How To Choose Compression Socks

Some people learn about compression socks when a doctor recommends compression therapy to address a medical condition. Other people discover compression socks through their own research into health and wellness. No matter how you found out about compression, you've come to the right place.

There is a lot of compression gear available for purchase, so you may be wondering what features matter most. Is it okay to wear a pair of compression socks designed for runners when you're working a 12-hour nursing shift? Can you opt for the same socks during pregnancy that you bought for a long plane ride? And, most importantly, how do you determine the correct fit?

In this article, we'll provide answers to all your compression-related questions. We'll also lay out some specific use cases in order to help you choose the best pair of socks.

Types of Compression 

Let's begin by listing some of the compression garments that you've probably seen advertised. Next to each, you'll see a brief description of how they're normally used.

Compression Stockings | Compression socks and stockings function the same way although they’re made out of different material. Both socks and stockings can be made to the same medical specifications.

Uniform Compression Socks | These socks apply a uniform pressure level throughout the entire length of the sock. They're often sold for athletic compression.

TED Hose | Also known as anti-embolism stockings, TED hose prevent embolism in bedridden patients. These stockings normally provide uniform compression measuring less than 20 millimeters of mercury (mmHg).

Graduated Compression Socks and Stockings | Most scientific studies about compression socks and stockings focus on graduated compression, and doctors usually prescribe this type of garment to treat medical conditions. This form of compression provides greater pressure on the foot and ankle as a way to assist venous return. Graduated compression socks are only available in longer lengths (knee-high, thigh-high, waist-high, etc.), and they're labeled with a numeric pressure range in mmHg.

Compression Sleeves | Like compression socks and stockings, compression sleeves offer either uniform or graduated compression. They're usually made of neoprene, and they don't cover the foot and ankle. Most commonly, athletes use these garments for recovery.

Pneumatic Compression Devices | These forms of compression therapy involve the use of air pumps to manually compress the legs or arms. These are frequently utilized in a hospital setting to prevent deep vein blood clots, also known as deep vein thrombosis (DVT). They can also be purchased from medical supply stores and online retailers.

Other Compression Gear | Athletes wear compression tights, shorts, shirts, and unitards under regular athletic gear to improve stability and optimize recovery. While there's evidence that compression shorts and tights work to improve recovery and blood circulation, there's less research to support the use of compression shirts and unitards for this purpose.

Compression Level 

Manufacturers label graduated compression socks with a pressure range, which is measured in mmHg. The lower number in the range indicates the amount of pressure applied to the calf. The higher end of the range reflects the pressure on the foot and ankle.

Light Compression: 8–15 mmHg 

This pressure alleviates mild symptoms, such as minor leg swelling and mild discomfort from long periods of sitting or standing. Doctors also recommend this compression level to prevent varicose veins during pregnancy. Light compression is sometimes used to promote stability and good posture in athletes.

Mild Compression: 15–20 mmHg 

Over-the-counter retailers, such as pharmacies and airport kiosks, normally sell socks with this level of compression. Mild compression socks offer protection from mild varicose veins, swelling, and achy legs. They also reduce your risk of developing DVT. Mild compression also promotes faster recovery after exercise.

Medium Compression: 20–30 mmHg (Medical Grade Class I) 

Class I compression socks relieve the symptoms of post-thrombotic syndrome (PTS), orthostatic hypotension, superficial thrombophlebitis, severe edema, and lymphedema. They're also recommended for the management of active ulcers.

Firm Compression: 30–40 mmHg (Medical Grade Class II)

Doctors recommend firm compression to address severe cases of edema, PTS, orthostatic hypotension, and superficial thrombophlebitis. Patients at extreme risk of developing DVT, such as post-surgical patients, may also benefit from this level of compression.

Extra Firm Compression: 50–60 mmHg (Medical Grade Class III) 

Class III compression socks require a prescription. These socks treat acute symptoms of lower body swelling, severe varicose veins, and DVT.

The Compression Sweet Spot

To get the most from your over-the-counter compression socks, we recommend choosing a compression strength that falls between mild and medium. Specifically, socks with 15–25 mmHg manage to balance comfort with optimal health benefits.

They offer the right compression level for:

• Arch support
• Sports recovery
• Improved posture and stability
• Injury prevention
• Prevention of spider and varicose veins
• Prevention of aches and pains
• Prevention of DVT
• Reduction of chronic venous insufficiency (CVI) symptoms
• Management of edema and lymphedema symptoms
• Treatment of active ulcers from CVI

Sizing

Compression socks should improve your overall blood flow. In order to do that, they need to fit you properly—from the toes to the calves.

Before you buy a pair of knee-high compression socks, measure your calves. You'll also need to know your shoe size. At Comrad, we can accommodate calf sizes from 10–20" and shoe sizes from women's 4 to men's 15.

A comfortable compression sock should fit so that your toes line up with the toe cap and your heel fits into the heel cup. You shouldn't feel any bunching or sagging. The cuff of the sock should fit snugly around your leg, but you don’t want it to squeeze so tightly that it cuts off circulation. After putting on the sock, make sure the fabric lays smoothly against your skin.

If the sock fits, you may notice that your legs feel energized, or even slightly warm—but your legs should never hurt as a result of compression.

Fabric 

All compression socks measured in mmHg must adhere to the same industry standards. Ultimately, the fabric content of a sock doesn’t impact the function of the compression; 15 mmHg should exert the same pressure across a range of fabrics. 

When you select a sock, think about choosing high-tech materials that will extend the time between washes. You can also choose a fabric based on its style and durability. Most compression socks consist of a blend of materials, and manufacturers sometimes use proprietary names to describe their textile blends.

Nylon | Socks made with nylon are fast-drying and durable.

Rayon | Rayon is known for being silky and lightweight.

Merino Wool | Wool is warm and naturally moisture-wicking.

Lycra | This is a synthetic material that's often used to make stockings.

Microfiber | Microfiber fabrics consist of either synthetic or natural materials woven together with high thread density.

Spandex | Most compression socks contain some quantity of spandex, which enables them to stretch.

SmartSilver | SmartSilver is an antimicrobial treatment that binds silver ions to the fabric at a molecular level. It reduces odors and reinforces the sock against holes.

Use Cases

Knee-high graduated compression socks work well for a number of different use cases. You can wear the same pair of 15-25 mmHg socks for the following:

Athletics

Graduated compression socks have been shown to lower recovery lactate values (Berry and McMurray Abstract), which can help to reduce post-workout soreness. Studies also show that they help people feel more comfortable while running (Ali et al. Abstract) and improve functional recovery after a workout (Armstrong et al. Abstract).

Venous Disease Prevention

Research indicates that graduated compression can prevent and alleviate the symptoms of chronic venous insufficiency, including spider veins, varicose veins, and venous ulcers (Lim and Davis E393-4).

Flying 

There is high quality evidence to support the use of graduated compression stockings during air travel as a way to reduce the risk of deep vein blood clots (Clarke et al. Abstract).

Work-Related Sitting or Standing 

Studies have shown that wearing compression socks reduces oxidative stress for standing workers (Flore et al. Abstract) and improves circulation during long periods of sitting ("Boosting...").

Swelling Prevention 

Graduated compression socks are a first-line treatment for the symptoms of edema and lymphedema.

Pregnancy 

Pregnant women are at high risk for venous disorders, which can cause DVT, spider veins, varicose veins, and swelling. Graduated compression socks help to prevent venous disorders and slow the progression of symptoms.

Recovery from Surgery 

Many doctors recommend the use of graduated compression socks during the three months following surgery. Throughout this period, patients have an increased risk of DVT.

In particular, compression therapy or TED hose is commonly prescribed after:

• General surgery
• Gynecological surgery
• Neurosurgery
• Elective Hip Replacement
• Elective Knee Replacement
• Varicose Vein Surgery

Ask your doctor if 15–25 mmHg compression socks would be the best choice for you. We call this range “the compression sweet spot” for a reason. 

Stronger than your average over-the-counter pair, knee-length Companions maximize your medical benefits Yet, with mild pressure at the calf, they remain comfortable enough to wear every day. 

Alternatively, give ankle-length Allies a test drive if you’d rather improve arch support and add stability to your workout.

Sources:

Ali, A., Creasy, R.H. & Edge, J.A. "Physiological effects of wearing graduated compression stockings during running." Eur J Appl Physiol, vol. 109, 2010, pp. 1017–1025, https://link.springer.com/article/10.1007%2Fs00421-010-1447-1.

Armstrong, Stuart A., Till, Eloise S., Maloney, Stephen, & Harris, Gregory A. "Compression Socks and Functional Recovery Following Marathon Running," The Journal of Strength & Conditioning Research, Vol. 29, Iss. 2, 2015, pp. 528-533, https://journals.lww.com/nsca-jscr/Fulltext/2015/02000/Compression_Socks_and_Functional_Recovery.30.aspx.

Berry M.J., McMurray R.G. "Effects of graduated compression stockings on blood lactate following an exhaustive bout of exercise." American Journal of Physical Medicine, Vol. 66, Iss. 3, 1987, pp. 121-132, https://europepmc.org/article/med/3605315.https://europepmc.org/article/med/3605315

“Boosting circulation with compression stockings.” Harvard Health Publishing, Harvard Medical School, Nov 2013, https://www.health.harvard.edu/staying-healthy/boosting-circulation-with-compression-stockings.

Clarke MJ, Broderick C, Hopewell S, Juszczak E, Eisinga A. "Compression stockings for preventing deep vein thrombosis in airline passengers." Cochrane Database of Systematic Reviews, Iss. 9, 2016, pp. 1-40, John Wiley & Sons, Ltd., https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004002.pub3/abstract.

Flore, R., Gerardino, L., Santoliquido, A., Catananti, C., Pola, P., and Tondi, P. "Reduction of oxidative stress by compression stockings in standing workers." Occupational Medicine, vol. 57, iss. 5, Aug. 2007, pp. 337–341, https://academic.oup.com/occmed/article/57/5/337/1404908.

Lim, Chung Sim and Alun H. Davies. “Graduated compression stockings.” CMAJ. Vol. 186, Iss. 10 pp. E391-E398. July 08, 2014, https://www.cmaj.ca/content/cmaj/186/10/E391.full.pdf.