radiofrequency ablation, as I’ll disclose in the following weeks).
3. After sclerotherapy treatments.
4. As a treatment for the post-thrombotic syndrome (the long-term consequence of a deep vein thrombosis).
5. As a complementary treatment to heal skin ulcers caused by varicose veins.
6. Prevention of the deep vein thrombosis and pulmonary embolism.
7. Lymphedema and lipedema (although in these conditions a different type of stocking is used, made from a different type of fabric).
8. Leg edema (swelling) of any other origin (similar to the previous one, another type of stocking is used).

The proper way to use them is: to put them on at the moment of getting up out of bed, since it is the time of day when the legs have less edema (swelling) or none at all (and veins are still empty because of the recent horizontal position); they have to be worn all day long, and remove them when going to bed. At this point it is also useful to apply some moisturizing cream, which will help protecting the skin around the ankle, as this is the one that suffers the worse consequences of venous insufficiency.

There is a wrong belief – or, better said, a widespread ignorance – about the compression stockings: it turns out that there are of very different types, they are not all the same (absolutely not!). Just as there are many different drugs to treat different diseases, there are also different types of compression stockings to treat different conditions. They do not only differ in size, length, or degree of compression, but also in the type of fabric and thus, the way they exert the pressure. To try to purchase a compression stocking in the pharmacy without an appropriate prescription from the doctor would be similar to enter the pharmacy and asking for a “pill”. Which medication would we be actually ordering, provided that there are hundreds of different pills? Same happens with these garments, as there are dozens of different models, every one of them designed to treat a different condition. So not all the compression stockings are equivalent, nor whichever of them can be used to treat the problem of a specific person.

Therefore, it is not a good idea to go buy the first one you see, but rather visit a doctor specialized in these issues, who should know which one needs to be prescribed.

A frequent complaint among patients to whom this garment has been prescribed, is that they find difficulty in putting it on. It is true that, as this is a compressive garment, it has to be so tight to the foot and leg that sometimes it’s not that easy to put on, especially when trying to cross the ankle joint. This might be even more complicated in elderly people, patients with problems in their hands or finger joints (they cannot grab them firmly) or in their backs (they cannot bend enough to put them on).

In order to collaborate in these issues, several aid devices have been developed, some of them really ingenious, which help a lot on this task. Just as an example, I will show you few images corresponding to some of these aids, and a video explaining how to use one of them. Usually, these aid devices for compression stockings placement can be ordered at the pharmacies or the orthopaedic distributors (depending on the country).

Below you will find the official video from SIGVARIS®, which shows how easy is the use of this device both to put the stockings on and to remove them:

If conservative treatment is done properly, it is possible to control and reduce symptoms in most cases, slow down the development or growth of varicose veins, and prevent their complications; but we can never expect the varicose veins to go away or heal only with conservative treatment. If our target is to remove the varicose veins, we need to use one (or more) of the invasive treatments, which I will begin explaining from next week.

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