Elastic graduated compression stockings: a complete guide.
How they work, the sizes available, how much they cost, how to wear them, and how to choose them correctly.
Elastic graduated compression stockings: what are they?
Elastic graduated compression stockings are garments for the lower limbs, characterised by an elastic mesh that compresses around the leg.
These garments are designed to exert a non-uniform compression on different points (and this is why the compression is said to be “graduated”).
The pressure is exerted on a decreasing scale from low to high, i.e. from the ankle (where the compression is greater), to the thigh (where the compression is lighter).
There are three types of product on the market that are often confused under this unique name. There are:
graduated compression stockings for medical and therapeutic use,
preventive elastic stockings, for use in your free time or at work (also known as “support stockings”),
elastic stockings for sports.
The intended uses of these products can be distinguished by:
- the product’s shape (in particular the degree of compression exerted),
- the materials used,
- and, obviously, the aesthetic appearance.
Graduated compression stockings: what do they do?
The underlying principle of these three different product types is the same: that of “graduated compression”.
According to in-depth hemodynamic studies, graduated compression stockings help the correct upwards flow of blood from the legs towards the heart. The advantage of this micro-massage is that it helps to prevent the stagnation of fluids, varicose veins and promotes muscle oxygenation.
The task of these particular stockings is to stimulate and promote venous blood circulation from the legs to the heart, thereby avoiding the onset of problems related to “venous insufficiency”, such as inflammation of the veins, varicose veins and similar pathologies.
In order to ensure improved blood flow, the compression must be “graduated”: the compression exerted by the stockings on the walls of the blood vessels has to decrease from lower to higher (i.e. there needs to be higher compression on the foot and ankle compared to on the knee, in order to make it easier for the blood to rise).
Obviously, at every stage of the condition there must be a corresponding suitable level of compression, therefore it is crucial to know the types of different products to understand the personal need of each individual.
It is important to remember that these are not simply “tight stockings”, or stockings that are particularly “skin-tight”: these are genuine medical aids designed with care to prevent or treat – through the different degrees of compression exerted on the walls of the blood vessels – possible leg conditions that can develop completely naturally.
Leg problems due to poor circulation: symptoms and warning signs
Veins are blood vessels that have the task of carrying blood from the tissues (for example, from the legs) to the heart. They are equipped with elastic fibres and valves which, due to their closing mechanism directed towards the heart, prevent the downward flow of blood, as they only open for blood that flows towards the heart.
When, for the following reasons, the function of these valves is compromised and they can no longer close properly (“valve incontinence”), allowing the blood to fall back downwards, the excessive blood pressure in the veins quickly leads to the formation varicose veins and consequent problems of varying severity and symptoms that can be more or less obvious.
Circulatory system disorders must definitely not be underestimated.
The first symptoms manifest themselves as a slight swelling of the ankles, which is usually thought to be due to atmospheric or long-standing foot conditions. The problems disappear quickly as soon as the legs are held in a raised position.
As the issues are aggravated, a feeling of congestion and pain, or of agitation, known as “restless leg syndrome”, will later emerge (for more information see Wikipedia).
These symptoms often do not appear at all in the initial stage, but they are the warning signs for possible and more serious problems.
Varicose veins: what causes them?
1. Historic reasons: human evolution
Leg vein problems are one of the most common disorders that have always afflicted mankind. Evidence from ancient China and Greek statues from the 5th century BC testify to the existence of these conditions since the dawn of civilisation.
When man’s ancestors decided to stand up tall, they were bound to face some problems due to their physical structure: the veins of the human legs and their internal valves were not able to withstand the long-term pressure of the blood which, in an upright position, weighed down on them.
Varicose veins prove this fact:
- animals – except for rare exceptions due to excessive selections – do not get varicose veins,
- they barely ever affect the upper limbs and upper parts of the body,
- and in general, they most frequently affect people who are forced to stand up for a long time.
2. Bad habits and predisposition
Issues of natural origin (and hereditary predisposition) are joined by bad habits or conditions that are typical of today’s civilised society, such as:
- a sedentary lifestyle (resulting in the inactivity of the leg muscles);
- being overweight and obese;
- overly tight clothing (which pose an obstacle to blood circulation in the superficial veins);
- shoes that are too low or heels that are too high;
- exposure to heat;
3. Physiological reasons
From a functional point of view, the veins of our circulatory system have the task of bringing blood from the tissues back to the heart, and form the main storage place of blood. As the pressure in the venous system is very low, the walls of these vessels are thin but equipped with a muscle layer that allows them to contract or expand according to the body’s needs.
The blood pressure in the veins gradually reduces from the feet up to the heart. In a person standing upright, the difference in blood pressure between the lower and upper parts of the body can cause significant problems, especially if they are in particularly problematic areas:
- the heart,
- the vein valves,
- the leg muscles,
- the elasticity of the vein walls.
Of great importance in the development of these problems is, in particular, the tonicity of the vein walls (their “elasticity”), which, together with the valves contained in the veins, prevents the decrease in the amount of blood in the legs.
When activating the leg muscles (when running or walking), the muscles compress the tissues and veins and push the blood towards the heart.
The natural consequence of problems with these organs is an increase in venous pressure in the legs, which can lead to chronic venous insufficiency or poor circulatory efficiency.
In an adult stood upright and completely still, the venous pressure at the feet is approximately +90 mm/Hg, simply because of the weight of blood present in the veins between the heart and the feet.
The standing pressure at the feet of a person standing upright would therefore always remain at +90 mm/Hg if there were no valves in the veins.
Following every, even tiny, normal movement of the legs, the muscles exert pressure on the veins of the lower limbs. The blood contained tends to be “squeezed” out of the compressed areas.
The vein valves are made in such a way that the blood can only flow towards the heart. Therefore, whenever a person moves their leg or makes their muscles work in any way, a certain amount of blood is pushed towards the heart and the pressure of the corresponding veins becomes lighter, preventing drainage and therefore the return of the blood to the lower parts of the body, avoiding oedemas and swelling.
This pump system, called the “Venous pump”, or “Muscle pump”, is so efficient that it normally maintains the pressure of the veins in the feet of a walking adult person below 25 mm/Hg.
If an individual is standing on their feet, absolutely still, the venous pump is not put to work and the venous pressure in the lower parts of the legs can rise rapidly, up to the actual value of 90 mm/Hg, in about 30 seconds.
In these circumstances, the pressure inside the capillaries also greatly increases, and a certain amount of fluid escapes from circulation to interstitial spaces. This results in a swelling of the legs and a decrease in blood volume. Vein and capillary pressure increases greatly due to the inefficiency of the venous pump, resulting in a constant oedematous state in the legs each time the affected person stands for more than a few minutes. In fact, by standing absolutely still and upright, the volume of blood can decrease by 15-20% within the first 15 minutes.
Unfortunately, veins “wear out”, and valves lose their tightness. In the case of pathological conditions, the valves of the venous system can, in fact, disappear. This especially occurs when the veins have undergone an excessive and prolonged increase in venous pressure, as can occur during pregnancy, or when standing for a long time.
When such a condition occurs, venous pressure in the leg increases, dilating the veins further and ultimately eliminating the valve function completely. In this way, varicose veins are formed, characterised by large bulbous protrusions of the subcutaneous veins of the whole leg, and in particular the sloping parts.
The resulting oedema in turn hampers the proper diffusion of nutrients from the capillaries to the muscles and the skin, so that the muscles become weak and sore, while the skin often becomes necrotic and finally ulcerates.
The best immediate treatment in these cases is to keep the limbs raised at the height of the heart, but the application of elastic stockings can be very beneficial to prevent oedema and its subsequent consequences.
Varicose veins: what are they?
Varices (or varicose veins) are any veins that are abnormally dilated.
Because of the congestion of the blood, which struggles to flow from the legs upwards towards the heart, the tissues of the lower limbs become severely damaged. In the walls of the blood vessels, a progressive formation of connective tissue deposits may occur, and if the pressure increase does not cease, elongated and sinuous veins take the form of a sack or tube, commonly called varices (varicose veins), which in 95% of all cases are visible on the legs.
“Varicose veins” are just the symptom of a vein disease, so the severity of these symptoms is by no means proportional to the extent and intensity of the alteration affecting the veins. Often other symptoms also develop alongside varices:
- dark patches on the skin due to red blood cells leaking out of the dilated veins, which are not normally present in the tissues;
- a feeling of heaviness, congestion and pain in the areas of varicose veins after standing upright for a while;
- night cramps;
If the triggering factors continue to act, chronic venous insufficiency begins its course and can lead to the most severe cases of Ulcus cruris (leg ulceration), commonly referred to as “leg sores”.
Varices can be divided into two types:
- Primitive varices that develop spontaneously: primitive varices are due to a constitutional weakness of the parietal structure of the vein, which is unable to withstand the pressure increases due to the upright position. These varices often run in the family, and are hereditary. One of the most important causes of their formation is poor development of the venous valves.
- Secondary varices due to venous obstruction: secondary varices are formed as a result of the obstruction of the deep veins. The veins of the legs are composed of superficial veins (located just under the skin), and deep veins (located in the lower part of the leg). Both have the task of carrying blood from the legs to the heart. When a thrombosis – that is, the closing of the vein due to an embolism (blood clot) – blocks the deep veins, the network of superficial veins, the only one that can then be used, is overloaded, causing distension and valve failure. Secondary varicose veins therefore represent the effort made by the superficial veins, which are subjected to a significant increase in pressure, to maintain collateral circulation.
The complications of varicose veins are the following:
- thrombophlebitis: an inflammation that affects small veins and capillaries, obstructs large veins, and finally destroys the valves;
- chronic venous insufficiency: increased blood pressure that reaches high figures when standing upright and therefore increases fluid stagnation and venous congestion (causing oedema and poor blood supply near the capillaries, muscles, joints, and skin).
All this is no more than the onset of a pathology that is constantly increasing and difficult to cure if it is not diagnosed and treated in time. The most obvious symptomatology is therefore characterised by the appearance of bluish or reddish “small capillaries” associated with tingling or itchiness, and heaviness of the limbs with swollen ankles.
Inflammation of the veins: chronic venous insufficiency and travel-related thrombosis
In dilated segments of the veins, the speed of the blood flow often decreases considerably. As a result, white blood cells and platelets cluster and emit substances that cause an inflammation that spreads rapidly along the vein wall.
Sometimes thrombosis may also occur in these conditions. When a clot becomes detached from the walls of a vein (even a deep vein in the legs) this can quickly reach the heart and, from there, the lungs. In the lungs, the clot remains trapped in thin capillaries. The obstruction of a pulmonary artery is called a “pulmonary embolism” and in many causes can lead to death.
The extreme danger of thrombosis in the deep veins of the legs is confirmed by a high mortality rate due to pulmonary embolisms: in Germany, they cause about 30,000 deaths every year.
In the case of long journeys by plane, car, or coach, the lack of movement and the sitting position with crossed legs causes increased blood congestion (the so called “economy-class syndrome”), which poses the risk of forming an embolism.
For this reason, on long journeys it is recommended to:
- take O-ß-Hydroxyethyl-Rutoside prior to travelling (in the form of tablets to be taken one week before travelling to improve circulation),
- use containment or compression stockings, which help to promote blood flow from the legs to the heart.
Depending on the maximum degree of compression exerted (at the heel), stockings can be divided into compression classes.
The international reference standard RAL GZ 387 provides the following subdivisions:
|CLASS||Type of compression||Compression exerted at the ankle|
|CLASS 1||Light||18-21 mmHG|
|CLASS 2||Moderate||23-32 mmHG|
|CLASS 3||Strong||34-46 mmHG|
|CLASS 4||Very strong||49 mmHG e sup.|
Elastic stockings and cellulite
A good blood supply ensures adequate nutrition for the surrounding tissues; if this is not present, the blood tends to stagnate in the capillaries present in the fatty tissue, thereby decreasing the nutritional functions.
This process favours a slow but inexorable degeneration of the fatty tissue that then becomes cellulite.
Unfortunately, we have lost the habit of activating all the mechanisms that allow normal physiological evolution to overcome this problem. The main cause is due to the nature of our professions, which force us to stay standing for hours or, the reverse, to sit down all day.
This is why there is a need for a preventive elastic stocking such as the “support stocking”, which is able to contain and therefore promote a certain elasticity for venous flow. This structure guarantees a continuous micro-massage even with the slightest movements of the limbs, thereby facilitating constant lymphatic drainage and blood flow, thus obtaining a more effective gaseous exchange at the tissue level, restoring tonicity and lightness to the legs.
The “preventive” aspect should not be underestimated, even in young people who are free from any pathological form. In this case the use of support stockings creates a stimulating effect aimed at protection and wellbeing.
Graduated compression stockings for medical and therapeutic use
1. Types of medical stockings and how to use them
This category includes:
anti-embolism stockings – for prophylaxis of thrombus embolisms (often called “anti-embolism”, “anti-thrombus”, or “anti-thrombosis”, or more commonly “anti-blood clot” socks);
therapeutic stockings – designated for the most important venous pathologies (available in Class I, Class II, open-toe, and closed-toe);
anti-ulcer stockings – an ulcer is a laceration in the epidermis of the lower legs, which arises as a consequence of a particularly acute phase of chronic venous pathologies affecting the lower limbs. Unlike the previous types, the anti-ulcer stockings are commonly knee-high, and are worn in pairs together one over the other (and are therefore called a “kit”).
Doctors and, in particular, surgeons, often require them to be worn before, after, or even during surgical procedures.
Due to the principle of graduated compression, these garments help to prevent increased blood viscosity and the formation of blood clots.
They are characterised by different lengths depending on the need, therefore the following variants are available:
knee-length graduated compression stocking (extending from the tip of the foot to the bottom of the knee),
thigh-length graduated compression stockings (extending from the tip of the foot to above the knee),
full-length stockings (extending from the tip of the foot to above the knee and equipped with an adjustable waistband)
2. 2. Materials and composition of therapeutic stockings
This type of stocking is mainly composed of Polyamide and Elastane yarns. These materials offer several advantages, and must both be present in order to offer a user-friendly, easy-to-wash product, with an absolute degree of compression from the very first use that does not change over time (normally: 18-20 mm/Hg at the ankle).
These materials are used in order to obtain the highest degree of hygiene, to guarantee greater compressive treatment, and especially – in view of the maximum elasticity offered with respect to other types of stockings – so that the stocking can be easily worn under critical conditions such as in the case of patients who have undergone surgery.
As a general rule, the yarn is characterised by a particular softness, and is hypo-allergenic as it does not contain latex.
They are traditionally white and, in almost all cases, have a lower inspection hole at the toes.
3. How to wear medical stockings
Wearing this kind of garment for the first time can- apparently – be more complicated than expected.
Measure the circumference of the leg to identify the correct size.
Turn the stocking inside out up to the heel.
Put on the first silk stocking.
With both hands, stretch the foot of the stocking and put your foot into it up to the heel.
Over the silk stocking, put on the previously rolled stocking, adjusting the position of the mesh with the palm of your hand, checking that the compression is uniformly stretched.
Pay attention to the heel.
Completely unroll the stocking and slide it to the correct position by positioning the mesh with the palm of your hand and without ever pulling directly on the top of the stocking*. Finally remove the silk stocking by pulling it up from the top.
Check that there are no wrinkles or creases that could cause irritation.
- For more information and a video tutorial on this topic, search our: “How to put on therapeutic medical stockings – Video tutorial“
Support stockings for free time and work
“Support” or “preventive” stockings are garments characterised by a degree of compression that is less than that used for hospital and sports use. This is because they are designed to be worn for long periods of time and to offer a sense of long-lasting comfort.
They are particularly suitable as a tool for recovering from fatigue after sport, but also – and especially – in occupations where people have to stand up for long periods of time: shop assistants, cashiers, hairdressers, nurses, chefs, waiters, and assembly line operators are but a few of the many professions that require standing for long periods.
A recent study published in the “Scandinavian Journal of Work, Environment & Health” entitled “Standing at work and varicose veins” reports that these pathologies include, first of all, varicose veins due to venous insufficiency – one of the top ten causes of hospitalisation in Denmark.
The high degree of softness of these garments is also due to the composition of the yarn, which is particularly rich in cotton (over 65%), making these stockings a perfect substitute for everyday stockings for both men and women.
Elastic stockings for sports use
Elastic stockings for sports – and, more generally, each graduated compression garment for sport use – are produced with yarns with exceptional breathability and thermal insulation properties.
This keeps the body temperature constant and is ideal for sport activities in all seasons.
Calze Sanyleg: technical characteristics
Thirty-years of experience in producing hosiery has allowed Sanyleg to produce specialist items of high technical quality, with particular attention to elegance, naturally combining two historically distant features of graduated compression stockings: wellbeing and style.
Sanyleg hosiery has been designed in minute detail to meet various needs and different uses.
These garments should ensure a proper compression gradient throughout the leg, with structural support to the venous system so as to restore the proficiency of the valve apparatus, promoting normal venous flow. By combatting increased pressure in the capillaries with its tensile strength, the elastic stockings prevent the formation of oedemas, due to the graduated compression mechanism.
How do you achieve graduated compression in practice? Through a caliber reduction, ideal for an increased flow rate with reduced viscosity. And this is how it relates to the specific support function from the elastic stockings.
At this point, you can truly understand how important and difficult it is to invent, design, and carefully produce high-quality elastic stockings that are able to cope with all these physiological dynamics when faced with such an important and delicate pathology. In fact, it should be pointed out that when an elastic stocking does not perform all its functions at its best, i.e. when the graduated compression is not calculated with suitable parameters, or when the yarn type is of poor quality, their function fails. Or, in most cases, the exact opposite effect is obtained, preventing normal blood flow and promoting oedema formation, slowly leading to the degeneration of vein tissues.
Sanyleg: quality has a history
At the beginning of 1992, Sanyleg invested a great deal to gain an in-depth knowledge of these issues. At the time, the company had been producing high-quality manufactured elastic stockings for many years, with several more functions than those of their competitors. After enhancing its Research and Development department it started specifically studying the product, which would provide a greater guarantee and more benefits.
By carefully analysing the garments produced by competitors present and widespread throughout the market, Sanyleg found that in many cases the elasticity of the mesh was totally inadequate and unsuitable for the pathology for which the products were required, thereby in many cases even having a counterproductive effect.
The main aspect of making a high-quality product was to define and calculate the different degrees of compression the stocking should offer.
In order to achieve this, several parameters and different tools existed. But of course, it was necessary to bear in mind that there are different types of people: tall and thin; tall and stocky; short etc. It was therefore impossible to create an exact circumference value, and therefore compression, for every single person. It was not technically possible to create customised elastic stockings using the technology of the time. This is why we introduced new solutions that have allowed us to definitively resolve all problems. How?
We used high quality yarns and an electronically measured decreasing compression parameter.
With the use of fine yarn, we have achieved an active elasticity in every degree and at every point of reference, guaranteed by an extreme wearability and softness at the same time.
To highlight this aspect, just take two crucial details for a stocking: the gusset and the back of the waistband; by extending it with force, it highlights one of the key features of this product. The differentiated compression along the leg was calculated with extreme care and adjusted on the basis of continuous tests and trials performed by competent people and experts in this pathology.
Obviously, we also put a lot of thought into the top part of the stockings, guaranteeing comfortable underwear at all points, with great adaptability depending on different types of people, due to a shaping membrane formed by a combination of yarns that together form a waistband that is both very comfortable and robust.
This type of “underwear” (formerly known more appropriately as “underpants”), detects, with absolute elasticity, every variation of the shape of the hips and buttocks, adapting to them carefully, generating a simple feeling of wellbeing, promoting lymphatic and blood drainage.
To carry out this process in the best way possible, a high-edge waistband has been designed, avoiding an annoying and, in this case, counter-productive narrowing in the most delicate parts.
The quality supply chain: the idea, design, and creation
At Sanyleg, we believe that we have achieved the production of garments designed with serious and conscious responsibility, aimed at an ever-wider public due to the particular historic moment we find ourselves in.
Investment in precious materials has allowed us to obtain graduated compression stockings with significant characteristics even as far as the aesthetic appearance is concerned.
The new type of “honeycomb” design ensures a very elegant mesh, different from the old elastic stocking concept.
The uniformity of the fabric identifies and is typical of a high fashion product, with an unmistakable softness.
In order to achieve elegant comfort, all the stockings are produced with a “genuine heel”, ensuring perfect grip and compression.
Even the most demanding customers have finally found a product that can satisfy – and exceed – all expectations. They are our best form of advertising.
Warnings and safety information
The following are some instances in which the use of elastic stockings for medical use is not recommended, in particular in the case of:
- localised dermatitis, erythema, necrosis
- vein stripping, pulmonary oedema, grafts
- vascular heart disorders
- legs with a wide girth
Pursuant to the New Guidelines of the Italian Ministry of Health of 28/03/2013 concerning health advertising for medical devices, in-vitro diagnostic medical devices, and medical surgeries, the user is advised that the information contained therein is directed exclusively at professional operators.
Compressive stockings for medical use have a maximum usage time of 6 months. Do not exceed the expiry date stated on the packaging.
If you would like more information about the products or to learn more on this subject, feel free to contact us: email@example.com