Fair warning this post is long, but hopefully helpful! The following are my two cents on compression stockings after wearing them for 10+ years. It’s my experience with them and while I think I have a few useful things to share, please do not take this as a be-all, end-all. Every person with lymphedema has different needs when it comes to the size/compression/brand/model/etc. of compression stockings (and you should always seek out the advice of a professional before ordering a pair). As always, this is just my story, but I hope that it can help you figure out your own
Compression stockings, compression stockings, how I love to hate thee.
I definitely have a love/hate relationship with my compression stockings. On the one hand I hate wearing them because I feel like I’m wearing medical socks on my legs and I don’t feel normal, but on the other hand they work — compression stockings for me are by far the most effective tool I have in my lymphedema tool box.
When I first started wearing stockings roughly 13 years ago, I wore what I think everyone who was diagnosed with lymphedema at least 10 years ago did — circular-knit stockings. I wore Juzo, Jobst and Sigvaris. I didn’t have a preference, just whatever was available at the time. I also wore off-the-shelf stockings — although my PT brought up custom stockings at one point, I think they were dismissed as being too expensive.
At first I insisted on wearing the open-toed stockings. I thought for sure my toes would feel restricted in the close-toed. (the below are flat-knit open-toed stockings.)
But then I finally crossed over. Thank Jesus. You might think that the close-toed would be restricting, but really they’re liberating. With the open-toed they were constantly rolling up my feet and I always felt like my toes swelled up like little sausages (my swelling is primarily in my ankles/feet/toes). The close-toed, on the other hand, are just like wearing a sock. No longer did I have to worry what kind of shoe I was wearing.
Well, not exactly. You can’t physically wear close-toed stockings with flip flops, and they look funny with open-toed sandals. But anyway, I digress.
Over the years I got really lazy at wearing my stockings. I mean really lazy. And I was full of excuses. In the colder months I wore my stockings a couple times a week, and in the warmer months…yeah no that never happened. I didn’t keep up with buying new stockings as often as I should (translation: I wore stretched out stockings) and I didn’t wash them after every use (translation: I wore dirty and stretched out stockings).
I was also rather vain about it all, so I wanted the stockings that were going to look the least like medical stockings. So, about half my stockings were 15-20 mmHg, aka NOT enough compression for someone with lymphedema. I picked these because they were every so slightly more shear and could (if you squinted) be passed of as pantyhose.
So really, Grace, what was the point?
Funny you ask that. I asked myself that question all the time.
And then my life changed in February of 2014. I know, I know, I’m getting all dramatic again. I started seeing a new therapist in DC. She introduced me to a bonafide (note: I said that wish a southern accent in my head, sounds better that way) garment fitter, who introduced me to the glorious world of the custom flat-knit stocking.
Key gospel singers.
Ok, ok, the flat-knit stockings aren’t PERFECT, but they’re a heck of a lot more effective than my circular-knit. When I wore my circular-knit, I thought it was normal that when I took them off I was left with a big crease in my swelling at my ankle. Note to self and everyone reading this: it is NOT normal. In fact, it means the stockings are not doing their job. They’re actually hurting your swelling/lymphatic flow. Think of it like a water hose — when you bend the water hose, you prevent water flow from one end to the other.
All this talk about flat-knit vs. circular-knit — I bet you’re wondering what the heck the difference is? Well, let’s start with a picture (I don’t know about you, but I’m a visual learner). The top is flat-knit is on the top and the circular-knit on the bottom.
Up until I starting seeing a new therapist last year I didn’t even know there was another kind of stocking — the flat-knit variety — and I certainly had no idea how life-changing custom stockings are.
What is the difference between circular-knit and flat-knit, you ask? Well, the short answer is that circular-knit is not made for lymphedema (rather they are designed for venous therapy), whereas flat-knit is. Or at least that’s how I understand it.
My own (vain) opinion of the difference? Circular-knit are way more comfortable and attractive than flat-knit.
Flat-knit are also much thicker (which is actually one of the reasons they are more effective) — it’s never easy to fit into dress shoes with lymphedema, but I had a much easier time with my circular-knit than I do with my flat-knit. There are a couple pairs of flats that I was able to wear with the circular-knit, but now are too tight with the flat-knit.
Despite how much I just complained about the flat-knit, I don’t plan on ever going back to the circular-knit. Once I get past my vanity and superficial complaints, I know that the flat-knit are infinitely more effective and worth my time and effort. Even worth all of the complaining 😉
Simple enough reason to wear flat-knit or circular-knit, right? Well, I know it’s a harder transition than that. Knowing what’s better for you and actually doing it are two entirely different things.
I also hope to never go back to off-the-shelf stockings, but I know how rare it is to have a health insurance plan that covers custom stockings. I no longer had the plan that I procured my 5 pairs of custom stockings on (cue gross sobbing), so for now I’m going to have to live out my current stockings for as long as they’ll last.
What kind do I have? The Mediven Mondi Leg in the (flat-knit) knee-highs (I have never worn thigh-highs). I believe that all of the major compression stocking brands now carry flat-knit stockings, so Medi is certainly not the only option.
I have four pairs of the color “sand” (aka the skin color for pasty people like myself) and one pair of the black. One pair is open-toed and the other four pairs are close-toed. Although I don’t like the open-toed as much, it’s still nice to have one pair if I want to wear sandals and look semi-“normal”. These particular stockings by Medi seem to be a lot better than the circular-knit open-toed stockings that I had, so they don’t “ride up” as much as the other, but I still find myself needing to pull them down periodically during the day. If I could only buy one or the other, I’d go with the close-toed. That said, I know people of people that like the open-toed. It’s personal preference!
The open-toed DO have the benefit of being able to wear with flip-flops…
I really wanted to get a pair in the “medi magenta” color to mix things up, but in the end chickened out and went with all practical colors. I kind of wish I had gotten at least one more pair of black ones.
As I mentioned all of the five pairs of garments I have are custom-sized — which means that a professional fitter measured my legs, sent the sizing to Medi and set up a follow-up appointment to make sure they fit right. I found it interesting that it’s not a requirement for lymphedema PTs to know how to measure for garments and that there are people whose entire job is to go around and measure patients for garments.
Anyhoo, I was super psyched when my first pair arrived and I discovered that my NAME was written on the tag:
One of the best things about the custom stockings (I’m not sure if it’s simply because they’re custom or it’s the Medi brand — either way I never had this feature before on my circular-knit off-the-shelf stockings) is what they do with the ankle area. As you can see in the below photo they’ve actually added seams (or something like that) to hug the ankle area to more effectively use the compression to prevent the bent hose effect that usually happens to the swelling in that area.
Also something I really like about these stockings (but I think is just the norm now with stockings) are the little dots at the top — they help to keep the stocking up/keep it from rolling down.
They do leave less-than-desirable indentations in your skin when you take them off, but heck, whatcha gonna do.
They also have this incredibly unattractive (and obvious) seam going up the back (this is, however, what allows them to be flat-knit instead of circular-knit). It took me a long time to get used to this — both in terms of how they look, but also in terms of how they feel (I could feel the seam on the bottom of my foot).
Now that I have my fancy new(ish) 5 pairs of stockings, I wear stockings about 5-7x/week. Why not every day? It’s what works for me. I sit at a desk Monday – Friday, so those are the days that I need the compression garments the most. On Saturday/Sunday I’m a lot more active (i.e. not chained to a desk) and I find that being active helps my swelling a lot. So, some weekends I don’t wear them at all. It’s a nice break from reality and gives my skin a chance to breathe. PLEASE NOTE: I do not recommend doing that unless you have talked to your doctor/physical therapist. I’ve talked this through with my physical therapist and it’s what works for me. On days I don’t wear my stockings I use other tools in my toolbox. Again, it is all about you and your needs.
How I wash them:
Unfortunately, compression stockings need to be washed after every time you wear them. Yes, you heard me right! It sucks. #crybaby
My washing routine is the lazy routine. It’s probably better for the health of the garment to hand wash them, but I much prefer the washing machine method I’m not so good at squeezing the water out my stockings when I hand wash them, so it’s not always guaranteed that they will be dry by the morning.
- Use a mild detergent (I use Woolite)
- Wash in warm water
- If using a washing machine, wash on a GENTLE/HANDWASH cycle
- If hand washing, make sure to squeeze out as much water as possible (otherwise they take forever and a year to dry). I usually just squeeze the garment between my hands, but a reader suggested putting the garment in between a towel and patting dry. Even better!
- ALWAYS ALWAYS air dry! Noooo dryer for these guys!
- I usually wash them in the evening and need to wear them by the next morning — as long as you squeeze out as much water as possible (and you don’t live in a rain forest), they should be dry by the morning.
Some tips/lessons learned for garment wear:
- Do not put lotion on your limb before you put on a garment. I mean, do you really want your lotion getting all over your very expensive stockings? I know there’s a more grounded reason than that not to do it, but all the same I just avoid it
- Always wash in between wears!
- Buy new stockings about every 6 months — this depends, though, on how often you wear them. Right now I have 5 pairs that I got March-May 2014 that I rotate, so I wear each pair 1-2/week. I’ve recently lost my really good insurance, so I will be wearing these for awhile longer (but I do recommend, if you can, to replace your stockings every 6 months if you wear them daily).
- I have a favorite pair of Birkenstocks with black leather straps — be warned the deep color from leather straps like this come off on your stockings and ruin your wonderfully skin-colored stockings On the bright side, when you wear open-toed stockings with the Birkenstocks the straps cover the end and you can barely tell you’re wearing stockings!
How I put them on:
Actually putting on the garments was a bit of a learning curve for me, so I thought I’d share how I do it and hopefully help someone out.
The first step (and this is crucial) is to make sure you have good gloves. “Good” gloves = gloves that are “sticky” / the hands have a textured coating so that you can move the fabric of the stockings by just placing pressure on the fabric (not grabbing at it with your fingers). My first couple pairs were these fancy medical ones you had to get from the medical store, but since they do wear out and I had to keep buying more, I wanted to find some that were more easily accessible. Gardening gloves to the rescue! Below are my latest pair — just got them from Ace Hardware. Here are the same ones on Amazon. Note that when looking for coated gloves you need to make sure that the coating is textured and not slick — I once ordered a couple pairs of these super adorable kitchen gloves that I assumed would work as well. Turns out the coating was slick and they didn’t work at all. What a bummer! Back to the ugly gloves.
Next step is to make sure your stocking is right side out (I’m lazy and wash my stockings inside out so this is always the first step for me):
Next stick one arm all the way in the stocking:
So that you can then turn the stocking inside out only HALF the way (roughly to the ankle):
Then put the half-inside out stocking on the correct foot. Make sure to align them correctly (this is one time when having that obnoxious seam makes it easier to know I’ve put them in the right place). It’s important to align the stocking correctly now because the farther you get in the process of putting the stocking on the harder it is to adjust the placement.
Next turn the second half of the stocking right side out by first pulling the top of the garment with your gloves as far as you can easily pull up the garment:
Once you are met with enough resistance from the stocking that you feel you are stretching the fabric STOP PULLING:
This is where the handy dandy textured gloves come in — put your palms on the fabric and shimmy the fabric up your leg until you get to the right spot. The texture on the gloves will grip the fabric just enough to “pull” it up. This is much better for the fabric than using your fingers to pull at the fabric (and inevitably stretch it).
How do I take them off? Well, there isn’t much technique to this (and sorry I don’t have a photo). I take the top of the garment with both hands and roll it down my leg (so it ends up inside out) until I get to the point where I have to pull it off with one hand. Please note: if you don’t have the best balance I’d suggest doing this sitting down. I usually can’t be bothered to sit down for this (I’m always so anxious to rip them off as soon as possible), which usually means I can’t put as much force into yanking them off (it can be quite hard) and sometimes means I lose my balance. Oh well!
Some additional compression stocking resources:
- The benefits of compression from Juzo
- More on compression garments from Lymphedema People
- And even more from BC Lymphedema Association
Some compression stocking brands to consider (this is not an exhaustive list):
Well, that’s all folks! Thanks for sticking with me until the bitter end