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GRADUATED COMPRESSION HOSIERY, SPORTS COMPRESSION AND DIABETIC SOCKS
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Click on a graduated compression hosiery style below to view its description further down this page:
Available from MEDIS®:
RxFit®:Anti-embolism Hosiery | Below Knee | Thigh Length | Pantyhose | Maternity | Hospital Stockings | Sports Compression
Flight socks | Diabetic socks | Anti-embolism
Flight socks | Diabetic socks | Anti-embolism
RxFit® products, produced in the USA are made of the finest yarns and the latest technology available. RxFit® simply has the widest range of styles available in Southern Africa.
Below Knee
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Thigh Length
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Anti-embolism
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Made to measure
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Armsleeves
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Below Knee
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Thigh Length
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Pantyhose
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Maternity
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Sports Compression
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Flight Socks
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Diabetic Socks
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Anti-embolism
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Armsleeves
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Below Knee
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Diabetic Socks
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Varicose Veins | Deep Vein Insufficiency | DVT prevention | Lymphoedema | Flight Socks | Leg Fatigue | Sports Compression | Maternity
Sclerotherapy | Mechanical Oedema | Organ Failure Socks | Diabetic Socks | Accessories
Sclerotherapy | Mechanical Oedema | Organ Failure Socks | Diabetic Socks | Accessories
Is due to venous insufficiencies and mean that we need long-term treatment in Class 2 compression. Always consider a below knee as first option. The best option remains a quality medical surgical stocking(RxFIT 201). These stockings are fitted according to ankle, calf, thigh and length measurements and are usually available in special sizes (RxFit 201W, RxFit201S, RxFit WS). You may want to try something more stylish which gives a similar compression. Below knee socks in cotton(RxFit 111), Coolmax(RxFit 120, 150) and Elastomide (RxFit 100) come in various fashionable colours but is always closed toe.
Your orthotist will exclusively supply you with the TOP quality medical-surgical stocking (Varisan TOP) on the market. These superb stockings are 100% cotton and open toe. The absolute ideal stocking for South African conditions. Cotton is simply more comfortable against the skin than standard elastomide hosiery. The downside is that elastomide hosiery wil probably give you an extra 20% in life-time, but this largely depends on the person who washes these items.
Thigh length hosiery is available in elastomide(RxFit 204,202,212) for patients that need compression above the knee. This is often indicated where veins travel over the knee area as sometimes occur in severe varicose disease.
Class 2 Pantyhose (RxFit 203) is an option, but should be left as last resort as they are difficult to fit, very hot in our climate and a pain when it comes to the visit to a loo!
Your orthotist will exclusively supply you with the TOP quality medical-surgical stocking (Varisan TOP) on the market. These superb stockings are 100% cotton and open toe. The absolute ideal stocking for South African conditions. Cotton is simply more comfortable against the skin than standard elastomide hosiery. The downside is that elastomide hosiery wil probably give you an extra 20% in life-time, but this largely depends on the person who washes these items.
Thigh length hosiery is available in elastomide(RxFit 204,202,212) for patients that need compression above the knee. This is often indicated where veins travel over the knee area as sometimes occur in severe varicose disease.
Class 2 Pantyhose (RxFit 203) is an option, but should be left as last resort as they are difficult to fit, very hot in our climate and a pain when it comes to the visit to a loo!
Deep Vein Insufficiency. This is a very broad term sometimes used in vascular language and could include the above varicose veins. Patients though need not present with varicose veins, but rather with skin discoloration,dryness and excema of the lower leg, oedema of (usually) lower leg and even leg ulcers. It is caused by damaged valves in the deep venous system, which dilates the deep veins and then leaks fluid into interstitial tissue. Such patients can be offered surgery, but will usually need compression therapy for life. What compression do you need? The answer is: the lowest compression which removes oedema effectively, without compromising arterial supply. This is usually a class 2 stocking.(see varicose veins). Patients with healed venous ulcers need compression from the day that they come off their compression bandages(see RxFit Bandages)
In some young individuals one often requires a higher compression to effectively remove oedema(RxFit 301, RxFit 305,RxFit 315). These are always made of elastomide and elasthane as cotton cannot accurately provide such high compressions over long periods.
Orthotists are best qualified to supply this class of compression and also stock the TOP quality (VARISAN TOP 6A5E1, 6A5N1, 6A5E9, 6A5N9) Italian product. Always insist on proper instructions when buying a pair of compression stockings and fit stockings before leaving the premises.
In some young individuals one often requires a higher compression to effectively remove oedema(RxFit 301, RxFit 305,RxFit 315). These are always made of elastomide and elasthane as cotton cannot accurately provide such high compressions over long periods.
Orthotists are best qualified to supply this class of compression and also stock the TOP quality (VARISAN TOP 6A5E1, 6A5N1, 6A5E9, 6A5N9) Italian product. Always insist on proper instructions when buying a pair of compression stockings and fit stockings before leaving the premises.
DVT (Deep vein thrombosis) prevention is about preventing a blood clot from forming in the popliteal or inguinal area, usually intra-operatively or post-operatively. Such clots can rarely dislodge and cause a lung embolism which often is catastrophic. There are a few modalities available to prevent this, of which increasing the venous flow rate with compression hosiery is still the most popular. It is now generally accepted that a Class 1 below knee stocking is all that is necessary. It will usually be used in combination with other products as patients need cost-effective prevention for up to six weeks post-operatively. Orthopaedic surgeons sometimes still insist on thigh length hosiery because of their special needs. In such cases, the patient should be warned not to bend the knee more then 15® as this can cause retrograde flow and increased incidence of DVT.
The ideal anti-embolism stocking is a Class 1 stocking with open toe for inspection(Rxfit 400,401,402)of circulation. Your orthotist has the new Varisan anti-embolism(Varisan RP 201, RP 209) stocking with advanced shape design, which is less prone to creasing at the ankle. Varisan is also available in beige in line with our Afro-centric strategy.
The ideal anti-embolism stocking is a Class 1 stocking with open toe for inspection(Rxfit 400,401,402)of circulation. Your orthotist has the new Varisan anti-embolism(Varisan RP 201, RP 209) stocking with advanced shape design, which is less prone to creasing at the ankle. Varisan is also available in beige in line with our Afro-centric strategy.
Lympheodema patients suffer from lymphatic obstruction. This usually is permanent and the patient needs to adapt to an unfortunate lifestyle. It could be secondary to carcinoma surgery and often no cause can be found.
Treatment consists of massage and compression bandaging, intermittent compression therapy (ICT machine) and compression hosiery. Whether you use massage and bandaging or ITC as primary therapy, one needs compression hosiery to maintain what has been achieved with these modalities. Otherwise hard earned eodema reduction is lost within hours.
The patient should really find the lowest compression that maintains the treated state by trial and error. Patients differ, but the majority unfortunately will need Class 3( 30-40mmHg) compression. The majority will also need a thigh length stocking which can be with(Varisan 6A5E9, 6A5N9)(RxFit 305,315) or without silicone stay-up top. Single leg cotton hosiery with belt is available from Varisan(CA4E2, CA4N2, CA4E3,CA4N3), but only in Class 2 compression.
Lymphoedema patients often need MADE-TO MEASURE stockings because of abnormal leg-shape. This is obtained via your local orthotist and can be ordered to specs such as: Single leg, Tights, Below knee or Thigh high, Stay-up, Synthetic or Cotton, Closed or Open toe. M-T-M hosiery is expensive(plus minus double that of off-the shelf-alternative) but often the only option.
Treatment consists of massage and compression bandaging, intermittent compression therapy (ICT machine) and compression hosiery. Whether you use massage and bandaging or ITC as primary therapy, one needs compression hosiery to maintain what has been achieved with these modalities. Otherwise hard earned eodema reduction is lost within hours.
The patient should really find the lowest compression that maintains the treated state by trial and error. Patients differ, but the majority unfortunately will need Class 3( 30-40mmHg) compression. The majority will also need a thigh length stocking which can be with(Varisan 6A5E9, 6A5N9)(RxFit 305,315) or without silicone stay-up top. Single leg cotton hosiery with belt is available from Varisan(CA4E2, CA4N2, CA4E3,CA4N3), but only in Class 2 compression.
Lymphoedema patients often need MADE-TO MEASURE stockings because of abnormal leg-shape. This is obtained via your local orthotist and can be ordered to specs such as: Single leg, Tights, Below knee or Thigh high, Stay-up, Synthetic or Cotton, Closed or Open toe. M-T-M hosiery is expensive(plus minus double that of off-the shelf-alternative) but often the only option.
The ideal flight sock is a Class 1 below knee sock(RxFit 103, 109,322)(Varisan Lui&Lei). To prevent DVT during flight, try to stretch legs every 2 hours, refrain from taking alcohol or sleeping tablets, take in lots of fluids, sleep with straight legs(or as close as possible). Actively exercising the calves during flight is of great importance.
Flight socks increase venous return during those long hours when you don’t exercise your legs.
Flight socks increase venous return during those long hours when you don’t exercise your legs.
Compression hosiery is well documented to reduce leg fatigue in shop/pharmacy assistants, theatre personnel (surgeons and nursing staff). The ideal product to use is a Class 1 (15-20mmHg) compression sock(RxFit 103,109,129,166,167)(Varisan Lui&Lei). Research shows that compression hosiery reduces creatine kinase levels in patients wearing Class 1 compression socks. Creatine kinase is the enzyme produced when muscle is damage. Leg fatigue patients often have slight oedema which is easily removed by Class 1 compression. Travellers often use their flight socks for leg fatigue when travelling abroad, walking many kilometers with tired legs.
MEDIS has been on the forefront of sports compression for many years. We have been involved with research in sports compression since 1999. In those days not a word could be found on the internet! Sports personalities and teams involved, include SA cricket (Eric Simons- the coach), various provincial cricket sides, Super 12 Rugby teams, Provincial Rugby sides, Provincial Hockey sides and athletes such as Elana Meyer. Ray Wicksell featured RxFit sports compression on his lifestyle program.
Research conducted by the University of Stellenbosch has shown a reduction of Lactic acid within 30 min of serious exercise in subjects wearing our CSOCK Prototype. Research is currently in progress as various aspects of sports compression is scientifically investigated.
The RxFit 111 and RxFit 120/150 has been the choice of sportsman so far but the CSOCK SPORT will ultimately be the sports compression of choice with much research going into aspects such as comfort, friction, heat production, wicking capabilities, sweat absorbtion and durability. Each fabric has its own unique features and not all are ideal for the athlete.
Research conducted by the University of Stellenbosch has shown a reduction of Lactic acid within 30 min of serious exercise in subjects wearing our CSOCK Prototype. Research is currently in progress as various aspects of sports compression is scientifically investigated.
The RxFit 111 and RxFit 120/150 has been the choice of sportsman so far but the CSOCK SPORT will ultimately be the sports compression of choice with much research going into aspects such as comfort, friction, heat production, wicking capabilities, sweat absorbtion and durability. Each fabric has its own unique features and not all are ideal for the athlete.
Venous valves become incompetent during pregnancy. This leads to oedema and even varicose veins in pregnancy. Research shows that in previously healthy subjects, all these varicose veins will return to normal post-delivery. Should we then use protection in the form of compression hosiery?
Well, research also shows that pathological varicose veins are more common in women with children and highest in multiparous women(Dindelli et al, Angiology 1993). This seems to suggest that something happens during pregnancy which could increase the incidence of pathological varicose veins.
The majority of pregnant women will at most need Class 1 (15-20mmHg) compression hosiery (RxFit 4, RxFit 109, RxFit 26). Although the Style 26 sheer pantyhose is very popular(available in black and beige), it is unnecessary to wear more then a below knee sock(RxFit 109) or stocking(Style 16).
Patients with previous varicose disease or very early varicosities should consider a higher compression(RxFit 8, RxFit 18, RxFit 111)
Well, research also shows that pathological varicose veins are more common in women with children and highest in multiparous women(Dindelli et al, Angiology 1993). This seems to suggest that something happens during pregnancy which could increase the incidence of pathological varicose veins.
The majority of pregnant women will at most need Class 1 (15-20mmHg) compression hosiery (RxFit 4, RxFit 109, RxFit 26). Although the Style 26 sheer pantyhose is very popular(available in black and beige), it is unnecessary to wear more then a below knee sock(RxFit 109) or stocking(Style 16).
Patients with previous varicose disease or very early varicosities should consider a higher compression(RxFit 8, RxFit 18, RxFit 111)
Sclerotherapy is the injection of a chemical irritant into a vein to produce inflammation, fibrosis and eventual obliteration of the lumen. Compression hosiery is used post-injection to reduce side-effects such as swelling and subcutaneous bleeding and discolouration.
For spider vein therapy a class 1 product is sufficient(RxFit 4, RxFit 16, RxFit 15). For larger veins most therapists use a Class 2 product(RxFit 8, RxFit 18, RxFit 202, RxFit 204, RxFit 205, RxFit 212)
For spider vein therapy a class 1 product is sufficient(RxFit 4, RxFit 16, RxFit 15). For larger veins most therapists use a Class 2 product(RxFit 8, RxFit 18, RxFit 202, RxFit 204, RxFit 205, RxFit 212)
Often patients due to previous fractures or simply old age cannot use their calf muscle pump. This leads to oedema which then is treated incorrectly with diuretics as “a touch of heart failure”. Elderly folk sometimes lose confidence and begin to stoop and shuffle- walk when they grow old. This method removes calf action and causes oedema.
Use a class 1 compression (RxFit 322, RxFit 103, RxFit 109) in these patients and stop their diuretics! You will be surprised at the result! No more unpleasant nocturnal diuresis and dizziness(caused by lowered blood pressure).
Use a class 1 compression (RxFit 322, RxFit 103, RxFit 109) in these patients and stop their diuretics! You will be surprised at the result! No more unpleasant nocturnal diuresis and dizziness(caused by lowered blood pressure).
At MEDIS we are busy with groundbreaking research into the use of compression hosiery in OFE(Organ Failure Oedema). OFE could be heart, liver or kidney failure. In all three these failures there is a tendency to treat the visible oedema with massive dosages of diuretics, often not to heal but simply to improve the quality of life of patients. In these patients a class 1 compression sock(RxFit 103, RxFit 109), might be a much better option.
The calves are really the hearts of the venous system. In stage 3 and 4 heart failure, these are totally incapacitated. At MEDIS we believe that by enhancing the venous return with compression hosiery, one could reduce the need for massive dosages of diuretics and thereby improve quality of life. Further research needs to be done on this subject.
The calves are really the hearts of the venous system. In stage 3 and 4 heart failure, these are totally incapacitated. At MEDIS we believe that by enhancing the venous return with compression hosiery, one could reduce the need for massive dosages of diuretics and thereby improve quality of life. Further research needs to be done on this subject.
The diabetic foot and its complications are a major cost in the care of the diabetic patient. This is the result of the peripheral neuropathy prevalent in diabetics. The best way to cope with this problem is to prevent injury to the diabetic foot wearing appropriate socks(RxFit 190 , CSOCK –Diabetic) and shoes(PF Diabetic).
Wearing compression hosiery can be eased by using the correct method to fit and sometimes certain accessories. See articles(How to fit) and invest in a stocking donner or gloves to improve your quality of life.
Measuring For a Perfect Fit | How to Fit Compression Hosiery | More About Stockings | Replacing Your Stockings | Thigh or knee length AES
Sports Compression | Leg Fatigue | Compression Hosiery and Allergy
Sports Compression | Leg Fatigue | Compression Hosiery and Allergy
Compression hosiery need to fit accurately for the graduated compression to work effectively. Please adhere to these instructions:
Below Knee:
With a tape measure, measure the narrowest circumference at the ankle just above the malleoli. Do not measure circumference at the malleoli. Take swollen ankles into account. If necessary see whether the opposite ankle wouldn't provide more accurate assessment. If you have to measure with swollen ankles, try measuring early morning or first use compression bandage to remove oedema. Measure the widest circumference at the calf. Measure the length from the heel (ground when standing) to the bend of knee. Bend of knee means literally bending knee, finding the crease and straightening the leg with finger in place. Beware of the patient with feet in plantar flexion when in bed. You could easily measure too short. Be sure to keep ankle at 90°.
Thigh Length:
Measure ankle and calf as above.Measure thigh circumference one inch (2,5cm) below gluteal crease. This usually is as high as one can get on the inner leg.Measure length from heel (ground when standing) to gluteal crease. Again, be sure to keep foot at 90° when measuring.
With a tape measure, measure the narrowest circumference at the ankle just above the malleoli. Do not measure circumference at the malleoli. Take swollen ankles into account. If necessary see whether the opposite ankle wouldn't provide more accurate assessment. If you have to measure with swollen ankles, try measuring early morning or first use compression bandage to remove oedema. Measure the widest circumference at the calf. Measure the length from the heel (ground when standing) to the bend of knee. Bend of knee means literally bending knee, finding the crease and straightening the leg with finger in place. Beware of the patient with feet in plantar flexion when in bed. You could easily measure too short. Be sure to keep ankle at 90°.
Thigh Length:
Measure ankle and calf as above.Measure thigh circumference one inch (2,5cm) below gluteal crease. This usually is as high as one can get on the inner leg.Measure length from heel (ground when standing) to gluteal crease. Again, be sure to keep foot at 90° when measuring.
Insert hand into stocking, grab heel of stocking, turn inside out. (Like Grandma use to do)
Insert the foot with thumbs on inside of stocking up to the heel. This could be made easier by bending the knee and placing the foot on the opposite knee. This way you are closer to the action! Arthritic and overweight patients might find this difficult. Try a chair in front of you for support! At this stage the stocking might slip back especially if you try to pull heel (stocking) over heel (foot). Don’t worry, this is fine.
Now slide stocking on itself over heel in single layer, taking care not to bundle the stocking and thus causing a thick elastic band which only makes it more difficult. The stocking will slide easily at first and then get stuck as it struggles to go over the heel. As soon as you experience resistance, insert your thumbs to “work” it up even further. At this stage the folded stocking will have reached the midway point between heel and toes.
Now insert you fingers under this fold formed at the foot arch and gently flip it over the heel which is easy because of the leverage effect and little compression at the fold.
Gradually work stocking upward until in place. Make sure the heel (stocking) is exactly over heel (foot) and the topband (cuff) is 2.5cm below bend of knee. This is probably the most important aspect of a correct fit. Bend the patients knee when fitted, to check that no tourniquet forms when bent and adjust if necessary. Explain at this stage to the patient the importance of no folds at this point as it will cause a tourniquet and discomfort.
Remove remaining creases by “playing” the stocking. This is done by rubbing the stocking length-wise until the crease disappears. Do not pull at the top!
Never fold back any stocking onto itself just because it seems too long or operative tools are in the way. Check the size of the stocking again and make sure it was not pulled up too high. Remember that any stocking can be pulled higher then the intended height.
Should you encounter any pain or discomfort having fitted a stocking, immediately remove stocking and elevate the leg. Pain or discomfort is almost always caused by improper use of stocking. Compression hosiery never causes pain, it relieves pain. Should you encounter pain and discomfort, contact your supplier or call the Medis Helpline for advice.
Insert the foot with thumbs on inside of stocking up to the heel. This could be made easier by bending the knee and placing the foot on the opposite knee. This way you are closer to the action! Arthritic and overweight patients might find this difficult. Try a chair in front of you for support! At this stage the stocking might slip back especially if you try to pull heel (stocking) over heel (foot). Don’t worry, this is fine.
Now slide stocking on itself over heel in single layer, taking care not to bundle the stocking and thus causing a thick elastic band which only makes it more difficult. The stocking will slide easily at first and then get stuck as it struggles to go over the heel. As soon as you experience resistance, insert your thumbs to “work” it up even further. At this stage the folded stocking will have reached the midway point between heel and toes.
Now insert you fingers under this fold formed at the foot arch and gently flip it over the heel which is easy because of the leverage effect and little compression at the fold.
Gradually work stocking upward until in place. Make sure the heel (stocking) is exactly over heel (foot) and the topband (cuff) is 2.5cm below bend of knee. This is probably the most important aspect of a correct fit. Bend the patients knee when fitted, to check that no tourniquet forms when bent and adjust if necessary. Explain at this stage to the patient the importance of no folds at this point as it will cause a tourniquet and discomfort.
Remove remaining creases by “playing” the stocking. This is done by rubbing the stocking length-wise until the crease disappears. Do not pull at the top!
Never fold back any stocking onto itself just because it seems too long or operative tools are in the way. Check the size of the stocking again and make sure it was not pulled up too high. Remember that any stocking can be pulled higher then the intended height.
Should you encounter any pain or discomfort having fitted a stocking, immediately remove stocking and elevate the leg. Pain or discomfort is almost always caused by improper use of stocking. Compression hosiery never causes pain, it relieves pain. Should you encounter pain and discomfort, contact your supplier or call the Medis Helpline for advice.
Handwash in luke warm water with mild soap. Do not tumble dry. Do not wash with fabric softener.
Air dry but not in direct sunlight or with direct heater/fire exposure.
Purchase some powder free latex (nice and sticky) gloves at your local supermarket and use them to fit stockings easier. Ask your supplier how to use them correctly. It makes a huge difference.
Often patients in need of stockings are arthritic or overweight. Always insist on special training by your supplier, otherwise you will never wear them. A little training goes a long way.
The majority of patients need only below knee stockings. This include patients with varicose veins in the upper leg. The reason is simple: Varicose veins do not cause side-effects in the upper leg, only in the lower leg. On the other hand compliance with below knee stockings is 100% better than with thigh length stockings for obvious reasons.
Air dry but not in direct sunlight or with direct heater/fire exposure.
Purchase some powder free latex (nice and sticky) gloves at your local supermarket and use them to fit stockings easier. Ask your supplier how to use them correctly. It makes a huge difference.
Often patients in need of stockings are arthritic or overweight. Always insist on special training by your supplier, otherwise you will never wear them. A little training goes a long way.
The majority of patients need only below knee stockings. This include patients with varicose veins in the upper leg. The reason is simple: Varicose veins do not cause side-effects in the upper leg, only in the lower leg. On the other hand compliance with below knee stockings is 100% better than with thigh length stockings for obvious reasons.
How often do I replace my stockings? Most companies would say every six months. A better way to look at it is to say:” When it stops doing the job” . If you had oedema and the stocking is still effective, good for you. If you had pain and the pain is still under control, good for you.
Replacement is very much in the hands of the user though and some users get away with 12-24 months. Others only two months.
Replacement is very much in the hands of the user though and some users get away with 12-24 months. Others only two months.
Anti-Embolism Stockings is effective because it increases the venous velocity in the deep vein system.
The increase in venous velocity is mostly brought about by graduated compression on the plantar plexus in the foot as well as the calf and its superficial venous plexus.
Compression on the thigh with its bulk of muscle and subcutaneous fat is 8-10mmHg and has a negligible effect on venous velocity.
If increased venous velocity is effected by below knee stockings, it has to equally increase venous velocity in the venous system of the upper leg. Where else could the increased flow go?
Anatomy of the majority of patients is such that thigh length stockings will always tend to roll down or crease in the fat folds causing a tourniquet effect. This has been proved to cause reverse gradient and increase in DVT incidence.
It is well documented that the majority of DVTs in the lower limb that dislodge and cause Pulmonary Embolism, originate from the popliteal and inguinal areas. This has understandably left practitioners with the perception that this area should be compressed. Not so; upper stocking has negligible effect on increased venous velocity.
A patient in thigh length stockings could increase the compression at the knee, to as high as 50mmHg, by bending the knee to 90°. This once again will cause a reverse gradient. Remember, the compression at the ankle is only 18mmHg. And what do we do on day one; we sit the patient in a chair, sometimes for two hours, knees bent to 90°!
Two situations may still warrant thigh length stockings: 1) Knee replacements where surgeons want to get rid of the oedema to mobilize quicker – At Groote Schuur this is not seen as good enough reason to go above knee. 2) Patient with oedematous thigh due to acute DVT.
In the acute DVT the latest is to mobilize from day one having been treated with LM Heparin. The patient is placed on 30-40mmHg thigh length compression stockings! This has been proven to have no increased incidence in PE.
References:
1 - Effectiveness of Elastic Stocking Decompression. E.F. Bryars et al. Arch Surg, 1977.
2 - Graduated Compression Stockings – Knee Length or Thigh Length. T. Benkö et al. Clinical Orthopaedics and related research. 2001
3 - Graded compression stockings in elective orthopaedic surgery. A.J. Best et al. J Bone and Joint Surg. 2000.
4 - Graduated compression stockings in the prevention of post-operative deep vein thrombosis. P. C. Jeffreys and A.N. Nicolaides. BR. J Surg, 1990.
5 - Graduated, static,external compression of the lower limb: A Physiological Assessment:D Lawrence and V.V. Kakkar. Br. J. Surg. 1980.
6 - Type of compression for reducing venous stasis. B. Sigel et al. Arch Surg. 1975.
7 - Effect of ‘anti-embolism’ compression hosiery on leg blood volume. R.A. Sparrow et al. Br. J. Surg. 1995.
8 - Thigh length versus knee length stockings in the prevention of deep vein thrombosis. M.J. LeF. Porteous et al. Br. J. Surg.1989
9 - Compression and walking versus bed rest in the treatment of proximal deep venous thrombosis with low molecular weight heparin. H. Partsch. J. of Vasc. Surg. ,Nov 2000.
10 - In Vivo pressure profiles of thigh-length graduated compression stockings. C.J. Wildin et al. Br. J. Surg., 1998.
The increase in venous velocity is mostly brought about by graduated compression on the plantar plexus in the foot as well as the calf and its superficial venous plexus.
Compression on the thigh with its bulk of muscle and subcutaneous fat is 8-10mmHg and has a negligible effect on venous velocity.
If increased venous velocity is effected by below knee stockings, it has to equally increase venous velocity in the venous system of the upper leg. Where else could the increased flow go?
Anatomy of the majority of patients is such that thigh length stockings will always tend to roll down or crease in the fat folds causing a tourniquet effect. This has been proved to cause reverse gradient and increase in DVT incidence.
It is well documented that the majority of DVTs in the lower limb that dislodge and cause Pulmonary Embolism, originate from the popliteal and inguinal areas. This has understandably left practitioners with the perception that this area should be compressed. Not so; upper stocking has negligible effect on increased venous velocity.
A patient in thigh length stockings could increase the compression at the knee, to as high as 50mmHg, by bending the knee to 90°. This once again will cause a reverse gradient. Remember, the compression at the ankle is only 18mmHg. And what do we do on day one; we sit the patient in a chair, sometimes for two hours, knees bent to 90°!
Two situations may still warrant thigh length stockings: 1) Knee replacements where surgeons want to get rid of the oedema to mobilize quicker – At Groote Schuur this is not seen as good enough reason to go above knee. 2) Patient with oedematous thigh due to acute DVT.
In the acute DVT the latest is to mobilize from day one having been treated with LM Heparin. The patient is placed on 30-40mmHg thigh length compression stockings! This has been proven to have no increased incidence in PE.
References:
1 - Effectiveness of Elastic Stocking Decompression. E.F. Bryars et al. Arch Surg, 1977.
2 - Graduated Compression Stockings – Knee Length or Thigh Length. T. Benkö et al. Clinical Orthopaedics and related research. 2001
3 - Graded compression stockings in elective orthopaedic surgery. A.J. Best et al. J Bone and Joint Surg. 2000.
4 - Graduated compression stockings in the prevention of post-operative deep vein thrombosis. P. C. Jeffreys and A.N. Nicolaides. BR. J Surg, 1990.
5 - Graduated, static,external compression of the lower limb: A Physiological Assessment:D Lawrence and V.V. Kakkar. Br. J. Surg. 1980.
6 - Type of compression for reducing venous stasis. B. Sigel et al. Arch Surg. 1975.
7 - Effect of ‘anti-embolism’ compression hosiery on leg blood volume. R.A. Sparrow et al. Br. J. Surg. 1995.
8 - Thigh length versus knee length stockings in the prevention of deep vein thrombosis. M.J. LeF. Porteous et al. Br. J. Surg.1989
9 - Compression and walking versus bed rest in the treatment of proximal deep venous thrombosis with low molecular weight heparin. H. Partsch. J. of Vasc. Surg. ,Nov 2000.
10 - In Vivo pressure profiles of thigh-length graduated compression stockings. C.J. Wildin et al. Br. J. Surg., 1998.
Very little research has been published on this very new subject. Much of the evidence is anecdotal and need to be proved with quality research. Compression for years has been the stepchild of the R>I>C>E family. It now finely arrived!
Sports compression has now been successfully introduced in many different sports in South Africa. :
Cricket – At national and provincial level
Rugby – Provincial and Super Twelve
Hockey – National and Provincial
Marathon and other Long Distance Running (Comrades)
Cycling
Golf
Hiking
Super Twelve Rugby teams use compression socks to prevent DVT during long distance flights. They are particularly prone to DVT’s due to muscle trauma with oedema or heamatoma after a heavy match.
An Australian study group showed that a high percentage of Olympic athletes treated for minor muscle injuries, in fact had asymptomatic DVT’s and were treated incorrectly! This could be partly due to the long flights and dehydration.
The incident of Economy Class Syndrome in the normal population is now thought by some to be lower than previously expected. Be careful though to extrapolate to sportsmen with a very specific make-up, especially rugby players.
Our research shows that:
CSOCK SPORT decrease muscle and ligamentous injuries. Muscles and tendons come under tremendous stress during exercise. Compression socks have a caging effect on muscle and tendon. This means muscle and tendon is held in close proximity of the tibia and fibula and restricts lateral movement. The sock though allows longitudinal motion.
CSOCK SPORT prevents DOMS (Delayed onset muscle soreness) which is stiffness on day two, following heavy exercise.DOMS is currently thought to be due to muscle damage at spindle level. Due to the “caging” effect explained above, muscle damage at this level is reduced to the minimum, which reduces DOMS.Athletes get back to training much faster!
CSOCK SPORT prevents oedema caused by centrifugal and gravitational forces typically seen in cricket, long distance running and cycling. Oedema causes unnecessary heaviness of the feet restricting leg mobility. The removal of oedema weight has the advantage of lighter feet for 42km in a marathon!
Cricketers fielding all day complain of heaviness and oedema of the feet. By wearing compression socks they are more nimble in the field. (As experienced by our national side)
CSOCK SPORT shortens recuperation following any inflammatory condition of the lower leg, including ligamentous injuries of the ankle, torn calf muscles and heamatoma of the calf. Oedema causes reduction in arterial (and oxygen) supply due to hydrostatic force of interstitial oedema.Torn ligamentous ends are separated by oedema. Compression forces them closer to each other with better healing.
CSOCK SPORT will improve aerobic and anaerobic efficiency of the athlete.Superficial plantar plexus and venous plexus of lower leg normally are filled with oxygen-depleted red blood cells.Compression forces these oxygen-depleted cells to the deep venous system where they are circulated and oxygenated. Spanish research shows a 6% increase in aerobic efficiency and 11% increase in anaerobic efficiency. Lateral movement of muscle constitutes a waste of energy. Energy is preserved by the caging effect of hosiery already explained.
CSOCK SPORT helps with removal of waist materials such as lactic acid from the interstitial tissue. Venous blood and lymph are the mediums in which cellular waste material is removed . Removal of oedema facilitates the removal of waste.
CSOCK SPORT has been shown to be highly efficient in controlling shin splint discomfort/pain (As experienced by Gogga Adams, cricketer). Shin splints or medial tibial periostitis is a common problem of athletes who changed shoes, surface or technique. Also common with training on hard surfaces especially with repeated explosive take-offs. The caging effect and removal of swelling/oedema explains it success in preventing and treating shin splints.
Sports compression has now been successfully introduced in many different sports in South Africa. :
Cricket – At national and provincial level
Rugby – Provincial and Super Twelve
Hockey – National and Provincial
Marathon and other Long Distance Running (Comrades)
Cycling
Golf
Hiking
Super Twelve Rugby teams use compression socks to prevent DVT during long distance flights. They are particularly prone to DVT’s due to muscle trauma with oedema or heamatoma after a heavy match.
An Australian study group showed that a high percentage of Olympic athletes treated for minor muscle injuries, in fact had asymptomatic DVT’s and were treated incorrectly! This could be partly due to the long flights and dehydration.
The incident of Economy Class Syndrome in the normal population is now thought by some to be lower than previously expected. Be careful though to extrapolate to sportsmen with a very specific make-up, especially rugby players.
Our research shows that:
CSOCK SPORT decrease muscle and ligamentous injuries. Muscles and tendons come under tremendous stress during exercise. Compression socks have a caging effect on muscle and tendon. This means muscle and tendon is held in close proximity of the tibia and fibula and restricts lateral movement. The sock though allows longitudinal motion.
CSOCK SPORT prevents DOMS (Delayed onset muscle soreness) which is stiffness on day two, following heavy exercise.DOMS is currently thought to be due to muscle damage at spindle level. Due to the “caging” effect explained above, muscle damage at this level is reduced to the minimum, which reduces DOMS.Athletes get back to training much faster!
CSOCK SPORT prevents oedema caused by centrifugal and gravitational forces typically seen in cricket, long distance running and cycling. Oedema causes unnecessary heaviness of the feet restricting leg mobility. The removal of oedema weight has the advantage of lighter feet for 42km in a marathon!
Cricketers fielding all day complain of heaviness and oedema of the feet. By wearing compression socks they are more nimble in the field. (As experienced by our national side)
CSOCK SPORT shortens recuperation following any inflammatory condition of the lower leg, including ligamentous injuries of the ankle, torn calf muscles and heamatoma of the calf. Oedema causes reduction in arterial (and oxygen) supply due to hydrostatic force of interstitial oedema.Torn ligamentous ends are separated by oedema. Compression forces them closer to each other with better healing.
CSOCK SPORT will improve aerobic and anaerobic efficiency of the athlete.Superficial plantar plexus and venous plexus of lower leg normally are filled with oxygen-depleted red blood cells.Compression forces these oxygen-depleted cells to the deep venous system where they are circulated and oxygenated. Spanish research shows a 6% increase in aerobic efficiency and 11% increase in anaerobic efficiency. Lateral movement of muscle constitutes a waste of energy. Energy is preserved by the caging effect of hosiery already explained.
CSOCK SPORT helps with removal of waist materials such as lactic acid from the interstitial tissue. Venous blood and lymph are the mediums in which cellular waste material is removed . Removal of oedema facilitates the removal of waste.
CSOCK SPORT has been shown to be highly efficient in controlling shin splint discomfort/pain (As experienced by Gogga Adams, cricketer). Shin splints or medial tibial periostitis is a common problem of athletes who changed shoes, surface or technique. Also common with training on hard surfaces especially with repeated explosive take-offs. The caging effect and removal of swelling/oedema explains it success in preventing and treating shin splints.
Research has shown that standing on your legs for long periods, causes muscle fatigue. Creatine Kinase (CK) levels which is released when muscle is damaged, is raised when measured over 24hr period. Research has shown these levels to improve to “normal” when the same routine is repeated 14 days later but wearing Class 1 compression hosiery. For this reason many doctors, theatre sisters, pharmacists, sales people etc. wear compression hosiery during working hours to reduce leg fatigue/pain.
Compression hosiery is mostly made of inert fabrics and rarely causes allergy. Fabrics used to manufacturer compression hosiery are:
Elastomide- In various forms including Microfibre, Coolmax etc.
Elasthane – Also known as Spandex, which provides most of the elastic compression.
Cotton – Often included for comfort and sweat absorbtion
Rayon - Also known as wood fibre or “wood silk”
Wool – Seldomly used
Mohair – Used for its special qualities in diabetic socks.
Of all the fabrics, Elasthane and Spandex theoretically should cause the most problems but rarely makes up more than 10% of the fabric. It is also “buried” in the weaving process which allows for very little skin contact if any.
Allergy however does occur in a very small percentage of patients. Always be aware that the allergy could be caused by soap left on the stocking or leg during washing. This is exacerbated by sweating which occurs under hosiery.
Be aware of skin rash cause by shaving of legs. This could irritate the hair follicle and cause an impetigo and mimick an allergy.
Elastomide- In various forms including Microfibre, Coolmax etc.
Elasthane – Also known as Spandex, which provides most of the elastic compression.
Cotton – Often included for comfort and sweat absorbtion
Rayon - Also known as wood fibre or “wood silk”
Wool – Seldomly used
Mohair – Used for its special qualities in diabetic socks.
Of all the fabrics, Elasthane and Spandex theoretically should cause the most problems but rarely makes up more than 10% of the fabric. It is also “buried” in the weaving process which allows for very little skin contact if any.
Allergy however does occur in a very small percentage of patients. Always be aware that the allergy could be caused by soap left on the stocking or leg during washing. This is exacerbated by sweating which occurs under hosiery.
Be aware of skin rash cause by shaving of legs. This could irritate the hair follicle and cause an impetigo and mimick an allergy.
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