Blood Clots, Varicose Veins, and Sore Legs: Can Compression Socks Help?

If your job requires you to be on your feet for hours on end or a medical condition is affecting the blood circulation in your legs, you may wonder if compression socks might be a solution. The short answer is that they might help.

For example, they can’t make a blood clot in the legs disappear, but they may help prevent one from forming. They can also soothe the achiness and fatigue that build up in the legs over the course of a long day.

But choosing the right compression socks—or stockings (the two terms are sometimes used interchangeably)—can be complicated. First, you need to get a pair that suits your situation. For instance, if you have a medical condition, you may need a prescription and a particular compression strength (low, medium, or high). Then, there is length. Do you need socks, knee-highs, or stockings that reach the top of the thigh? Even if you don’t have a medical condition but think these stockings can soothe your legs, the multitude of choices available over the counter and online can be overwhelming.

“First of all, if you’re having a problem like leg pain or swelling, it's important to get to the root of why that’s happening before you think about compression stockings,” says Britt Tonnessen, MD, a Yale Medicine vascular surgeon who has prescribed them for many patients. “For example, do you have varicose veins? Do you have lymphedema [swelling due to an accumulation of lymph fluid in the legs or another part of the body]? Or is there some other reason for your pain?”

Compression stockings won’t cure these conditions, but whether you have a serious medical issue or not, they can help manage symptoms, she adds.

Below, Dr. Tonnessen discusses how compression stockings can help with certain issues and situations.

Compression socks, which are made from synthetic materials, are tighter than regular socks. They apply controlled pressure to improve blood flow in the veins of the leg.

There are medical-grade compression stockings that are “graduated”—tightest at the ankles, with the compression gradually easing up the legs. This gently squeezes the legs to move blood to the upper body to be pumped back to the heart. That can help keep blood flowing properly so it doesn’t pool in the legs, which can prevent a number of issues. One is chronic venous insufficiency (CVI), a condition marked by a weakening of the veins and valves that causes such symptoms as swelling, aching, itching, tingling, and cramping in the legs, as well as pain that worsens when standing.

There are also nonmedical compression stockings, which are sold over the counter. They aren’t as tight as medical-grade ones, and they provide a lighter degree of pressure that is uniform—as opposed to graduated. This lighter compression may be enough to soothe swelling, aching, and heavy feelings in the legs if you spend a lot of time sitting or on your feet.

Talk to your doctor. Most medical-grade compression socks are available by prescription (although those that provide the lowest level of compression can be bought without one) and are manufactured according to standards set by the Food and Drug Administration (FDA).

They won’t prevent or cure a medical condition, and evidence of their effectiveness may be mixed depending on the condition. “We don't have longitudinal studies to say for sure if they prevent varicose veins or anything else,” Dr. Tonnessen says. But she does prescribe them, along with other nonsurgical therapies, to reduce pain and swelling caused by such conditions as:

• Chronic venous insufficiency (CVI): This condition, caused by damage in the veins in the legs, can lead to ulcers and serious swelling in the legs, spider veins, and skin color changes. There is high-quality evidence that compression stockings can help heal ulcers and prevent their recurrence.
• Deep vein thrombosis (DVT): Compression socks can help with acute edema (swelling) and pain caused by this condition, characterized by one or more blood clots in the legs.
• Varicose veins: Compression socks can reduce swelling and leg fatigue caused by the condition, which is characterized by bulging, enlarged veins.
• Lymphedema: Compression socks can help reduce swelling and prevent attacks of cellulitis (a bacterial skin infection) for people with this condition, in which lymphatic fluid, a protein-rich fluid usually eliminated through the lymphatic system, doesn’t drain properly in the legs. (Women may wear compression sleeves to manage breast cancer-related lymphedema in the arm.)

In addition, “pregnancy is a great time to wear compression stockings and thigh-high ones in particular,” Dr. Tonnessen says. "There is also evidence that venous disease is more prevalent during pregnancy, and compression stockings are a standard therapy."

Finally, compression socks can help with recovery from surgery, especially if an operation is done on the leg, knee, or hip, where there will be swelling. “A compression stocking can be particularly helpful for reducing swelling and improving circulation,” Dr. Tonnessen says. “But it’s important to remember that there is a small risk of getting a blood clot after any operation or procedure, so if you're having exorbitant swelling in one leg and not the other after surgery, your doctors may request an ultrasound to make sure you don't have a blood clot.”

Yes. Many people who don’t have medical issues wear nonmedical compression stockings to soothe tired legs.

Over-the-counter compression stockings are safe to wear. Some people (such as nurses, teachers, and retail workers) consider them because their jobs keep them on their feet all day. Others wear them because their jobs involve sitting for long periods.

“There is a lot out there commercially, as far as low-grade stockings. They may not have any major health benefit, but they may feel good and make your legs feel better by the end of the day,” Dr. Tonnessen says.

Anyone who has leg pain, progressive pain, or varicose veins should consult a doctor, Dr. Tonnessen says. “Serious problems are rare, but they do come up. I would be most concerned when a leg problem comes on suddenly over a period of days or weeks as opposed to having gone on for years. Or, if it's really affecting one leg and not the other—that may warrant more investigation.”

Anything that would signal that there might be a blood clot in your leg, such as pain or tenderness, warmth, swelling, and/or redness or discoloration, is a sign to see your doctor, she adds. “We see that story many times: Patients say they took a long ride in a car, on a motorcycle, or in an airplane, and then their leg was swollen for a week, which could be a symptom of a blood clot. That would be a sign to see a doctor urgently,” Dr. Tonnessen says.

A primary care doctor can examine your legs, check if any medications you’re taking could be contributing to the swelling, order blood work, and make a referral to a specialist if necessary, she notes.

People with peripheral arterial disease (PAD), a narrowing of the arteries that carry blood from the heart to other parts of the body, should avoid compression stockings, Dr. Tonnessen says.

People who are bedbound or in a wheelchair should talk to their doctor before buying compression stockings, depending on their condition. “I would hesitate to put somebody who doesn't have sensation in their legs in compression stockings, because if they're pinching or not fitting well, it could cause damage, such as pressure sores,” she says.

Likewise, anyone who doesn't have normal cognitive function, or is not able to communicate well may not be able to provide feedback if their compression stockings are pressing against the ankle or toes in a strange way, or just don’t feel comfortable.

It depends on why you’re using them. Medical-grade compression stockings come in different pressures:

• Low pressure (under 20 mmHg)
• Medium pressure (20 mmHg to 29 mmHg)
• High pressure (30 mmHg to 40 mmHg)

(The mmHg stands for millimeters of mercury, a unit of pressure that is also used to measure blood pressure).

If you have a medical reason for wearing compression stockings (and a prescription), your doctor should be able to make recommendations regarding pressure and length, and you can buy them from a medical-supply outlet where they will be fitted by a professional. (It’s also a good idea to check with your insurance company to see if it covers them.)

If you are buying over-the-counter compression stockings, many choices are available in a pharmacy, retail outlet, or online in a variety of lengths and in a low-pressure level (likely 10 mmHg to 15 mmHg) that should be specified on the label. "You may have to try different kinds to determine which ones are the most comfortable," Dr. Tonnessen says.

Dr. Tonnessen notes that she commonly prescribes the lowest pressure for patients with minimal swelling and medium pressure if there is significant swelling or a condition like CVI.

"Compression socks are generally safe, and side effects are rare," Dr. Tonnessen says. "But if they feel uncomfortable in any way—if they are too tight or are causing skin irritation or bruising, for instance—it can help to consult a medical provider and determine whether a different type may work better."

Some compression stockings contain latex, so people who are allergic to latex should be careful to purchase stockings that are latex-free, she adds.

The legs usually have the least amount of swelling early in the day, so the best time to put on compression socks is first thing in the morning.

People who have mobility issues—arthritis in their hands, for instance—might have difficulty gripping the tight stockings as they are pulling them on. “For people with impairments, it can help to use stocking-donning devices,” Dr. Tonnessen says. An example is a “stocking butler,” a cane-like device that the stocking can be loaded onto; the person steps into the stocking and then releases the cane. “There are a variety of accessories available to help don the stockings,” Dr. Tonnessen says.

Other advice includes rubbing cornstarch or smoothing lotion on your legs and putting the stockings on after the lotion dries.

One alternative is light compression sleeves, which don’t cover the feet and are available with a doctor’s prescription, Dr. Tonnessen says. An example is Tubigrip®, a tubular support bandage that comes in a roll so that the user can cut off a sleeve that can be slipped onto the leg. “That can be easier to don for somebody who is older or is more confined to a sedentary lifestyle,” Dr. Tonnessen says.

People with impaired mobility might also consider compression garments, which are special clothes that wrap around the leg, starting at the foot and going up the leg, and fastened with Velcro® or another adhesive material.

They should feel tight around the legs, with less pressure higher up the legs (if they are medical grade). If they hurt, that’s probably a sign they aren’t helping—perhaps they are the wrong size—and a reason to consult the doctor, Dr. Tonnessen says.

“If they are well-made stockings, they should feel good, like they’re giving your leg a big hug,” she adds.