Compression Stockings: Measuring, Sizing and Putting Them On

Before measuring: check with the doctor

Compression is not right for everyone. It needs a check of leg circulation and the cause of swelling. Ask a doctor, nurse or trained fitter which style, length and compression level to use and for how many hours a day. Measurements and sizing charts are specific to each maker, so use the chart of the exact product.

When and how to measure

Time of day. Measure in the morning, soon after getting up, before the legs swell. If the leg swells a lot during the day, a measurement taken at the end of the day gives a larger size. A trained fitter will advise. Re-measure if swelling or weight changes.

Position. Measure with your parent sitting or standing as the chart specifies, with the foot flat on the floor and the knee bent at a right angle, or lying down. Some charts require the measurement of leg length from the floor.

Tools. A soft, flexible tape measure, in centimetres. Pencil and paper. A helper if possible.

Measurements usually needed (check the chart):

1. Ankle circumference at the narrowest point just above the ankle bone. 2. Calf circumference at the widest part of the calf. 3. Leg length from the floor to the back of the knee (for knee-high), or from the floor to the crease of the buttock or groin (for thigh-high). 4. Thigh circumference at the widest point, for thigh-high stockings. 5. Foot size or shoe size, and sometimes the circumference around the heel and instep for foot-covering garments. 6. Hip or waist measurement for pantyhose.

Technique. Keep the tape snug, not tight, flat against the skin without twisting. Write each value down. Measure both legs. Legs are often different sizes, and you may need two sizes. Take each measurement twice.

Choosing the size. Compare the measurements to the chart. If the ankle falls in one size and the calf in another, a doctor or fitter may suggest the larger one, or a made-to-measure stocking. If you are between sizes, ask for advice rather than guess.

Choosing length and style

• Knee-high: the usual choice for swelling below the knee. The top band sits about two finger-widths below the bend of the knee, so as not to press behind it. Easier to wear.
• Thigh-high: for swelling or veins above the knee. A grip band holds it at the top of the thigh. These are more likely to roll down, and harder to put on.
• Pantyhose: for hip-to-toe coverage. Rarely needed.
• Open or closed toe: choose open toe for large feet, bunions, hammer toes, or where toes need checking; see bunion correctors: what they can and cannot do.
• Colour and fabric: a breathable cotton blend suits the Indian climate. Skin-coloured stockings are common, but dark colours may hide marks, so be careful to check the skin.
• Silicone grip bands hold thigh-high stockings, but may irritate skin; ask for alternatives if so.
• Made-to-measure stockings suit unusual leg shapes, very large or small legs, or when the usual sizes do not fit.

Putting them on: step by step

Put stockings on early in the day, before the legs swell, ideally before getting out of bed, or after a short period with the legs raised. Dry skin, and work slowly.

Preparation. - Clean and dry the legs and feet. Do not apply moisturiser just before; it makes the stocking hard to slide on and can damage the elastic. Apply cream at night. - Remove rings and bracelets, and trim rough nails or hard skin that can snag the fabric. Wear soft cotton gloves or rubber gloves to grip and protect the fabric. - Make sure the legs are dry. Talc or a small amount of powder can help the stocking slide on dry skin, for some people, but check with the doctor if there is skin disease.

Method: the inside-out roll for knee-high stockings.

1. Sit comfortably with the leg slightly raised. 2. Reach into the stocking and hold the heel pocket. Turn the stocking inside out down to the heel, so that the foot part is the right way out and the leg part is turned back over it. 3. Slide the foot into the foot part, making sure the heel pocket lines up with your heel, and the toes sit in the toe part, without wrinkles. 4. Gently pull the leg part up over the heel and ankle, a little at a time, using your palms or gloved hands, and not your fingertips or nails. 5. Continue up the leg, smoothing as you go. Avoid pulling at the top band. 6. The top should sit below the bend of the knee, about two finger-widths. Do not fold it over. 7. Smooth out wrinkles from the ankle upwards, working the fabric evenly. Wrinkles are tight bands and can damage skin. 8. For open-toe stockings, check that the toe opening lies at the base of the toes and does not pinch. 9. Check the heel position, and that the foot is not twisted.

Thigh-high stockings are done in two stages: pull up to the knee as above, then pull the thigh part up, smoothing until the grip band sits at the top of the thigh, without rolling over.

If the leg is swollen or fragile, a nurse can show a gentler method, and may advise on using aids.

Donning aids that make life easier

If putting on stockings is hard, particularly with arthritis, a stiff back or weak grip, aids may help.

• Rubber gloves for grip and to protect fabric.
• Frame or slider donning aid: a plastic or metal frame that holds the stocking open, so the foot can slide in, then you pull the frame upwards. Many styles exist for different strengths. See dressing aid guide.
• Stocking slip sock or silky liner: a thin, slippery sock placed over the foot, which lets the stocking slide on, then is pulled out through the open toe.
• Long-handled devices for reaching.
• A seat at the right height, and a stool to raise the foot to the knee.
• Help from a carer. A carer should wear gloves, keep fingernails short, avoid pulling at the top band and check the skin each time. Teach them the method.
• Practice. The first weeks are the hardest. A nurse or fitter can show the method in person.

Taking them off

• Take them off at the time advised, usually at night.
• Peel the top band down and fold the stocking back on itself like a sock, over the heel, then slide it off the foot. Do not tug at the toe.
• Inspect the skin, then wash and dry the legs; apply a gentle moisturiser if the doctor advises.
• Check the stocking for tears or wear.

Common fitting errors

• Wrong size, from guessing or using a different brand's chart.
• Measuring after swelling, leading to a stocking that is too big in the morning.
• Wrinkles and folds, which create pressure lines.
• Rolled-down top band, acting as a tourniquet.
• Top band too high, pressing on the knee crease.
• Heel pocket in the wrong position, twisting the stocking.
• Wearing over cream, which damages elastic and makes slipping.
• Using damaged or stretched stockings.
• Two stockings worn together, unless prescribed.
• Ignoring discomfort.

Signs a stocking does not fit

• Red or purple marks that last long after removal, grooves, indentations or blisters.
• Pain, numbness, tingling, cold or discoloured toes.
• Swelling above the top band or below the toes.
• Constant slipping or bunching.
• Itching, rash or skin breaks.
• A feeling of the stocking cutting in or being too loose.

If any of these occur, remove the stocking, check the skin and contact your doctor, nurse or fitter. Seek urgent help for a hot, painful, swollen calf or sudden breathlessness; see swollen legs in older adults.

Care and replacement

• Wash after each wear, or as the label says, with mild soap in lukewarm water, rinse well, squeeze gently and dry flat in the shade.
• Do not use bleach or fabric softener, which damages elastic, and avoid direct sun or heater drying.
• Have at least two pairs, so one can be washed.
• Replace every few months, or when they lose their elasticity, develop holes or no longer feel firm; follow the maker's guidance.
• Keep nails and rough skin smooth.
• In the humid season, dry thoroughly to prevent fungal infection; see skin conditions in older adults and diabetic foot care at home.

Support for carers

If you help a parent, be gentle, patient and respectful. Some people find it embarrassing to ask for help with their legs. Choose a quiet time, work in good light, and make it part of the dressing routine; see dignity in intimate care. Protect your own back by sitting or kneeling at the right height; see how to lift and transfer safely. For a person with dementia, keep instructions simple; see dementia communication tips.

When to ask a professional

Ask a nurse, pharmacist or trained fitter to measure and teach donning, particularly for the first pair. A doctor should be consulted before starting and when there is pain, wounds, sudden swelling, numbness or colour changes. An occupational therapist can recommend aids for stiff hands and backs. A podiatrist can check feet. A vascular specialist can advise for complex cases or ulcers.