Swollen ankles? How compression socks work to improve circulation and reduce swelling – Seniors Matter

Tracy Mitchell Griggs

Socks are a wardrobe staple whose chief utility hasn’t changed much in centuries. Yet, their use for health can be traced to ancient civilizations where versions were used to bind and treat injuries.

Fast forward to the 1930s when specialized hosiery was manufactured in Europe to help prevent varicose veins, as well as reduce the chance of developing blood clots and deep vein thrombosis. The stocking designs were continually refined and arrived in the U.S. in the early 1950s where their medical evolution continues. 

Today, the elastic, snug-fitting foot and leg coverings are called compression socks (or compression stockings) and are often used to treat swollen ankles and underlying conditions.

How do compression socks work and who should wear them? 

The socks apply gentle pressure that helps blood vessels work better. They help arteries (which take oxygen-rich blood to muscles) to relax, allowing blood to flow freely. Veins also get a boost, pushing blood back to the heart. This process improves circulation between lower extremities and the heart and can help prevent damage to vein walls and valves, minimizing inflammation and preventing clots.

Swollen ankles and feet are common and usually not cause for concern. If they stay swollen and are accompanied by other symptoms, however, it could be a signal of health problems that can include:

After a medical evaluation, your physician may recommend daily use of compression socks and will help you determine the best size and compression strength. Socks are also used by patients recovering from surgery or those confined to a bed or wheelchair. 

What to look for in compression socks

Compression sock strength is rated by a measurement called mmHg—which is systolic pressure, or when your heart pushes blood out. Diastolic pressure is when your heart rests between beats. For example, if your blood pressure is “140 over 90” (or 140/90mmHg), it means you have a systolic pressure of 140mmHg and a diastolic pressure of 90mmHg.

Sock compression levels are rated from mild to extra firm, and each level treats specific conditions:

  • Mild: 8-15 mmHg – This level maintains healthy circulation and alleviates mild symptoms and swelling. If you don’t have venous issues but spend a lot of time sitting or standing (and experience heavy, aching legs), this level will improve fatigue.
  • Medium: 15-20 mmHg – This level helps swelling and tired, aching limbs, and relieves pain from other venous issues like varicose and spider veins and deep vein thrombosis.
  • Firm: 20-30 mmHg – Firm is indicated for serious venous issues, including moderate to severe edema or lymphatic edema (swelling); low blood pressure; active ulcers and post-thrombotic syndrome (a long-term condition that results from DVT); and superficial thrombophlebitis, an inflammatory condition caused by a blood clot just below the skin.
  • Extra firm: 30-40 mmHg – This is recommended for managing symptoms of lymphedema and more severe versions of conditions treated by the 20-30 mmHg compression level. 
  • 40-50 mmHg: This is the highest level of compression used to manage the most serious venous conditions and only used if recommended by a doctor.

“The amount of compression provided by a pair of socks will vary depending on both leg size and sock,” said Dr. Eugene Ichinose, MD, a vein specialist with the Oklahoma Heart Institute. “Patients commonly complain that compression socks cut into their legs, and it’s usually because the size is too small.” 

When considering sock size, ankle measurement is the most important number for medical-grade socks. To get the right size, have a doctor measure your leg or self-measure at home the following measurements:

  • Calf circumference 
  • Length of calf – Measure from the knee to the heel while sitting with thighs parallel to the ground. You may need help to double check accuracy.

There are several types of compression designs:

  • Anti-embolism helps prevent blood clots when mobility is an issue such as during surgical recovery. They feature graduated compression that decreases from the ankle toward the knee. Available in different levels of compression, they generally require a doctor’s prescription and professional fitting. 
  • Graduated exerts the strongest pressure at the ankle that decreases toward the knee. Stockings that end just below the knee help limit peripheral edema (lower leg swelling) due to fluid buildup. Socks that extend to the thigh or waist help reduce pooling of blood in the legs and help prevent low blood pressure. These require a professional fitting to ensure appropriate pressure and fit. 
  • Support provides the same level of pressure throughout the sock. Worn to enhance comfort, they’re a good choice for swollen ankles (with no serious underlying medical condition) and if legs ache at the end of the day. No prescription is required. 

If your doctor has prescribed compression stockings, check legs daily for skin changes, such as irritation or redness, which might indicate an improper fit, an infection or allergy, or that they’re not being put on or taken off properly.

Unless your physician advises otherwise, compression socks can be worn all day. Made from a variety of fabrics including merino wool, bamboo, cotton blends and nylon, they can be purchased at pharmacies, big box stores, online retailers and medical supply outlets. It’s a good idea to try several brands for fit and comfort before purchasing a supply.

When considering price, Ichinose said it’s best to investigate the quality. 

Juzo, Sigvaris, Medi and Jobst have made medical-grade socks for decades and are known for their superior workmanship.”

And you won’t need to sacrifice style: Many leading hosiery brands have responded to market demand for fashion-forward designs. A leading “social-good” sock company, Bombas, has gotten into the game, selling everyday compression (15-20 mmHg) and strong compression (20-30 mmHg) styles—and they donate one pair to those in need for each pair sold. 

It might take a few days to adjust to the close fit, but if you’re wearing the correct size, they shouldn’t be painful. For adults with mobility challenges, the Sigvaris Doff N’ Donner is a device used to help socks glide easily on and off and is suitable for both independent use or by a caregiver. Applying a small amount of talcum powder to feet and legs can also help to put them on. Wash and dry between each use, just like any other socks or stockings.

Who shouldn’t wear compression socks?

Ichinose said compression socks are not recommended for some patients.

“If you have peripheral vascular disease affecting lower extremities, you shouldn’t wear compression socks,” he said. “The pressure may make ischemic disease worse. And diabetic patients can be at increased risk of complications, as sensation loss from neuropathy can prevent detection of changes in the feet.”

He advises patients to first compare toe color to foot and leg color and report any differences to a physician. 

He also cautioned about sock “bunching,” which could create a tourniquet effect that might interfere with circulation. 

Are compression socks covered by Medicare? 

In most instances, Medicare won’t cover compression socks because they aren’t considered “durable medical equipment.” However, Part B will cover compression socks if a doctor writes a prescription to treat a venous stasis ulcer that occurs due to poor leg circulation. A wound care doctor may dress the wound and instruct you to apply a compression sock over it.

Medicare doesn’t provide coverage for compression socks that treat varicose veins, circulation issues or for ulcer prevention. 

Although benefits vary by state, some state Medicaid programs may cover compression socks. If you need financial assistance, you may be able to secure financial support from nonprofit organizations specific to certain medical conditions:

Lymphedema Advocacy Group

American Cancer Society

American Diabetes Association 

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About the Author: Eugene Berry