Stockings Clinic

Graduated pressure profile

Compression is highest at the ankle and decreases progressively up the leg toward the thigh. This gradient, typically around 100% of the prescribed pressure at the ankle tapering to roughly 40% at the top of the stocking, mimics and augments the natural pumping action of the calf muscles.

Supporting venous return

Veins in the legs rely on one-way valves and the calf muscle pump to push blood back toward the heart against gravity. In venous disease, damaged valves let blood pool and reflux downward. External pressure narrows the veins, helps the valves close more effectively, reduces reflux, and improves the efficiency of the muscle pump with each step.

Reducing capillary filtration

The same external pressure reduces the pressure gradient across capillary walls, limiting the amount of fluid that leaks into the surrounding tissue. This is central to controlling swelling (oedema) in both venous disease and lymphoedema.

Improving lymphatic drainage

Compression assists the lymphatic vessels, which like veins rely partly on external tissue pressure and muscle movement to move fluid, helping to shift protein-rich lymphatic fluid out of swollen tissue.

Chronic venous insufficiency

Ranging from spider veins and varicose veins through to venous eczema, lipodermatosclerosis and venous ulceration, this is the most common indication for compression therapy.

• Symptom control: reduces heaviness, aching, throbbing and leg fatigue that build through the day, particularly with prolonged standing or sitting.
• Swelling and skin changes: limits fluid leakage into the tissues, reducing ankle and lower leg swelling and slowing the skin changes of long-standing venous hypertension.
• Ulcer prevention and healing: one of the few interventions with strong evidence for both healing existing ulcers and preventing recurrence.
• Adjunct to intervention: used before and after open surgery, endovenous ablation or sclerotherapy, and as part of ongoing management once reflux has been treated.

Lymphoedema

Swelling caused by impaired lymphatic drainage, whether primary (congenital) or secondary (for example following cancer surgery, lymph node removal or radiotherapy), is managed differently to venous disease, but compression is equally central.

• Maintenance of reduction: after intensive treatment phases (manual lymphatic drainage, multilayer bandaging), well-fitted garments keep limb volume down and stop fluid re-accumulating.
• Higher, more sustained compression: firmer classes are often needed, worn for longer periods and in some cases overnight, under specialist guidance.
• Custom and made-to-measure options: irregular limb shapes or volume differences between limbs frequently call for custom garments rather than off-the-shelf sizes.
• Skin protection: compression protects fragile, swollen skin from injury and reduces the risk of cellulitis.

Acute DVT

• Symptom relief: once appropriate anticoagulation is established, properly fitted compression can reduce leg pain and swelling in the acute phase.
• Reducing post-thrombotic complications: early, appropriately timed compression alongside anticoagulation may reduce the risk and severity of post-thrombotic syndrome.
• Careful timing and assessment: compression in the acute setting, and the pressure used, needs individualised medical assessment including confirmation of adequate arterial supply. Inappropriate compression on an acutely swollen or compromised limb can cause harm.

Chronic DVT and post-thrombotic syndrome

• Long-term symptom control: a mainstay of management for chronic swelling, heaviness and discomfort after DVT.
• Skin and ulcer protection: helps protect skin integrity and supports healing where venous ulceration has developed as a consequence of past DVT.
• Ongoing, often lifelong, use: many patients with significant post-thrombotic changes need compression indefinitely, with garments reviewed and replaced regularly as they lose elasticity.

Precise limb measurement

Accurate measurement at specific anatomical points, typically ankle circumference, calf circumference and leg length, and for thigh-high or custom garments, thigh circumference and additional lengths. These determine both stocking size and, in many cases, the achievable compression gradient.

Professional fitting

Fitting is best performed by trained staff experienced in compression garment selection, who can assess limb shape, skin condition and any areas of concern, and select the appropriate style, class and size accordingly.

Reassessment over time

Limb dimensions change with treatment response, weight change, fluid status or disease progression, so garments should be remeasured and refitted periodically rather than assumed to remain correct indefinitely.

Garment lifespan

Compression garments lose elasticity with regular wear and washing. Most require replacement every three to six months of regular use to maintain their therapeutic pressure.