Should You Wrap a Leg with Cellulitis?
No, do not apply a compressive wrap during acute cellulitis—instead, elevate the affected leg above heart level for at least 30 minutes three times daily to promote gravity drainage of edema and inflammatory substances. 1
Why Compression Is Not Recommended During Acute Infection
The provided evidence addresses compression wraps for sprains and strains, not cellulitis. 2 The 2024 AHA/Red Cross guidelines explicitly state that compression wraps for ankle sprains should be "performed without compromising circulation," and even in that context, systematic reviews found no benefit for swelling, pain, or recovery time. 2
For acute cellulitis, the standard of care is elevation—not compression. 1 The Infectious Diseases Society of America emphasizes that elevation hastens improvement by promoting gravitational drainage, which is the primary adjunctive mechanical intervention. 1
When Compression May Be Considered (After Acute Phase)
Compression therapy has a role only after the acute infection resolves, specifically for:
Prevention of recurrent cellulitis in patients with chronic leg edema: A 2020 randomized controlled trial showed that daily compression garments reduced cellulitis recurrence by 77% (hazard ratio 0.23,95% CI 0.09–0.59, P=0.002) in patients with chronic edema and prior cellulitis. 3
Management of underlying venous insufficiency and lymphedema: Once acute infection clears, compression stockings become part of long-term prevention strategy by addressing predisposing edema. 1, 4
Evidence on Compression During Acute Cellulitis
Two recent studies examined compression during active cellulitis:
A 2019 study found that compression bandaging does not impair microcirculation in patients with acute lower leg cellulitis (p=0.61), suggesting it does not compromise blood flow. 5
A 2025 randomized controlled trial showed that early compression therapy (within 24 hours of starting antibiotics) using medical adaptive compression wraps reduced CRP levels faster and alleviated symptoms without causing complications. 6
However, these studies conflict with established guideline recommendations that prioritize elevation over compression during acute infection. 1 The guideline evidence takes precedence, and the practical concern remains that compression could theoretically trap inflammatory exudate or mask worsening infection.
The Correct Approach: Elevation Protocol
Elevate the affected leg above heart level for at least 30 minutes three times daily. 1 This simple intervention:
- Promotes gravity drainage of edema and inflammatory substances 1
- Hastens clinical improvement 1
- Carries no risk of compromising circulation 1
Additional Essential Adjunctive Measures
Beyond elevation, address predisposing factors:
Examine interdigital toe spaces for tinea pedis, fissuring, scaling, or maceration—treat aggressively to eradicate colonization and reduce recurrence risk. 1, 4
Treat underlying venous insufficiency and chronic edema with compression stockings after acute infection resolves. 1, 4
Keep skin well-hydrated with daily emollients to prevent dryness and cracking. 4
Common Pitfall to Avoid
Do not apply compression wraps during acute cellulitis based on the ankle sprain guidelines—those recommendations explicitly state compression is for sprains/strains, not infections. 2 The risk of compromising circulation or masking progression outweighs any theoretical benefit during the acute inflammatory phase.
Long-Term Prevention Strategy
For patients with 3–4 episodes per year despite addressing predisposing factors, consider: