Pedorthists are often on the front line when it comes to seeing patient’s legs and feet, being the first professionals to observe and assess biomechanical and circulatory issues. Many patients do not show their legs or feet to their physicians, and may not realize that issues such as swelling, discolouration and varicose veins can benefit from compression therapy. Canadian Certified Pedorthists, or C. Ped (C)’s, may be certified in fitting compression stockings and custom garments, and can help to make sure that patients are receiving the best treatment to alleviate their circulatory issues.

How Compression Can Help

Compression therapy is used to help with circulatory problems arising from the venous or lymphatic systems in the leg. Compression can help to improve the effectiveness of the valves within the veins and can therefore improve blood circulation.
People with all levels of discomfort can benefit from compression socks or stockings, from swelling brought on by long work shifts, to traveling on long flights, to problems arising from varicose veins, to post-surgical issues, deep vein thrombosis and more serious venous and lymphatic diseases. Venous ulcers also often require specialized compression therapy, although patients needing this level of support may receive their compression treatment through their specialist or at a hospital.
When a patient is mobile, the calf muscles work as a secondary “heart,” meaning that they pump the blood back up the legs after it has circulated into the feet. When there is damage within the veins, or lack of mobility of the client, the calf muscles are not working to effectively help the blood flow back up the legs against the pull of gravity. This is also where compression therapy can be of benefit.

Compression Fit

It is essential that patients are properly assessed and fitted for compression therapy garments, as socks or stockings that are too tight or ill-fitting can cause more problems than they solve. These can range from mild compression in a knee-high sock to full pantyhose that provide compression throughout the full length of the stockings.
Compression is available in a wide range of styles, sizes, and levels of compression. A C. Ped (C) that is trained in compression therapy fitting can help to ensure that the proper garment is being dispensed to the patient. There are also many options when it comes to fitting patients that have major edema or swelling. These can include stockings with zippers on the side, custom bandaging that is wound around the leg, or a custom-made stocking that is created based on measurements taken from the patient.

Levels of Compression

Socks and stockings for compression therapy have their compression levels measured in millimeters of mercury. The higher the level of compression, the tighter the garment will be when it is donned. Over the counter compression is usually measured at 8-15mmHg or 15-20mmHg, and prescription compression is usually 20-30mmHg, 30-40mmHg or 40-50mmHg.
Over the counter compression socks do not have a custom fit for the patient, meaning they can be purchased based on shoe size, and are found in a variety of locations. Prescription level compression is custom measured and sized for the patient. Since garments can be custom made for the patient, clients must see a certified professional to provide this type of sock or stocking to them. Since these compression socks or stockings are called “prescription,” a prescription from a physician is required in order to fit and dispense these garments.
Ideally the compression socks or stockings will have graduated compression, meaning they have a higher level of compression at the ankle than they do at the calf. This can help reduce the diameter of the vessels and can help ensure the valves within the vessels are working effectively and improving blood flow up the leg.

Other Uses for Compression Therapy

Compression socks are also becoming popular within the athletic community, although scientific evidence proving their effectiveness is sparse. Essentially, if compression socks are comfortable during activity, such as a long run, and the athlete feels they help to alleviate muscle soreness, then there is no reason they can’t be worn for sports.
Patients that have diabetes are cautioned when it comes to compression, and it’s recommended that the pedorthist works together with the patient’s physician to ensure that the risk factors are mitigated. Although compression can greatly benefit the issues that arise from having poor circulation, there are increased risks associated with wearing a sock that would be causing pressure or friction on the skin that may go unnoticed by the diabetic patient. Ideally the stockings in this case would have extra padding, flat seams, and a custom fit.
Canadian Certified Pedorthists that are certified in compression therapy fitting can help clients with many situations that arise from poor circulation in the legs.
For more information about the Pedorthic Association of Canada or to find a Pedorthist near you visit pedorthic.ca.
Janelle Coultes, B.Sc., C. Ped (C)