How do I choose the correct size of compression stockings and what does the size 455-44-22 represent?

How to Choose the Correct Size of Compression Stockings

Compression stockings should be properly fitted by measuring specific leg dimensions—typically calf circumference and leg length—to ensure appropriate pressure delivery and avoid complications such as venous pooling or skin ulceration. 1

Understanding Compression Stocking Sizing

Standard Sizing Parameters

• Measure calf circumference and leg length to select from manufacturer size charts, as noncustom stockings can effectively deliver graded compression in mesomorphic patients when chosen by these two measurements 2
• Ankle circumference is also measured by some manufacturers to ensure proper pressure at the critical ankle region where maximum compression (typically 20-30 mm Hg or 30-40 mm Hg) should be delivered 3, 4
• Custom-tailored stockings are not necessary for most patients, as properly sized noncustom, low-modulus, circular-knit stockings deliver equivalent compression and venous velocity improvements 2

The "455-44-22" Notation

This appears to be a manufacturer-specific sizing code that likely represents measurements in millimeters or centimeters for different leg segments. While not a universal standard, such codes typically indicate:

• First number (455): Possibly leg length or total stocking length
• Second number (44): Likely calf circumference
• Third number (22): Likely ankle circumference

Contact the specific manufacturer for their sizing chart interpretation, as there is no standardized universal sizing notation across compression stocking brands 3

Critical Fitting Considerations

Pressure Requirements by Indication

• For occupational leg swelling prevention: Stockings exerting 11-21 mm Hg pressure are sufficient to reduce or prevent evening edema 4
• For varicose veins and VTE prophylaxis: 20-30 mm Hg compression at the ankle is the standard therapeutic range 1
• For post-venous ablation procedures: 30-40 mm Hg compression is recommended immediately post-procedure 5
• For air travel DVT prevention: Both 10-20 mm Hg and 20-30 mm Hg ranges have been studied, with below-knee stockings being standard 1

Avoiding Dangerous Fitting Errors

• A stocking too tight around the knee can prevent essential venous return, causing blood pooling around the knee and paradoxically increasing DVT risk 1
• Excessive tightness can cut into skin on prolonged wear, potentially causing ulceration and increased DVT risk rather than prevention 1
• Insufficient pressure gradient (less than 20% reduction from ankle to calf) renders stockings ineffective, as one tested brand showed only 8% gradient compared to the recommended 20-50% reduction 3

Practical Fitting Protocol

• Wear stockings around the house prior to travel or extended use to ensure good, comfortable fitting and identify problems before critical need 1
• Verify that ankle pressure is within the stated range (e.g., 20-30 mm Hg), but be aware that calf pressure often falls below stated ranges—in one study, all but one brand measured below 20 mm Hg at the calf despite being labeled as 20-30 mm Hg stockings 3
• Check for proper length: Thigh-high stockings may be preferable to knee-high based on indirect evidence from stroke patients, though below-knee stockings are standard for most indications 1

Stocking Length Selection

• Below-knee (knee-high) stockings are the standard for most indications including air travel, occupational edema, and varicose veins 1, 4, 6
• Thigh-high stockings showed no benefit over below-knee stockings for DVT prevention in stroke patients and increased skin complications 1
• For stroke patients specifically: Graduated compression stockings (either length) are not recommended as they increase skin damage without preventing DVT 1

Brand and Cost Considerations

• Significant variability exists between manufacturers in both absolute pressures delivered and pressure gradients, even among stockings with identical labeling 3
• Lower-cost generic brands provide compression equivalent to expensive brands, with discount stockings offering similar absolute compression and pressure gradients 3
• Manufacturing standards in the United States are inadequate, and current labeling requirements do not mandate complete pressure disclosure at multiple leg locations 3

Common Pitfalls to Avoid

• Do not assume labeled pressure is accurate: Testing shows significant deviation from stated compression values, particularly at the calf level 3
• Do not use compression stockings as sole VTE prophylaxis in high-risk hospitalized patients: Pharmacologic prophylaxis is superior, and stockings may cause harm (skin damage) without benefit in certain populations like stroke patients 1
• Do not apply stockings to patients with peripheral vascular disease, dermatitis, skin breakdown, or recent lower-extremity bypass without vascular consultation 1
• Do not expect deep vein diameter reduction from stockings alone in standing position: Compression stockings do not reduce deep vein diameter when standing; reduction occurs only with weight-bearing muscle contraction 7