Venous Insufficiency: a Guide to Compression Stockings
Venous insufficiency is a common yet overlooked condition that affects 40% of women and 25% of men in Canada.
A lot of people may be experiencing aching or swelling in the legs and not even know what is causing it. Fortunately there is a way to manage these issues, with the easiest (and most stylish) solution being compression stockings. Let's dive into the topic of venous insufficiency and explore how compression stockings, and other solutions can provide relief from these symptoms and improve daily function.
What is venous insufficiency?
Healthy veins in our lower extremities are sturdy and flexible with valves throughout them. These valves allow for one way travel of blood, ensuring your blood is continuously flowing away from your legs and back towards your heart.
Our calf muscles surround veins in the lower leg and when we walk the muscle contraction act as a pump. With each step we take the muscles squeeze the veins, pushing the blood through these one way valves, back towards the heart. When the muscles relax, the valves prevent the blood from flowing back down towards the legs.
Venous insufficiency occurs when the vein wall weakens and the valves do not fully close. This will cause the blood to stagnate or allow gravity to pull the blood downwards towards the legs.
This is a chronic disease that can result in spider veins (clusters of small veins under the skin) or varicose veins (enlarged and twisted veins under the surface of the skin).
Common signs and symptoms of venous insufficiency:
- swelling
- the feeling of achiness and/or heaviness in the legs
In extreme situations, the stagnant blood in a dysfunctional vein can form a blood clot. This is known as deep vein thrombosis or a DVT. If this DVT gets dislodged, it can travel into the lungs, becoming a pulmonary embolism, blocking blood flow to the lungs.
Common signs and symptoms of a DVT:
- Calf pain,
- redness,
- warmth and swelling in the calf
Who is at risk for venous insufficiency?
There are a number of factors that can put you at a higher risk for developing venous insufficiency.
These risk factors include:
- Age - over 55 years old
- Genetics
- Pregnancy
- Obesity
- History of smoking
- Sedentary lifestyle
- Traveling/prolonged sitting
- Prolonged standing
- Previous DVT
Conservative treatment for Venous Insufficiency
Exercise:
Exercise is a great way to help manage your venous insufficiency. Earlier we talked about the calf pump that helps to ensure that the blood is flowing up towards the heart. Any exercises that involve working the calf muscles can help to make this pump more efficient. Some of the exercises would include:
- Ankle pumping
- Toe raise
- Cycling
- Walking
Exercise can also help with weight management which we know is a risk factor in developing venous insufficiency.
Elevation:
Elevating the legs throughout the day can help to reduce swelling in the lower extremities by allowing gravity to assist in returning blood to the heart.
Compression stockings:
Compression stockings are another common conservative treatment approach to manage venous insufficiency.
How does compression work?
Graduated compression is applied to the leg externally from a stocking. Pressure is stronger at the ankle and eases towards the calf. This graduated compression squeezes the leg and helps the blood to flow in the proper direction through the dysfunctional veins.
How do I know if compression is right for me?
There are many indications for why someone would choose to use compression stockings. There are also different kinds of stockings.
Medical grade compression stocking ranges from delivering a pressure of 20mmHg to 60mmHg. These stockings require a doctor's prescription. Medical grade compression is used for varicose veins, venous ulcers, painful and heavy legs, swelling, etc.
Over the counter compression socks are also available and deliver a pressure of 15-20mmHg. These do not need a prescription to purchase. The over the counter stockings are considered for more preventative uses. Some of these indications would include:
- Mild ankle swelling (potentially from an injury)
- Traveling (prolonged sitting)
- Pregnancy
- Having a job that requires prolonged standing (ie. nurse)
- Spider veins
Compression stockings are not for everyone. Contraindications to compression therapy would include some of the following.
- Arterial insufficiency
- Intermittent claudication
- Dermatitis and skin conditions that may be irritated further from the stocking
Medical grade compression socks need to be fitted specific to you in order to achieve the desired results. At Fit For Life Physiotherapy, our physiotherapists are trained through Sigvaris on how to properly fit compression stockings.
The consumer line products do not need to be sized by a certified fitter. You just need to know your shoe size and ankle circumference.
At Fit for Life Physiotherapy we carriy some compression socks from both the consumer line and medical grade line from Sigvaris. The medical grade compression socks may require a prescription from your family doctor and may be covered by your extended benefits.
If the type of sock, size or colour is not available in clinic, we can order specifically for you. Sigvaris offers an extensive collection of compression socks so your physiotherapist will work with you to find the sock that meets your specific needs.
If you are curious about compression stockings and how they might be able to help you, talk to your physiotherapist at your next appointment or contact us to book in a FREE 15 minute consultation to discuss with one of our physiotherapists.