Compression therapy of the feet; Yes or No? Why or Why Not?
Authors: Dean J Bender, Albert Fliss PhD.
Aim: a review of current knowledge and misconceptions regarding the use of compression therapy on the feet.
Misconception: The compression level required for the foot is equal to or greater than that of the ankle.
Discussion: Over the years working with a variety of healthcare professionals from around the world one of the largest misconceptions regarding the use of compression therapy is in regards to the compression applied to the feet. A general misconception exists that the compression level applied to the foot must be equal to or greater than the compression level at the ankle otherwise a swollen foot will result.
For the most part, this misconception has developed from a lack of knowledge of the specific design parameters of “gradient compression stockings”. Typically, stocking manufacturers provide the following information on their label:
- average compression level at the ankle (i.e. 20-30 mmHg)
- states whether the garment is gradient or not
- size
Unfortunately, no other design information is typically provided and as such we have made our conclusions as to how the stocking is actually designed. So the issue becomes our understanding or perhaps more accurately the general misconception of what gradient means in regards to a compression stocking or bandage system.
In regards to gradient compression stockings, existing design standards such as the RAL and ASQUAL, gradiency is required and defined as a decrease in compression level from the ankle to the calf and further to the thigh. The proximal pressure should always be lower than the distal pressure. The specifications even provide the percentage decrease required at each level as we move up the leg. For example a Class II RAL compression stocking gradient profile is:
| Measuring Point | Percentage of Ankle Pressure |
| Ankle | 100 |
| B1 (below calf muscle) | 70-100 |
| C (calf) | 50-80 |
| F or G (thigh) | 20-50 |
The current standards are quite explicit in most regards with the exception of any requirement for the compression level for the foot. There is not even a comment that any level of compression is even required for the foot.
And so what has transpired over the years is the general misconception that a compression stocking provides a greater or equal pressure level on the foot versus the ankle in order to maintain gradiency throughout the stocking.
The Facts: A review of designs from the major compression stocking manufacturers around the world revealed that the compression levels currently provided in the foot portion of a stocking is lower than the ankle pressure. While the manufacturers would not provide specific compression design parameters for the foot, on average the design objective is to provide the same general level of compression as is provided in the calf, 50-80% of the ankle pressure.
Additionally Partsch measured compression levels under a RAL Class II elastic stocking utilizing a Pico Press measuring device revealing that the pressures at the dorsal and ventral measuring points of the foot (x position in chart below) are indeed in the same range as the calf measurements. Also of note is that the lateral and medial measurements are significantly higher, an effect of the smaller radius’ associated with the side of the foot. This does bring our attention of the potential for too high a compression level in these areas of the foot and possible detrimental consequences.
So if we apply the RAL gradiency profile for a typical gradient compression stocking with an average ankle compression of 25 mmHg we see that the expected compression levels are from the foot to the thigh are:
We have learned over the years from practical experience and observation that the typical compression “gradient” profile achieved with stockings, compression bandages and adjustable wraps is more than adequate to deal with edema in the foot even though true gradiency is not achieved.
So when making decisions regarding the type compression needed for the foot it is important to keep in mind that the current methods of compression provide a lower compression level to the foot than what we traditional believe.
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Employee Spotlight: Kathleen Kramer
CircAid’s customer service representatives are often relied upon by patients, therapists and physicians to help decide which compression garment will fit their needs. Our customer service team is dedicated to giving exceptional service and Kathleen Kramer is no exception. Her commitment to the patient, efficient service and her caring attitude is well known among her colleagues and customers.
“My father is elderly, so I understand how he feels when he can’t get the assistance that he needs. When I’m on the phone with a customer, I want to help them find the right product that will help them comply with their prescribed compression therapy,” says Kramer. “I want to get things right the first time, because our products directly affect the quality of their lives.” Kathleen goes above and beyond to help her customers, often following up with them after they have received their garment to ensure that it’s the right fit.
“Juxta-Lite™ is a really great, all-around product for our patients. Whether they have mild to moderate lymphedema, venous disease or another ailment, Juxta-Lite™ is an affordable option. Patients will often express how happy they are to find an affordable option for compression.”
Kathleen is the personification of CircAid’s commitment of making compression easier. Her compassion, strong work ethic, and the pride that she takes in her job embody the dedication of the entire CircAid staff.
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Juxta-Fit™ Fashion Tips
The Juxta-Fit™ Armsleeve fits well under clothing, so wearing a long-sleeved shirt, jacket, or sweater will cover the garment well.
Wearing a Comfort CoverUp™ on both arms that match your shirt is a great, lightweight option for disguising your armsleeve.
In addition, wearing a pair of Comfort CoverUps™ on both arms with a sleeveless shirt is a sporty look as well.
To view more accessories for compression garments, visit our webstore: www.circaid.com/store
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The New 2011 Product Guide for Venous Insufficiency from CircAid®
Here is a sneak peak at the new 2011 Product Guide for Venous Insufficiency from CircAid Medical Products.
Click Here to get your name on the mailing list or call (800) CIRCAID (247-2243) for assistance.
Posted in Helpful Tips, Juxta-Lite, Uncategorized, Venous Disease | Leave a comment