Venous skin ulcers: Using compression stockings

A venous skin ulcer is an open wound that typically develops on the lower leg and can take months to heal. If you have had a venous skin ulcer before or have one of a number of high-risk conditions that impair your lower-leg blood circulation, you have a significant risk of developing a venous skin ulcer.

Key points

• Wearing compression stockings is the single most effective way of controlling the painful fluid buildup and pooling of blood in the lower legs that cause venous skin ulcers.
• You can greatly improve your chances of remaining ulcer-free by wearing compression stockings on a daily basis.
• If you develop a venous skin ulcer, you can speed healing by wearing compression stockings during your waking hours and elevating your legs above the level of your heart whenever you can.

 What are compression stockings?
 Why is compression treatment so important?
 How do I put on compression stockings?
 Where to go from here

You can find more information about vein, circulation, and skin ulcer problems in these topics:

• Venous Skin Ulcer
• Varicose Veins
• Deep Vein Thrombosis

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Specially fitted compression stockings are designed to help prevent blood from pooling in the legs. Compression stockings:

• Are tightest at the foot. The tightness gradually lessens until you reach the top of the stocking (graduated compression).
• Cover the leg from the arch of your foot to just below or above your knee, or as panty hose.
• Can be purchased from a medical supply store with a doctor's prescription. They may cost between $60 and $100 a pair (panty hose style are more expensive) and usually need to be replaced after 4 to 6 months of regular use.
• Are available without a prescription. But nonprescription support hose do not provide the higher level of compression needed to prevent venous skin ulcers.

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If you have had a venous skin ulcer before or are considered at risk for developing one, it is very important that you use compression stockings during waking hours to keep your blood circulating. When blood and fluid pool in your lower legs, not only do they become swollen and achy, but eventually your skin begins to break down, forming open wounds. A skin ulcer can become a long-standing problem.

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At first, putting on a pair of compression stockings can be tricky, but you'll find the best technique for you with some practice. Consider the following:

• If your compression stockings are new, it might help to wash them before putting them on. This can help make the stockings more flexible and easier to put on.
• Make sure you put a dressing on any open wound before putting on the compression stockings.
• Sit in a chair with a back while you put on the stockings. This gives you something to lean against as you pull up the stockings.
• It is usually best to put on the stockings early in the morning, when you have the least swelling in your legs. Put silicone lotion (such as ALPS) or talcum powder on your legs to help the stockings slide on.
• Turn your stocking inside out, and place your toe in as far as it will go. Readjust the stocking by folding it back onto itself at the ankle and grab both sides of the folded stocking. Pull toward your body as far as you can. Fold back the stocking again farther up on your leg, and pull the stocking up to that point. Repeat folding back and pulling until the stocking is correctly placed. See a picture of how to put on compression stockings.
• Wearing rubber gloves may help grip the fabric. For a toeless stocking, wear a silk "slip sock" (from your medical supplier) to help the stocking slide over your foot more easily. Pull the slip sock off through the open toe when you're done.
• If you're still having trouble, use a "stocking butler," a metal device that holds the stocking open while you step into it. Although this device is often recommended for people who have trouble grasping, leaning, or pulling, try one before deciding to buy one—some people find them difficult to use.

Talk to your health professional or the certified fitter at your medical supply store about any difficulties you might have with your compression stockings. Call your doctor if your toes get numb or painful or turn dark while you are wearing compression stockings.

Every day, have your stockings at your bedside, ready to put them on before you get out of bed. Once you've mastered the technique, you'll find this becomes a regular part of your daily routine. If your stockings are properly fitted, they should feel comfortable when you have them on.

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Now that you have read this information, you are ready to take an active part in your treatment by wearing compression stockings on a daily basis.

Talk with your health professional or medical supply store certified fitter about any problems you have with your compression stockings. The risk of going without compression treatment is too great to neglect wearing them.

Take your stockings and anything you use to put them on with you when you visit your doctor. If you have questions about this information, take it with you when you visit your doctor. You may want to use a highlighter to mark areas or make notes in the margins of pages where you have questions.

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