Compression Stockings for Varicose Veins: Are They Effective?

Compression stockings have been a standard treatment for varicose veins for many decades, and are still prescribed today as a first-line therapy to manage symptoms and prevent the progression of chronic venous insufficiency (CVI).

While compression stockings can provide effective symptom relief for some, many patients find them uncomfortable and have a hard time staying compliant with their treatment plan. Even when patients strictly adhere to their compression therapy, stockings are unlikely to be a curative treatment for vein disease. These limitations can lead physicians to believe that they’re effectively managing their patients’ vein problems with a simple compression therapy prescription when in reality, vein disease may be progressing as it would without any prescription at all.

To help explain the role of compression therapy versus more effective vein treatments, we take a look at why compression stockings are prescribed, their limitations, and what the clinical evidence has taught us about their efficacy.

In this Article

• How compression stockings may help manage varicose veins
• The challenges and limitations of compression stockings for varicose veins
• The comparative data between compression stockings and curative vein treatments

Choosing the Right Pressure Level (mmHg)

Not all compression stockings are created equal. The strength of the compression is measured in millimeters of mercury (mmHg), the same unit used to measure blood pressure. The higher the number, the stronger the squeeze.

Choosing the wrong pressure level is a common reason patients find stockings uncomfortable or ineffective. Here is a general guide to the different grades:

• Low Compression (8–15 mmHg): Available over-the-counter (OTC) without a prescription. These provide mild relief for tired, achy legs and are often used by healthy individuals who stand for work or want a slight boost in circulation.
• Medium Compression (15–20 mmHg): Also typically available OTC. This level is ideal for preventing minor swelling during travel (such as long flights), managing leg fatigue during pregnancy, or supporting legs with minor varicose veins.
• Medical Grade Class I (20–30 mmHg): This is the most frequently prescribed level for patients with medically diagnosed varicose veins, chronic venous insufficiency (CVI), or mild edema. It provides firm support to manage moderate symptoms and prevent the progression of vein disease.
• Medical Grade Class II & III (30–40+ mmHg): These are high-strength prescription garments. They are typically reserved for severe cases, such as managing active venous ulcers, severe lymphedema, or post-thrombotic syndrome after a DVT.

Note: You should always consult a vascular specialist before using stockings rated 20 mmHg or higher to ensure they are safe for your specific circulatory health.

Common Uses: Pregnancy, Travel, and Work

While compression stockings are a standard treatment for diagnosed vein disease, they are also highly effective tools for preventing vein damage in specific high-risk situations. You don’t need a diagnosis to benefit from the support they provide.

High-Risk Occupations

Your job may be hurting your veins. Professions that require prolonged standing (such as nurses, teachers, hair stylists, and retail workers) force your veins to fight gravity all day without rest. Conversely, desk jobs and truck driving require prolonged sitting, which can kink veins and stall circulation. For these workers, compression stockings act as an external support system, helping to energize the legs and prevent the evening fatigue and aching associated with occupational vein stress.

Who Should NOT Wear Compression Stockings? (Safety Warning)

While compression stockings are generally safe for most people, they are not suitable for everyone. Because they physically squeeze the leg to manipulate blood flow, they can be dangerous for individuals with certain underlying health conditions. You should never start a high-compression regimen without consulting a specialist if you have any of the following:

Peripheral Arterial Disease (PAD)

This is the most significant contraindication. While stockings help veins push blood out of the leg, they can obstruct arteries trying to bring oxygenated blood into the leg. If you have PAD (narrowing of the arteries), wearing compression stockings can severely restrict blood supply, potentially leading to ischemia (tissue death) or worsening claudication pain.

Peripheral Neuropathy and Diabetes

Patients with diabetes or peripheral neuropathy often have decreased sensation in their legs and feet. This is dangerous because they may not be able to feel if a stocking is too tight, bunched up, or cutting off circulation. Without that pain signal, a tight stocking could cause pressure sores, skin breakdown, or ulcers that the patient doesn’t notice until it is too late.

Active Skin Infections or Fragile Skin

If you have cellulitis, open untreated wounds, or extremely fragile skin (often called “tissue paper skin”), compression stockings can aggravate the issue. The fabric can trap bacteria against the skin, increasing the risk of infection, or cause friction that tears delicate tissue. In these cases, the skin must be fully healed or properly dressed by a wound care specialist before compression is applied.

Tips for Success: How to Wear Your Stockings

One of the main reasons patients abandon compression therapy is simply the struggle of getting the stockings on. Because they are designed to be tightest at the ankle, pulling them over the heel can feel like a wrestling match.

However, a few adjustments to your routine can make the process significantly easier and more comfortable.

Use Donning Aids and Tricks

If you have arthritis, limited flexibility, or simply find the fabric too stiff, consider using tools to help:

• Rubber Gloves: Wearing standard household rubber gloves gives you extra grip, allowing you to smooth the fabric up your leg without tearing it with your fingernails.
• Cornstarch or Powder: Dusting your legs with cornstarch or baby powder reduces friction, allowing the stocking to slide up over the skin more smoothly.
• Stocking Butlers: For those who cannot reach their feet, a “stocking butler” is a metal frame device that holds the stocking open for you, allowing you to step into it without bending over.

Compliance with Compression Stockings Can Be Challenging

Compression stockings are only effective while they are worn. Because swelling increases when sitting or walking, stockings must be worn throughout the entire day to have maximum benefit. Most physicians recommend wearing them throughout the day and only taking them off at night before sleeping. Care must be taken to not get them wet, and any open sores or ulcers that may be present on the legs must be cleaned and bandaged before putting on the stockings.

Many patients find that keeping up with compression therapy for varicose veins is difficult. A literature review published by the European Society of Vascular Surgery in 2017 found that patient compliance with compression stockings was only 66%, and patients were more likely to be compliant when prescribed lower degrees of compression. ³ The investigators of this review cited a number of reasons why patients have a hard time keeping up with compression therapy. Challenges include:

• Forgetting to wear stockings
• Difficulty putting stockings on
• Dissatisfaction with stocking appearance
• Discomfort wearing stockings on warm days

Another study found that compression stockings can cause a number of uncomfortable side effects,² including:

• Itchiness
• Numbness in the legs
• Sweating
• Pain related to stocking use
• Skin breakdown if the stockings are too tight
• Fungal infections if the skin is not cleaned properly or if an open wound is present
• Contact dermatitis if allergic to stocking material

Compression Stockings Do Not Cure Vein Disease

Studies examining both compression stocking therapy and venous surgery have demonstrated the differences in efficacy between passive management (compression) and proactive vein treatment (surgery). One such study done over two years in Finland showed that patients who underwent surgery had a significant reduction in symptoms and improvement in quality of life measures such as itching, appearance, ability to perform daily activities and swelling. And of the patients who underwent compression therapy alone, 36% of patients had opted to undergo vein surgery after the trial ended.⁴

Another way to look at the long-term effects of compression therapy is to examine their effect on venous stasis ulceration, the ‘end-stage’ complication of vein disease. One such randomized controlled trial published by The Lancet in 2004 compared compression stockings alone versus surgery and compression stockings. This trial, popularly called the ESCHAR trial, found no difference between the two therapies for ulcer healing within 24 weeks. However, patients who had gone through both superficial venous surgery and compression therapy had a 19-20% reduction of ulcer recurrence compared to compression therapy alone.⁵

While these studies looked at surgical vein treatment compared to compression stockings, these findings certainly apply to minimally invasive treatments like thermal vein ablation, VenaSeal, and ultrasound-guided foam sclerotherapy as well.⁶

Ultimately, the data highlights a clear distinction: compression stockings merely manage symptoms, while medical procedures address the root cause. To help you decide which path fits your goals and lifestyle, here is a direct comparison of the commitment and results required for each approach:

Conclusion: Are Compression Stockings Effective in the Treatment of Varicose Veins?

Compression stockings may provide symptom relief and help prevent vein disease from worsening, but they require continuous use to be effective and do not address the underlying source of vein disease. Clinical studies have demonstrated that more proactive vein treatments are more effective than simple compression therapy. Taken together, these facts point to compression therapy as a very conservative treatment approach with a high likelihood of failure. And while the risks of compression therapy are minimal, the real risk is that effective vein treatment is delayed when we rely too heavily on compression stockings to provide effective long-term vein disease management.

At the Texas Vascular Institute, we tend to say that vein problems are very common and very treatable. Minimally invasive treatments like thermal vein ablation are more than 95% effective in treating varicose veins and resolving vein-related symptoms. ⁷ If you’ve had enough of compression stockings, it may be time to see a vein specialist.

About the Author

Dr. Dev Batra, M.D. is a vein specialist and founding partner of Texas Vascular Institute. Holding board certifications in radiology and vascular & interventional radiology, he is well-versed in vein issues and has been voted one of D-Magazine’s best doctors in Dallas for three years running.

This blog post was written with research and editorial assistance from OnChart.

References

[1] Rohan, C.P-Y., Badel, P., Lun, B., Rastel, D. & Avril, S. (2013). Biomechanical response of varicose veins to elastic compression: A numerical study. Journal of Biomechanics, 46:599-603.

[2] Motykie, G.D., Caprini, J.A., Arcelus, J.I., Reyna, J.J., Overom, E. & Mokhtee, D. (1999). Evaluation of therapeutic compression stockings in the treatment of chronic venous insufficiency. Dermatol Surgery, 25:116-120.

[3] Kankam, H.K.N., Lim, C.S., Fiorentino, F., Davies, A.H. & Gohel, M.S. (2017). A summation analysis of compliance and complications of compression hosiery for patients with chronic venous disease or post-thrombotic syndrome. European Journal of Vascular and Endovascular Surgery, 55:406-416.

[4] Sell, H., Vikatmaa, P., Albäck, A., Lepäntalo, M., Malmivaara, A., Mahmoud, O. & Venermo, M. (2014) Compression therapy versus surgery in the treatment of patients with varicose veins: A RCT. European Journal of Vascular and Endovascular Surgery, 47(6):670-677.

[5] Barwell, J.R., Davies, C.E., Deacon, J., Harvey, K., Minor, J., Sassano, A., Taylor, M., Usher, J., Wakely, C., Earnshaw, J.J., Heather, B.P., Mitchell, D.C., Whyman, M.R. & Poskitt, K.R. (2004). Comparison of surgery and compression with compression alone in chronic venous ulceration (ESCHAR study): randomized controlled trial. Lancet, 363:1854-59.

[6] Lohr, J., & Kulwicki, A. (2010). Radiofrequency Ablation: Evolution of a Treatment. Seminars in Vascular Surgery, 23(2), 90–100.

[7] Morrison, N., Gibson, K., Vasquez, M., Weiss, R., Cher, D., Madsen, M., & Jones, A. (2017). VeClose trial 12-month outcomes of cyanoacrylate closure versus radiofrequency ablation for incompetent great saphenous veins. Journal of Vascular Surgery: Venous and Lymphatic Disorders, 5(3), 321–330.

Medical Disclaimer

The Materials available in the Texas Vascular Institute blog are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients.