Risks of Improperly Fitted Compression Stockings
Compression stockings that are not properly measured and fitted can cause serious harm, including paradoxically increasing the risk of DVT, skin ulceration, and superficial vein thrombosis, particularly when stockings are too tight around the knee or upper calf.
Critical Risks of Improper Fitting
Increased DVT Risk from Tourniquet Effect
- If a stocking is too tight around the knee, it can prevent essential venous return, causing blood to pool around the knee rather than preventing thrombosis 1
- This tourniquet effect directly contradicts the intended purpose of DVT prophylaxis and creates a localized area of venous stasis 1
Skin Damage and Ulceration
- A stocking that is too tight can cut into the skin and potentially cause ulceration, especially during prolonged wear such as long flights 1
- In stroke patients, improperly fitted compression stockings significantly increased lower-extremity skin damage (RR 4.02,95% CI 2.34-6.91), representing 39 additional skin damage events per 1000 patients treated 1
Superficial Vein Thrombosis
- In varicose veins, improperly fitted stockings can cause constriction at the upper band, leading to superficial vein thrombosis in the knee region 1
- Four cases of superficial vein thrombosis in varicose veins at the knee region were documented as being compressed by the upper edge of the stocking in clinical trials 1
Specific Fitting Problems
Size-Related Issues
- Stockings come in different sizes and must be properly fitted to the individual patient's leg measurements 1
- In varicose legs, improperly sized stockings may fail to compress the long saphenous vein at mid-calf level even when supine, while simultaneously creating dangerous constriction at the upper band 1
Ineffective Compression When Standing
- Even properly measured 20-30 mmHg graduated compression stockings may not effectively compress superficial or deep veins in the standing position, though they work well when supine 2
- This highlights the importance of proper measurement in multiple positions to ensure adequate compression throughout daily activities 2
Quality of Life Impact
Discomfort and Restriction
- Stockings that are too thick or improperly fitted can be restrictive with tight footwear, reducing patient compliance 1
- Overall compliance with compression stockings is only 66.2%, with lower compliance (65%) for higher compression levels >25 mmHg versus ≤25 mmHg (77%) 3
Testing Before Use
- Patients should wear stockings around the house prior to travel or extended use to ensure good, comfortable fitting and identify problems before critical use 1
Clinical Implications
The evidence demonstrates that proper measurement and fitting is not merely a matter of comfort but a critical safety issue. Without proper measurement, compression stockings can transform from a protective device into a harmful intervention that increases thrombotic risk, causes tissue damage, and defeats the therapeutic purpose entirely. The American College of Chest Physicians guidelines explicitly emphasize that compression stockings "should be fitted properly" to avoid these complications 1.