Compression Stockings Guide for People with Diabetes

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Compression stockings, sometimes referred to interchangeably as compression socks, are stockings that are designed to provide compression therapy to the foot, ankle, and lower leg. They apply gentle pressure when worn, making it easier for blood to flow to your heart from your legs (Compression Stockings, n.d.).

Compression socks fill a number of important therapeutic roles. Their ability to reduce pain and swelling in your legs and ankles is a major benefit for anyone who suffers from edema, for example. Also, since foot care is essential for anyone diagnosed with diabetes, the ability of compression stockings to improve circulation, reduce swelling, and protect the foot and leg from injury are all crucial to preserving a diabetic’s health (Diabetes and Your Feet, 2019).

Not every pair of compression stockings is created equal, of course. Here are some more details about compression stockings, how they work specifically for diabetics, the different types of socks and stockings out there, and how to wear them properly to minimize the possibility of side effects.

How Compression Stockings Work for Diabetics

As a chronic illness that often requires lifelong care and treatment, diabetes needs to be monitored carefully. Of the many complications that are associated with diabetes, many of them affect the feet. Someone with diabetes has a higher risk of foot infections and other serious complications, and this means that there needs to be consistent and careful foot care. Without this care, these complications can lead to serious conditions that might require amputation of several toes, the entire foot, or even the entire lower leg. This makes practicing good foot care crucial - and choosing appropriate socks is often the first defense against diabetes-related food complications (Feldman & Davis, 2001, p. 59).

Diabetics have to face many risks associated with high blood sugar. One of these risks is neuropathy, or nerve damage (Skerrett, 2020). Most commonly, neuropathy occurs in the nerves found in the feet. The symptoms of neuropathy include numbness in the feet and/or toes, sharp pains in the feet (especially at night), muscle weakness, tingling or burning sensations, and even foot ulcers and deformities. Diabetics with neuropathy can become injured and not even realize it, as deadened pain receptors never report the problem to your brain. This can lead to your injuries easily becoming worse or even infected. Other issues diabetics face include poor blood circulation and swelling, both of which can contribute negatively to injuries by slowing down the healing process considerably.

This is where compression stockings come in. Not only do they provide gentle compression to the foot and leg to encourage blood flow back to the heart to minimize swelling, good compression stockings also provide a measure of protection for a diabetic that’s suffering from foot neuropathy. While it’s not a perfect solution - a diabetic still needs to pay careful attention to the condition of their feet regularly - it’s well-established by medical research that a compression stocking is an excellent tool for diabetics to live a more healthy lifestyle (Otter et al., 2015, p. 9).

Types of Compression Stockings

There are a number of different types of compression stockings. Not all of them are exclusively meant for diabetics, as swelling and edema in the feet and legs is not just a complication from diabetes. Some of these stockings are more ideal than others when providing support for diabetics, so it’s important to understand their individual benefits and drawbacks. Here’s a short list of the different types of compression stockings you’re likely to find and what the main differences are between them.

Graduated Compression

Graduated compression socks or stockings feature strong levels of compression at the ankle and then gradually decreasing levels of compression towards the top. Usually requiring a professional fitting, these stockings are designed with mobility in mind while still meeting certain medical specifications for strength and length. They can help limit the swelling of the lower leg, or edema, if they stretch to just below the knee; stockings that extend higher, as to the thigh or even the waist, can help reduce blood pooling in the legs and are used in the prevention of orthostatic hypotension. Many suppliers of graduated compression socks will allow for a choice of color and whether they come in a closed-toe or an open-toe design.

Anti-Embolism

Anti-embolism stockings are similar to graduated compression socks in many ways. They’re primarily used to reduce the possibility of developing deep vein thrombosis, which is when a blood clot forms deep within your body. The compression on anti-embolism socks is likewise graduated, but the amount of compression can be much different from a typical graduated compression stocking. Additionally, anti-embolism stockings are not designed with mobility in mind, as they’re meant for patients that spend more of their time immobile, either sitting up or lying down.

Nonmedical

Non Medical compression stockings, unlike graduated or anti-embolism stockings, are routinely available without a doctor’s prescription. Instead, these are the types of compression socks and stockings you’re likely to find in your local drug store, the pharmacy section of your favorite supermarket, or available for order online. These nonmedical stockings come in a number of flavors, such as flight socks and elastic support hose, and they typically don’t offer the same amount of compression as other stockings. They almost always have uniform compression instead of graduated as well. They’re recommended for anyone suffering from tired or aching legs - a favorite of cashiers and anyone else who’s on your feet all day.

Diabetic

Diabetic compression stockings are meant to do much more than simply provide compression to reduce edema. In fact, they’re designed to also protect the foot in general, keep it dry and warm and minimize injuries. The best diabetic socks include the following characteristics:

Padded: these stockings are cushioned to protect the foot from injury
Fitted: to prevent loose fabric from rubbing against skin, diabetic socks are meant to be worn snugly
Seamless: to avoid blisters or ulcers caused by seams rubbing against skin, these stockings often don’t have seams
Square-Toed Box: wide-toed socks prevent toe squeezing, preventing moisture buildup and discomfort
Warm: stockings are insulated to help improve blood circulation and to counteract restricted blood vessels caused by diabetes
Breathable & Moisture-Wicking: important for keeping feet dry and preventing infections of the skin

Compression Levels

Whether you’re considering a uniform compression stocking like you would find in a drug store or a graduated compression stocking that you would receive with a prescription, you’ll have to decide what level of compression is best for you. Compression levels are measured by their tightness or compression strength, and it’s measured in millimeters of Mercury. You’ll likely recognize it abbreviated as mmHg, which is how doctors measure blood pressure.

There is a wide variance in the number of compression levels you’ll typically encounter. In general, mild compression begins at around 8 mmHg, which is usually reserved for normal cases of tired, aching feet, minor varicose veins, and small amounts of edema. On the other side of the equation, compression can go as high as 40 mmHg or even higher for treating very serious issues like deep vein thrombosis or severe lymphedema.

In regards to how much compression you need, either as a diabetic, someone with edema, or any other conditions that compression stockings are used to treat, it’s imperative that you be assessed by a physician first. When wearing stockings that have the proper compression for your condition, research shows that these stockings are not only beneficial but completely safe (Rother et al., 2020). However, compression stockings that don’t provide enough pressure aren’t going to be as effective if they’re not providing you the support you need. Meanwhile, stockings that provide too much pressure could end up doing more harm than good if they’re too tight, dangerously restricting blood flow to your toes or feet.

Sizing Guide

In addition to choosing a compression stocking with the right amount of pressure, you also have to choose a stocking that fits properly otherwise. It’s not as simple as shopping for dress socks, though; there’s a lot to consider when you’re trying to find a good fit. You’ll need stockings that will fit both your ankle, your calf, and, if your choice of stocking goes even higher, your thigh as well. Here are some important steps to follow:

Measure your legs first thing in the morning when swelling is at a minimum
Take the circumference of your ankle at its narrowest part, right above your ankle bone
Measure the fullest part of your calf for calf circumference
Measure the length of your calf as well, from the back of the knee to the bottom of your heel
Thigh high stockings require your thigh circumference, measured from its fullest part, and the length of your thigh from the gluteal fold (the bottom of your rear) to the bottom of your heel
Fitting compression pantyhose will require your hip measurement at their widest part
Remember: each style and brand often has different sizing. A Medium from one brand may be a Small or a Large from another brand, so check size charts carefully

The Final Word on Compression Stockings for Diabetes

If you’ve been diagnosed with diabetes, you know that you have some serious responsibilities. Depending on your treatment plan, you could be tasked with changing your diet, engaging in regular exercise, and taking medication regularly, and even checking your own blood sugar levels every day. All of these components of your treatment need careful monitoring by your doctor to ensure that your glucose levels are under control and that you’re not developing complications.

As some of those complications can be neuropathy and edema, it’s important for both you and your doctor to pay close attention to your feet and lower legs. In the event that you’re showing signs of edema, neuropathy, or both, you may be given a prescription for compression stockings. If that’s the case, rely both on your doctor’s advice and this guide for the best guidance on finding the right compression stockings for you.