Recommended Compression Stocking Dosing
Compression stockings with a pressure of 20-30 mmHg are recommended as first-line therapy for patients with venous insufficiency symptoms. 1
Compression Level Guidelines
The appropriate compression level depends on the severity of symptoms and underlying condition:
20-30 mmHg (moderate compression):
- First-line therapy for most patients with symptoms of venous insufficiency
- Recommended for ongoing prevention after healing
- Appropriate for patients with mild to moderate symptoms 1
30-40 mmHg (high compression):
- For patients with more severe symptoms
- For visible varicosities that don't respond to lower compression
- For post-thrombotic syndrome
- For venous stasis ulcers (inelastic compression at this level) 1
Application Recommendations
- Timing: Apply stockings first thing in the morning before edema develops 1
- Position: Compression should be primarily over the calf rather than just the ankle for improved effectiveness 1
- Duration: Wearing compression stockings for the entire day provides better edema control than half-day use, though partial-day use is still better than no compression 2
Style Selection
- Knee-high stockings: Sufficient for most patients with symptoms limited to below the knee 1
- Thigh-high or pantyhose style: Consider when symptoms extend above the knee 1
Special Considerations
Elderly patients (≥65 years): Lower compression (18-21 mmHg) may provide better wearing comfort, especially in those with foot deformities, arthritis, or rheumatism 3
Mixed arterial disease:
- For ankle-brachial indices between 0.6-0.9: Use reduced compression (20-30 mmHg)
- For ankle-brachial indices <0.6: Compression is contraindicated; arterial revascularization needed first 1
Evidence of Effectiveness
Even lightweight compression (8-15 mmHg) has been shown to significantly improve symptoms of discomfort, swelling, fatigue, and aching when worn regularly during waking hours 4. However, stronger compression provides better control of edema and is more effective for treating more severe venous conditions 5.
Compliance Considerations
Patient compliance is crucial for effectiveness. The French Society of Vascular Medicine survey found that most vascular medicine physicians prescribe compression therapy with an ankle pressure gradient of 15-20 mmHg (64.3%) or 20-36 mmHg (35.5%) 6, suggesting that moderate compression may be more commonly used in clinical practice to balance effectiveness with patient comfort and adherence.
Complementary Measures
- Regular walking and calf muscle exercises to improve venous return
- Leg elevation when sitting to reduce edema
- Weight management and skin moisturizing to maintain skin integrity 1
By following these evidence-based guidelines for compression stocking dosing, clinicians can effectively manage venous insufficiency symptoms while promoting patient comfort and compliance.