Marlin W. Schul, MD, RVT, DABVLM, is the lead physician at the Dothan, Alabama, location of Center for Vein Restoration. Board-certified by the American Board of Emergency Medicine, Dr. Schul is a part of many professional organizations, including VEIN Magazine (where he is the Medical Director & Advisor), Foundation for Venous & Lymphatic Disorders (current chair), American Vein & Lymphatic Society (immediate past president), serves as RUC advisor to the American Medical Association, and a member of the Alabama State Medical Association.
During this second in a three-part series, Dr. Schul discusses the importance of proper measurement to the success of compression stockings to relieve symptoms of vein disease.
Where can I get quality compression stockings?
Dr. Schul shares that merely one out of five of his patients report that the stockings purchased from a drug or big-box store gave them the relief they were seeking. That means approximately 80 percent of patients had a negative compression experience when purchased outside of a medical setting. Dr. Schul theorizes that compression stockings bought without a doctor’s guidance may not have the correct fit, measurements, dose or strength to do the job, or merely may be a poorly constructed garment which is extraordinarily common as so few companies make quality garments.
Start by asking: why do I need to wear compression?
Dr. Schul believes that identifying the right compression level for an individual starts with asking, “what do we need the compression for? If the purpose of wearing compression is related to a venous concern or any complication related to veins (such as blood clots or lymphedema), a healthcare professional should advise the patient on what compression garment is best for his or her unique conditions.
A doctor or doctor’s assistant custom measures the patient to ensure that the stockings fit correctly and are in the correct “dose” of compression to meet the wearer’s specific needs. Dr. Schul adds that not all compression applications involve a stocking and that alternatives to compression do exist. Ask a vein specialist if you are a candidate for these alternatives.
What is a dose of compression?
A “dose” of compression refers to the amount of strength or the firmness of the stocking. There are different levels of strength based on the needs of the patient. Dr. Schul explains that a lightweight dose of 15-20 mmHg is good for someone who is asymptomatic and wants to wear a compression stocking as a preventative measure during work
or travel. He describes a dose of 20-30 mmHg as the “wheelhouse” for patients experiencing symptoms of vein disease, including leg swelling, pain, heaviness, or fatigue. For patients with advanced vein disease symptoms, including skin changes and heavy swelling, a higher 30-40 mmHg dose of compression is needed. “In rare instances, we have to go beyond that,” he adds.
How is compression wear measured?
Knee-high compression stockings
To get the right measurements for appropriate compression, Dr. Schul explains that one “must understand what the smallest ankle size is, what the largest calf size is, and understand the height of the crease at the back of the knee (called the popliteal crease) to the floor for a knee-high garment.”
Dr. Schul warns that knee-high garments should go only to the top of the calf, never all the way to the knee, because it may roll. He cites this roll-down effect as the reason why people have trouble with compression. Dr. Schul admits that he has approached compression garment manufacturer executives to consider changing the product from a knee-high to calf-high garments to avoid the common confusion.
Thigh-high compression stockings
This garment requires a measurement of the circumference at the level of the buttock crease, and that corresponding height to the floor. This measurement is vital to getting the right fit to ensure a benefit to the wearer. If there is a mismatch between the ankle/calf/thigh relationship, there is a good likelihood that fit will be poor.
In addition, in the case of heavier legs, Dr. Schul recommends specific garments designed to fit ‘funnel shaped’ thighs. A silicone band is essential and the use of an adhesive at the skin level is often helpful.
Ask a vein professional if compression stockings are right for you
The vein doctors at Center for Vein Restoration (CVR) are the nation’s leading vein care experts. They can access your vein health and, if compression stockings are recommended, measure you for the perfect fit. You will not get this level of care and attention at the local pharmacy or big box store!
Call 1-800-FIX-LEGS or visit centerfrovein.com for more information or to schedule an appointment.