Compression stockings and varicose veins: A practical guide

If you have been diagnosed with varicose veins, or you are experiencing symptoms such as aching, heaviness or swelling in your legs, your doctor may recommend compression stockings. They are a well-established way to help manage symptoms and for many people they can provide meaningful relief.

Compression stockings only work well when they are fitted correctly and are used in the right way. If they don’t fit properly, they can be uncomfortable and ineffective, which is why understanding how to use them can make a difference.

In this article, we explain how compression stockings work, how to measure for the correct sizing, how to use them day to day and how to avoid common problems. We also explain when compression stockings may not be effective enough on their own, and what your treatment options might look like at that stage.

If you are experiencing severe pain or swelling in one leg, shortness of breath, or chest pain, call 111 or go to your nearest A&E immediately, as you may need urgent medical attention.

 

 

What are compression stockings and how do they work?

 

Compression stockings are specially designed garments that apply a controlled level of pressure to the legs. Unlike ordinary socks or tights, they are made with graduated compression, meaning the pressure is greatest at the ankle and gradually reduces up the leg. This design works with gravity to help the veins in your legs push blood back up towards the heart more effectively.

In varicose veins, the valves inside the veins are not functioning as effectively as they should, which causes blood to pool rather than flow upwards. Compression stockings can help to compensate for this by providing external support to the vein walls, reducing the pooling that causes symptoms such as aching, heaviness, swelling and the visible appearance of veins.

It is important to understand that compression stockings help manage symptoms rather than treat the underlying cause. They do not repair or close faulty vein valves, and this means they are a symptom management tool rather than a cure. Compression stockings are particularly useful in the earlier stages of varicose vein problems or when treatment is being planned.

 

 

Who are compression stockings suitable for?

 

Compression stockings are suitable for a wide range of people, including:

• People with varicose veins who are experiencing symptoms such as aching, heaviness, swelling or itching
• Pregnant women experiencing varicose veins during pregnancy, where treatment is not appropriate until after birth
• Women with vein changes after pregnancy, while waiting for vein symptoms to settle
• People who stand or sit for long periods as part of their work and wish to reduce the risk of symptoms worsening
• People who are waiting for vein treatment and want to manage symptoms in the interim
• People who have had vein treatment and have been advised to wear compression stockings as part of their aftercare

Compression stockings are not suitable for everyone. They should not be used for significant arterial disease affecting the leg, as the compression can further reduce blood flow. Your doctor will confirm whether they are appropriate for you based on your condition, personal circumstances, lifestyle and medical history.

 

How to measure for the correct size

 

Sizing is the single most important factor in whether compression stockings will work well for you. A stocking that is too loose will not apply enough pressure to be effective and one that is too tight can be uncomfortable, restrict circulation and potentially cause harm. Therefore, measuring yourself for the right size is essential.

 

What to measure

It is recommended to use a tape measure and record all the following measurements in centimetres to correctly size compression stockings:

• Ankle circumference: Measure around the narrowest part of your ankle, just above the ankle bone.
• Calf circumference: Measure around the widest part of your calf.
• Leg length: For a below-knee compression stocking, measure from the floor or the bottom of your heel if seated to just below the back of your knee. For a thigh-length compression stocking, measure from the floor to the crease in your groin.
• Thigh circumference: If you need a thigh-length stocking, measure around the widest part of your thigh.

Most compression stocking manufacturers provide a sizing guide based on these measurements, and your GP, pharmacist or vein specialist can help you interpret them to identify the right size.

 

When to measure

Always measure your legs in the morning, before you have been on your feet for a significant period. Leg swelling can increase throughout the day, so measurements taken later will be larger and may result in a stocking that feels too loose in the morning and too tight at night.

 

Compression class

Compression stockings are available in different levels of compression, measured according to their pressure in millimetres of mercury (mmHg). The most commonly used classes in the UK are:

• Class 1 (14-17 mmHg): mild compression, may be suitable for mild varicose veins and minor swelling.
• Class 2 (18-24 mmHg): moderate compression, usually recommended for more significant varicose veins, moderate swelling and during pregnancy.
• Class 3 (25-35 mmHg): strong compression, may be used for severe varicose veins, significant swelling or venous leg ulcers, usually prescribed by a specialist.

Your GP or vein specialist will advise on the compression class that is appropriate for your symptoms and condition. You should not assume that a higher compression class is better, as using a class that is too high without professional guidance may not be appropriate for your situation, cause discomfort, or worsen your condition.

 

 

Tips for daily use

 

Put compression stockings on first thing in the morning

The most effective time to put on compression stockings is immediately after you wake up, before you get out of bed or spend time on your feet. At this point, any overnight swelling should have reduced, the stockings will be easier to put on, and they can provide compression from the start of the day.

 

Use a donning aid if needed

Compression stockings can be difficult to put on, particularly if you have limited dexterity, are pregnant, or are using a higher compression class. There are devices known as donning aids that can help make the process significantly easier, such as rubber-coated gloves that improve grip, or frame-based devices that hold the stockings open while you step in. Donning aids are widely available from pharmacies.

 

Smooth out any wrinkles

Once you have put on your stockings, take a moment to smooth out any wrinkles or folds, particularly around the ankle and behind the knee. Wrinkled compression stockings can create pressure points that cause discomfort, skin marks or, in some cases, skin damage in the area of the crease. The stocking should fit smoothly and evenly along the full length of the leg.

 

Wear them throughout the day

For compression stockings to be effective, they should be worn consistently throughout the day, not just for a few hours. You can take them off when you go to bed, unless your doctor has specifically advised otherwise. Most people find it helpful to establish a routine, for example, putting them on as soon as they wake up and taking them off before bed.

 

Maintain the quality

You can wash compression stockings after each day’s wear according to the manufacturer’s instructions, usually by hand or on a gentle machine cycle with a mild detergent. Do not tumble dry them, as heat can damage the elastic fibres and reduce the level of compression they provide. Having two pairs allows you to rotate them, extending their use. Most compression stockings will need replacing every three to six months as the elastic gradually loses its effectiveness.

 

 

How to avoid common problems

 

Incorrect sizing

Incorrect sizing is the most common reason why compression stockings fail to work well. If your stockings feel consistently painful or leave deep indentations in the skin, they may be too small. If they feel loose, slip down, or do not seem to be providing any noticeable support, they may be too large. In either case, re-measure your legs in the morning, check the manufacturer’s sizing guide, or ask a pharmacist or your specialist for help.

Stockings slipping down is a common complaint, particularly with thigh-length stockings. It usually happens because the stocking is too large at the top, or the silicone grip band at the top has worn out. If you are using the correct size, the top of the stocking should fit snugly but comfortably on the thigh. Stocking suspender belts are also available if slipping is a persistent problem.

 

Discomfort from heat

Compression stockings can feel uncomfortably warm, particularly in summer or in heated environments. Choosing stockings made from lighter, breathable materials can significantly help, and many manufacturers now produce open-toe or cotton-blend options. Cooling the legs with a cool, not cold, damp cloth before putting on your stockings and choosing lighter colours may also reduce heat-related discomfort. If this is a persistent problem for you, speak to your GP or vein specialist, as this may indicate that the compression class you are using is not appropriate for your lifestyle.

 

Difficulty putting them on

Many people find compression stockings hard to put on, particularly in higher compression classes. The most practical solutions are turning the stocking inside out to the heel, placing your foot in, and then rolling it up over the leg, rather than pulling it up from the top, or using a donning aid. If putting on your stockings is difficult or if this is causing you distress, speak to your GP or specialist, as there may be an alternative product or compression class that is easier to manage.

 

When compression stockings are not enough

Compression stockings are a valuable tool for managing varicose vein symptoms, but they do not address the underlying faulty vein valves that allow blood to pool. For many people, particularly those with more significant or progressive vein changes, long-term symptom management with stockings alone is not sufficient.

We would recommend speaking to a vein specialist if:

• Your symptoms are not adequately controlled by compression stockings
• Your varicose veins are visibly worsening despite wearing stockings consistently
• You are developing skin changes around your lower legs or ankles, such as discolouration, itching or hardening
• You have a varicose vein that has become hard, painful or inflamed
• You are concerned about the appearance of your veins and would like to understand your treatment options
• You have finished breastfeeding following a pregnancy and your vein symptoms have not resolved

Modern vein treatments are minimally invasive and have shorter recovery times. Your initial consultation at Revela Clinic includes a full assessment with our specialist and an ultrasound scan of your veins, to give you a clear picture of your condition and the treatment options suitable to you. To find out more about the treatments available, watch our video FAQs.

 

 

Understanding your next steps

 

At Revela Clinic, we understand that living with varicose vein symptoms can be tiring, and compression stockings can be helpful, but they do not address the underlying cause. Our team will take the time to understand your symptoms and goals, explain your options clearly and support you from your first consultation through to recovery. If you would like to discuss whether treatment might be right for you, book a consultation with us today.