Support Hosiery – Compression Socks / Stockings

What is Hosiery?

Hosiery refers to knit or woven garments for the feet and legs that are designed to be worn inside shoes.

Women’s stockings and tights are the most common examples, but socks for men, women, and children also count as hosiery.

While it’s easy to think of hosiery as a modern thing, it’s actually not. People have been wearing them since long before the knitting machine was invented in the 17th century in England.

Origins

The advent of hosiery seems to have gone hand in hand with clothes themselves. Ancient Greek poems reference leg coverings made from matted animal hair.

Knit socks have also been discovered in Ancient Egyptian tombs. On the other hand, widespread use of compression therapy dates back to the Medieval times. Since then, they have been used for the treatment of venous stasis and ulcers, among other ailments.

Support Hosiery – What Are They?

Our focus today, however, is on support hosiery. Unlike traditional dress stockings, support hosiery is designed with elastic material for the sake of compression therapy and comfort. Support hosiery is an umbrella term for individual leg garments. These include compression socks, compression stockings, and compression pantyhose, all of which can be used interchangeably.

How do they differ from normal socks?

The major difference between compression hosiery and run-of-the-mill socks is in elasticity. Support hosiery is made from higher quantities of elastic fibers like Lycra and Spandex. This enables them to exert more pressure at graduated intervals.

Regular socks or stockings designed for warmth or aesthetic purposes are not intended to provide health benefits. They are just regular garments and worn as such. Support hosiery, on the other hand, is a specialized garment used to treat a wide range of illnesses ranging from fatigue and aching legs to venous thrombosis.

As a result, support stockings improve circulation by exerting gentle pressure on your legs and ankles, directing blood flow back to the heart. Support hosiery, like the name denotes, is mostly for supporting weak blood vessels and muscles. Their fabric holds muscles in place and keeps them in perfect shape.

Essentially, support hosiery delivers maximum benefits with comfort in mind. Support hosiery has an edge over other garment-based treatment options. This is because they incorporate an already important piece of attire (socks) into something with medical benefits, all while preserving the aesthetic and cosmetic appeal of regular socks.

Why Is Compression Hosiery Necessary?

Think of it this way; your legs are one the largest parts of your body. As well they should be, considering they carry your torso constantly. However, their ability to do this can also become an impediment when blood pools in the feet, which deprives vital organs of oxygen.

The fact that your legs are at the bottom of your body, which is literally the lowest point that blood has to flow to, only compounds the problem. Unfortunately, the chances of developing venous complications are very high if you’re on the older side or spend long periods on your feet.

Gravity influences blood pressure just like anything else, but blood may not flow upward easily in people with certain conditions. This is where compression stockings come in, as they gradually coerce blood up the legs and back to the heart.

It is advisable for people who spend lots of time on their feet to wear support hosiery because they’re at risk of having their blood clot. These people include doctors, nurses, surgeons, athletes, and people who engage in heavy physical activity, among others. It’s important to note that support hosiery is not just used to cure certain conditions, it’s also used to prevent them.

Types of Compression Hosiery

There are usually three types of compression hosiery:

1. Anti-Embolism Compression Stockings

An embolism is the result of blood clotting while it circulates in your veins or arteries. It’s a serious and potentially life-threatening condition that often occurs in those who have undergone surgery or experienced physical trauma. In those cases, there is a great risk of blood pooling in the feet, which may cause a blood clot and possible heart failure. The graduation of these stockings occurs at different levels, although the level of compression varies. These stockings are most often recommended for the treatment of deep vein thrombosis in immobile patients.

2. Gradient Compression Stockings

These stockings are designed in a tapered fashion, so they are narrowest at the ankles while continuing to widen as they go toward the thigh. They aid the calf muscles in pumping blood back to the heart. They are recommended for those who are prone to blood clots, lower limb edema, and blood pooling in the lower extremities due to prolonged periods of inactivity. They are also frequently used to address complications caused by diabetes, lymphedema, thrombosis, and cellulitis, among other conditions.

3. Non-Medical Support Hosiery

These are mild compression stockings that generally do not require a prescription. They include support hose and flight socks. Self-diagnosing is usually safe with these types of support hosiery as their mild level of compression is not thought to have any adverse effects on the wearer. On the contrary, they are touted for their many benefits, which include improved performance among athletes, quick relief for muscles, and overall healthy limbs and circulation.  

The level of compression is measured in the same way pressure is. It’s done by determining the millimeters (mm) of mercury (Hg), which is abbreviated as mmHg. The levels of compression differ from low to very high as illustrated in the table below:

         Table 43-1. Compression Classes (European Standard Classification)^∗

Compression Class	Pressure at Ankle (mm Hg)
A (light)	10-14
I (mild)	15-21
II† (moderate)	22-32
III (strong)	33-46
IV (very strong)	>46

 Anything from 20 mmHg is considered high pressure and is usually recommended by a physician after an examination. Those below 20mmHg, however, can be easily purchased without a prescription and are very effective as well.     

How Do They Work?

Clever Design

Compression pantyhose are essentially two-way stretch stockings. They can stretch both longitudinally, or vertically, and in the transverse, or horizontally. This double stretch is very important to the concept of support hosiery, as it differentiates them from bandages, which were typically used before compression hosiery came on the scene.

The transverse elasticity allows for the sock to have the smallest diameter at the ankle while still allowing it to be comfortably worn over the heel. The difference in diameter must be compensated for so as to preserve compression without sacrificing comfort.

The longitudinal elasticity, on the other hand, allows for differing leg lengths. It makes it possible for compression socks to be worn over limbs of differing lengths. That said, sharing support hosiery is definitely not recommended.

The main purpose of compression hosiery is to facilitate joint movement. Generally speaking, joint movement increases the length of the limbs and therefore necessitates the stretching that longitudinal elasticity enables. Taken together, these two forms of elasticity allow compression socks to provide their full range of benefits.

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Effect on the Limbs

By exerting pressure on your legs, compression hosiery decreases the size of distended veins, which increases the rate of blood flow. Arteries supply oxygen-rich blood to the whole body from the heart, while veins transport it back to the lungs for oxygenation. By compressing the surface muscles and vessels, compression hosiery relaxes the muscles so that arteries can transport blood quickly and freely. This allows veins to push blood through more easily.

Veins also work under a valve mechanism to prevent the backflow of blood to the feet. Similarly, support pantyhose also help in the effectiveness of closing these valves by promoting blood flow to the heart. They clamp on the valves, holding them in a graduated grip that enables them to go about their work without strain.

Graduated compression stockings typically exert the most pressure on the ankles. As such, the pressure reduces as you go up the leg and toward the knees and thighs. The support hosiery also presses on surface muscles, which acts a constant, gentle massage that continually relieves muscle aches.

Benefits of Compression Hosiery

Compression therapy is becoming increasingly popular because of its purported medical benefits. Ever since the discovery of its ability to aid in blood flow, compression therapy has been used for everything from increased comfort to the treatment of various medical ailments.

Compression stockings only help when they are on. Ideally, they are to be worn daily. However, they are generally removed before bed to make sure the reduction in limb volume is maintained. Compression socks may be worn for years or even for life when alternative treatments are unavailable or not the best choice.

Some of the benefits of compression socks include:

• Improved circulation in your legs and throughout your body
• Support for veins in the ankles and calves
• The prevention of blood pooling in your extremities
• Reduced leg swelling and muscle aches
• Reduced orthostatic hypotension, which is systolic pressure from being in the supine or standing position that causes dizziness or unsteadiness when you stand
• The prevention of venous ulcers and lacerations
• The prevention of  deep vein thrombosis
• Reduction in the discomfort caused by varicose veins
• Reduction on the impact and appearance of spider veins
• Reversing of venous hypertension
• Improved lymphatic drainage
• The alleviation of the symptoms of edema

Leg Problems

Leg problems are a pervasive ailment across the globe which causes lowered productivity and is usually a tell-tale sign of something bigger. It’s important to check the health of your limbs so you can get started with compression therapy or the right medication immediately. With venous complications, the earlier the treatment, the better.

Limb problems don’t just pop up suddenly. Usually, they manifest themselves in signs that are often attributed to fatigue or age and therefore largely ignored. However, most of these signs are worth looking into. Some of the most common signs are sudden changes in the way your legs feel. This may present as increased tiredness and fatigue in the legs despite little to no activity. Or it may be a feeling of hotness and flushing in the legs accompanied by numbness. These are both signs to watch out for. A physical examination is also absolutely necessary to see whether ankles are swollen and to check for varicose veins so as to nip them in the bud.

What Leads to Leg Problems?

Leg problems may have a variety of causes, there is not a single, universal cause we can pinpoint. Their onset is usually a combination of one of many causative factors. Some of these factors include:

• Aging – Most people impacted are over 35-years-old.
• Heredity – Like many non-communicable diseases, your family history plays a large part in determining whether you’ll experience the condition.
• Obesity – Excess weight puts more pressure on the legs, which results in an increased workload that causes strain on the blood vessels.
• Lifestyle – An inactive lifestyle combined with unhealthy eating leads to the accumulation of cholesterol in the veins. This reduces their diameter, thereby limiting blood flow to the heart.
• Occupation – Occupations that involve a lot of time sitting or standing have a debilitating effect of the veins by either underworking or overworking them, which leads to inevitable complications.

Who Needs Support Pantyhose?

Compression hosiery is required for different reasons and worn by a large demographic. A large number of people with circulatory complications or venous disorders are turning to compression hosiery as opposed to medication. This may have to do with how easy it is to understand how they treat these conditions. In addition, career people who may be at risk are also embracing the compression therapy offered by support hosiery. Generally speaking, compression therapy is prescribed for (but not limited to) the following conditions:

• Tired, Aching Legs

This comes about when the blood flow slows down in the legs and maybe a symptom of deep vein thrombosis.

• Edema

This is a swelling of body parts due to excessive fluid that is usually stored in your organs.

• Venous Insufficiency

This is when veins pump less deoxygenated blood to the heart.

• Varicose Veins

These are enlarged, swollen, and twisted veins, often appearing blue or dark purple. They are the result of valve malfunction which allows blood to pool or flow backward. Varicose veins are an external sign of weak veins.

• Spider Veins (mild varicosities)

Spider Veins are the small, cutaneous blood vessels that shimmer bluish or reddish through the skin.

• Deep vein thrombosis (DVT)

This occurs when blood flow decreases (especially in the lower extremities), causing blood to pool in the legs and leading to blood clot (thrombus) formation.

• Lymphedema

This is swelling due to an abnormal accumulation of lymph fluid, which occurs when there is interference with the normal drainage of lymph fluid back into the blood. This commonly occurs in the arm, leg, neck, or abdomen.

• Phlebitis

This is inflammation and clotting in a vein, most often a leg vein, due to infection, inflammation, or trauma. People with varicose veins are more likely to experience this. The inflammation occurs suddenly, causing the thrombus to adhere firmly to the vein wall, which can clog a superficial vein.

• Lipodermatosclerosis

This is inflammation of subcutaneous fat, a form of panniculitis.

• Pregnancy

Hormones released during pregnancy and the expanding uterus (which creates pressure on the inferior vena cava – the major vein returning blood up to the heart) can affect leg veins.

The use of elastic compression stockings can reduce volumetric variations during standing hours. Many physicians and vein specialists recommend wearing compression stockings after varicose vein stripping. However, studies show that wearing elastic compression socks has no additional benefits following elastic bandaging for three days in post-operative care. This conclusion was drawn after assessing the control of limbs, edema, pain, complications, and the ability to return to work.

Conclusion

Support hosiery is a useful garment that, if fitted and worn properly, may help in alleviating many conditions while increasing the comfort for the wearer.

This page last updated December 16, 2022