When Should you Wear Compression Socks? (And For How Long)

What are the different types of compression stockings available?

There are two main types of compression for lower limbs:

1. Compression socks
2. Compression stockings

The idea behind compression is that applying pressure on the legs can reduce venous stasis and blood pooling by promoting blood circulation in the veins.

Good blood circulation is one of the indicators of relatively good health and may help prevent or treat certain problems or conditions.

Compression can vary in intensity. In most cases, compression stockings of class 2 are prescribed or recommended. However, there are also graduated compression socks and stockings of class 1, 3, or 4.

The level of compression is sometimes measured in millimeters of mercury (mmHg) or hectopascals (hPa). For example, class 2 compression may be noted as 15-20 mmHg / 20.1-27 hPa.

Compression socks and stockings are graduated, meaning that the level of compression varies at different points. This is what distinguishes medical compression stockings and socks from those sometimes found in stores for athletes, which are not graduated.

There are not many studies comparing the effectiveness of stockings versus socks. However, it is reasonable to assume that both are effective.

If you tolerate them well, it is more beneficial to wear compression stockings than compression socks.

Where does the fluid go when wearing compression stockings?

When you wear compression stockings, the amount of fluid in your body remains the same! The stockings apply graduated pressure, which helps to compress the veins and promote blood flow.

This compression prevents fluid from pooling in the lower extremities, especially in the ankles and feet.

As a result, the fluid is more evenly distributed throughout the body, and there is less accumulation in the legs.

When should compression stockings be worn?

A bias present in the scientific publication system (and more generally in how we communicate) often leads us to overestimate the effects of treatments. This also applies to compression stockings.

We tend to claim their effectiveness in curing or preventing many things, but without necessarily having evidence to support it.

Therefore, to list the indications for wearing compression stockings, I relied on the most reliable source to my knowledge: the syntheses of international scientific publications produced by the Cochrane Collaboration.

Cochrane is an international non-profit organization that works to improve our knowledge and reasoning on health topics. It has thousands of members (I am one of them) from 180 countries.

Cochrane follows a very strict methodology to assess the available evidence for a treatment, including compression stockings.

For establishing my list of situations where wearing compression stockings is “effective,” I relied solely on the work of this association: the Collaboraton Cochrane.

For the rest of the article, I used other sources when there were no Cochrane studies available.

List: When to wear compression socks

The table below summarizes all the pathologies and situations where Cochrane has evaluated the effectiveness of compression stockings.

Pathology	Probable Effect of Compression Stockings	Reference
🥇 Treatment of leg venous ulcers	Faster complete healing of the wound	Shi 2021
	Increased chance of complete wound healing.
	Reduces pain
	Improves disease-specific quality of life.
	Uncertainties regarding adverse effects and cost-effectiveness.
Preventing the occurrence of new venous ulcers	Reduced risk of venous ulcer recurrence compared to not wearing stockings.	Nelson 2014
	Insufficient evidence to facilitate choice among different types, brands, or lengths of elastic compression.
Preventing post-thrombotic syndrome	May reduce occurrence but data of poor quality.	Appelen 2017
Preventing phlebitis and edema during air travel	Decreased risk of phlebitis (moderate evidence) and lower limb edema (weak evidence).	Clarke 2021
Preventing the risk of phlebitis after surgery	Reduces the risk of phlebitis, but it is unclear whether full-length stockings are more effective than knee-length compression socks.	Sajid 2012
Preventing phlebitis after a stroke	No, compression stockings do not reduce the risk of phlebitis after a stroke.	Naccarato 2010
Treating varicose veins in people without venous ulcers	No evidence of effectiveness.	Knight 2021
Preventing or treating leg edema and varices during pregnancy	No evidence of effectiveness.	Smyth 2015
Preventing the risk of phlebitis during pregnancy (and post-natal) in pregnant women at risk	No evidence of effectiveness but very limited data on the subject.	Middleton 2021
Preventing phlebitis after a major “high-velocity” trauma	Despite limited strength of evidence, consideration of information from related situations, such as surgery, leads us to recommend the use of some form of thrombosis prophylaxis in persons with severe trauma (medications or stockings).	Barrera 2013
Preventing phlebitis after a significant lower limb amputation	Insufficient evidence to draw conclusions.	Herlihy 2020
Preventing the risk of phlebitis after knee arthroscopy	Insufficient evidence.	Perrotta 2022
Preventing venous insufficiency in people who work standing	Poor-quality data.	Robertson 2013
Preventing the risk of phlebitis in patients undergoing chemotherapy for cancer	No data available.	Rutjes 2020

In the rest of this article, I’ll give you a little more detail on the situations in which my patients ask me the most about the benefits of compression stockings or socks in their case.

Should compression stockings be worn every day?

Yes, regardless of the indication, it is recommended to wear compression stockings every day.

Because the action of the stockings ceases as soon as they are removed, especially when standing or sitting for prolonged periods.

When to remove compression stockings?

Normally, the person who prescribed the compression stockings will inform you how long to wear them.

Here are some examples:

• If you have previously had leg venous ulcers and want to reduce the risk of new ulcers, you may need to wear them for life.
• After a major trauma (e.g., ankle fracture in a car accident), you can remove them after a few weeks. However, they should be kept if you do not have any medication treatments for phlebitis (injections or medications).
• If you wore them to prevent the risk of phlebitis during a flight, you can remove them within hours after landing.

When to remove compression stockings after surgery?

The timing for removing compression stockings after surgery can vary depending on:

• the type of surgery;
• your medical condition;
• your risk of complications.

Compression stockings after surgery are generally kept for at least a few weeks. Or until you resume a more active lifestyle: daily outdoor walks of several hundred meters, little time spent lying down, etc.

When can I stop wearing compression stockings after hip replacement?

You will often be instructed to wear compression stockings for at least 1 month after hip replacement. However, in some hospitals, you may not be prescribed compression stockings but only anti-coagulant injections!

It is up to you to form your own opinion on the potential benefits of wearing compression stockings considering the discomfort they may cause. Most importantly, make sure to wear them, as it can be challenging in the weeks following a hip replacement surgery!

When can I stop wearing compression stockings after knee replacement?

Same response as for the hip replacement! You will often be instructed to wear compression stockings for at least 1 month after your knee surgery (for knee replacement of for an other reason).

And in some hospitals, they won’t prescribe stockings but only administer anti-coagulant injections!Once again, it’s up to you to form your own opinion on the potential benefits of wearing stockings considering the discomfort they may cause. Most importantly, it’s crucial to put them on, as it can be challenging in the weeks following knee prosthesis surgery, even with the use of sock aids!

If you feel the need to learn more about the recovery period after a knee replacement, I wrote this guide in eBook format:

Can compression socks be removed in hot weather?

Wearing compression stockings in hot weather can be uncomfortable for some people. However, it is not a “medical” criterion for removing the stockings.

An alternative option is to wear compression socks instead or choose stockings in lighter colors (as they absorb less heat from the sun!).

Some people decide to “take the risk” and not wear compression stockings in the summer because the constraints outweigh the benefits for them.

Can compression stockings be removed at night?

Can you sleep with compression stockings on? Yes, there is no contraindication to wearing them while sleeping, especially if you are active during the day. It is not dangerous to sleep with compression stockings at night.

Some people even find it comfortable to wear them at night.

However, even if compression stockings have been prescribed to you, it is entirely possible to remove them at night if you prefer.

The ideal practice is to put them back on as soon as you get out of bed (and not 1 or 2 hours after waking up).

Why?

When you are lying down, there is less venous stasis, and blood circulates better (as the foot is not in a dependent position). Gravity has less effect on blood flow when lying down.

But as soon as you stand up (even while sitting), venous stasis can resume.

Hence, it is possible to remove compression stockings at night, but it is better to put them back on as soon as you get up, ideally.

When is the best time to wear compression socks?

The best time to wear compression socks is throughout the day, if you are in one of the situations where it is indicated to wear them.

This means wearing them consistently, regardless of the season or your activities during the day. If you have a sedentary job, travel long distances, engage in physical activity, are recovering from surgery or injury, experience pregnancy-related swelling, or have specific medical conditions that benefit from compression, wearing the socks throughout the day is recommended for maximum effectiveness.

When should you not wear compression socks and stockings? Main contraindications

Even if you have one of the issues listed above for which compression socks are effective, there are certain cases when it is better not to wear them due to the risk of side effects. Here is a list of situations where it is better not to wear compression socks:

1. Suspected or confirmed peripheral arterial disease, including a history of peripheral arterial bypass. This includes conditions like peripheral arterial occlusive disease (PAOD), as the pressure exerted by compression socks can worsen cutaneous arterial insufficiency.
2. Severe peripheral neuropathy (such as diabetic neuropathy) or any other cause of sensory impairment.
3. Allergy to the material of the compression socks.
4. Massive leg swelling or pulmonary edema caused by congestive heart failure.
5. Local skin or soft tissue conditions, including recent skin graft, fragile skin (like “paper-thin” skin), gangrene, oozing dermatitis, and severe cellulitis.
6. Extreme leg deformity or an unusual leg shape or size preventing proper fitting of the compression socks.

(source: Lim 2014).

These are general guidelines. The ideal approach is to discuss this with your healthcare professional (physician, physical therapist, etc.) so you can together assess the balance of benefits and risks of wearing compression socks in your specific case.

Compression stockings after surgery: when?

After certain surgeries, you may not be able to move your legs much during the recovery period. You may need to stay bedridden, and even in that position, you might have limited mobility.

This is particularly true if you have undergone surgery for a complex fracture after a serious car accident or another major trauma.

However, it can also happen after any type of leg surgery or surgery elsewhere in the body.

In these situations, there is an increased risk of blood clots forming in your legs due to reduced blood circulation. This risk is heightened because the surgeon may have had to manipulate some blood vessels and capillaries during the operation, which can alter blood flow.

The concern is that a blood clot might migrate and cause severe complications.

Compression stockings are one of the methods used to reduce the risk of clot formation, along with receiving Lovenox injections or taking heparin in the form of medication.

Compression stockings are sometimes prescribed even for less invasive procedures, such as knee surgeries (knee arthroscopy surgery, total or unicompartmental knee replacement).

They are especially prescribed after surgeries that require prolonged bed rest or involve intervention on the legs following significant trauma.

Compression stockings & pregnancy: when to wear them?

Compression stockings are sometimes prescribed or recommended for pregnant women, primarily to prevent the risk of phlebitis (blood clot formation).

This is particularly important if they have other risk factors for phlebitis, such as smoking, air travel, or a family history of phlebitis.

As mentioned earlier, there aren’t many studies evaluating the effectiveness of compression stockings in preventing phlebitis during pregnancy. Even fewer studies have assessed their impact on reducing edema or leg pain.

However, some pregnant women who experience discomfort due to edema may still consider wearing compression stockings to observe their effect on swelling, considering the minimal constraints associated with wearing them. (Adas 2022)

Swelling & compression stockings: when to wear them?

There are different types of edema (=swelling):

• Lymphedema (most often associated with cancer).
• Venous edema (most common, often occurs after a sprain or fracture).
• Edema of cardiac origin (in cases of heart failure).

Compression stockings are generally contraindicated for edema of cardiac origin as they can exacerbate heart failure. They are sometimes prescribed for edema of lymphatic or venous origin. There is not much high-quality evidence to conclusively state that compression stockings significantly reduce edema of venous origin.

However, since they are a relatively inexpensive measure, they may be recommended for individuals greatly bothered by their venous edema. Compression stockings will not make venous edema disappear faster, but they can potentially provide better comfort and help reduce the edema when worn.

Compression socks when flying?

While we may not have evidence of effectiveness for compression stockings in all situations, we do have evidence supporting their use during air travel ✌️.

Wearing compression stockings during a flight helps reduce the risk of phlebitis (blood clot formation). The longer the flight, the more significant the potential benefit.

Ideally, you should put on the compression stockings before boarding the plane and keep them on for a few hours after the flight.

This can further enhance their effectiveness in preventing blood clot formation during and after the journey.

Baker’s cyst & compression stockings

Many people wonder if wearing compression stockings can speed up the healing process of a backer’s cyst or provide relief from discomfort.

A baker’s cyst is not a problem related to venous circulation. It involves the accumulation of synovial fluid (fluid from the joint) and not in the veins.

As a result, compression stockings will not have a direct effect on the cyst itself.

The only potential benefit they may offer is alleviating any knee edema associated with the cyst, but only while they are worn.

Currently, there are no clinical studies examining the effect of compression stockings on baker’s cysts.

Examples of compression stockings ands socks

You can find compression socks or stockings at:

1. Pharmacies or drugstores.
2. General retail stores.
3. Online, including second-hand options.

Ensure that you are purchasing graduated compression stockings of the desired class (often class 2).

Here are two examples: