Debunking myths: Compression hosiery

Myths abound in discussions about healthcare (just think chicken soup). But when it comes to the use of compression hosiery, some tales can be debunked easily.

The benefits of compression hosiery include improved blood circulation for patients with varicose veins, or achy swollen feet—especially helpful for those with diabetes.

Traditionally, home medical equipment (HME) and durable medical equipment (DME) companies have dispatched representatives to practitioners’ offices to educate them about the availability of products. Typically, these reps leave behind a locally printed prescription pad for physicians, a scenario that leads to the first big myth.

Myth 1: Compression stockings require a prescription.

By law, no prescription is re­quired. Practically speaking, though, many pharmacies require a pre­scription for higher-level compression hosiery. Compression levels range from 10 to 30 mm Hg and above; compression above 10 to 15 mm Hg falls into the higher range.

“Most pharmacies won’t dispense higher-level compres­sion hosiery without a prescription,” said Marybeth Crane, DPM, of Foot and Ankle Associates of North Texas, in Grapevine, TX.

Patients, however, can get lower-level compression hose that work very well without a prescription, said Bill Meanwell, CPed, of the International School of Pedorthics in Broken Arrow, OK.

Most patients can use 10- or 15-mm Hg hosiery without a problem, but using higher levels of compression requires more knowledge on the part of the patient, said Bret Ribotsky, DPM, a podiatrist in private practice in Boca Raton, FL, and founder of www.PodiatricSuccess.com, a website featuring audio interviews with prominent podiatrists. If 10 to 15 mm Hg is not effective, patients should see a practitioner for further guidance, Ribotsky added.

“It’s a good idea to have a physician to pick out the compression level,” he said.

Myth 2: Compression stockings are appropriate only for certain patients.

“The only people who don’t need compression stockings are giraffes,” Ribotsky said. “Gravity is your enemy, so you might as well use the stockings.”

Almost all individuals can benefit from compression, said Crane, especially patients with diabetes, as long as they have adequate arterial circulation.

“I wear compression stockings in the operating room to help with leg fatigue,” she said.

Professional athletes are taking advantage of compression wear to improve performance and recover faster from injuries, according to Crane and Meanwell.

“If you have absolutely zero edema, and you have an excellent venous system, well, maybe the compression hose aren’t necessary,” Meanwell said.

Myth 3: The risks of compression hosiery outweigh the benefits.

“Ridiculous,” Crane said. “A patient with severe vascular disease should not use compression wear, but otherwise it’s not dangerous.”

In fact, said Meanwell, “the risk of not wearing them and developing a blood clot or pooling of blood in the foot is definitely a major risk.”

There are no risks if the hose are properly fitted, he added.

“The compression hose must be properly and professionally fitted and professionally selected [probably by the specialist at the pharmacy],” he said, adding that it’s best to measure the legs in the morning before they expand and swell.

Myth 4: Your patients can’t afford compression stockings.

“I think it’s all about making them a must rather than a should,” Ribostsky said. “You have to tell a compelling story. You might ask, ‘Do you want to take your grandkids to Disney World without your legs hurting?’”

Myth 5: Your patients won’t wear compression hosiery even if you prescribe them.

It’s true that compression hose can be intimidating to patients, Meanwell said.

“It’s like a wrestling match with yourself,” he said. “If you’re not a flexible person by nature, you would be worried that you’d find yourself in a video on YouTube putting on these hose. They can be quite taxing.”

But these issues can be addressed through patient education and the use of assistive devices to help with donning and doffing.

“If you need the strong compression but can’t get them on, then start with the light compression,” Ribotsky said. “A little compression is better than nothing

Should I Be Concerned About Varicose Veins?

Q: I am 64 years old and have only recently started developing varicose veins in my legs. I'm using compression stockings, but they're uncomfortable during the warm months. What other options do I have to deal with them? Aside from the increased risk of a blood clot, do they pose any serious health risks? Will the varicose veins start to look worse as I get older?

— Tania-- Wichita, KS

A:

Varicose veins can be very unpleasant, particularly from a cosmetic point of view. These enlarged and tortuous veins usually show up in the legs; they are subject to high pressure when you’re upright and therefore likely to be uncomfortable and perhaps even painful while you're standing or walking. Varicose veins can also sometimes itch, and scratching them can cause ulcers. Ulcers that infect your veins can lead to blood clots — this is a condition known as superficial thrombophlebitis and is usually isolated to superficial veins. In rare cases, these blood clots can extend into deep veins, becoming a more serious problem. Still, varicose veins very rarely bring on serious complications. More than anything else, they are considered to be a cosmetic problem, which, unfortunately, can worsen as you grow older.

One of the options you might wish to consider to reduce the appearance of your varicose veins is surgical intervention. Vein stripping is one particular surgical treatment that can help. There are also newer, less-invasive treatments such as ultrasound-guided foam sclerotherapy, radiofrequency ablation, and endovenous laser treatment, each of which has its own pros and cons. Nonsurgical treatment options include elastic stockings, elevating the legs, and exercise.

Learn more WWW.CKPA.NET .

Why Are My Feet Swelling?

Q: Is it normal for your feet and ankles to swell, and can anything be done to stop it? I've noticed I begin to swell three days ago. The swelling does go down a little at night when I prop my feet up.

— Angela, Wichita
A:
Fluid retention is very common and the easiest way to diminish the swelling is by lowering your intake of salty foods (chips, fries, olives, fast-food items, etc.) and drinking plenty of water. You could also try wearing elastic stockings (also known as support or compression stockings), which can help stimulate circulation in your legs and stop swelling. If you spend all day on your feet, the stockings are probably your best bet for long-lasting relief.

Another option: Try elevating your feet even a few inches off the ground when you're sitting down. For example, keeping a small ottoman or stepstool under your desk at work and using it to prop your feet up can help reduce the swelling a lot. Finally, mild diuretics can help ease swelling in severe cases, but these are medications that your doctor will need to prescribe. The best idea is to discuss all of these options with your doctor, so the two of you can devise a plan together.