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Gradient Compression Stockings for Patients with Venous Leg Ulcers

Gradient Compression Stockings for Patients with Venous Leg Ulcers

Gradient Compression Stockings for Patients with Venous Leg Ulcers


WHAT are gradient compression stockings?

Gradient compression stockings are special elastic hosiery that healthcare professionals recommend to treat or prevent certain conditions. They are usually made of different materials such as wool, spandex, nylon, silicone and latex. They have different styles (knee-high, thigh-high, pantyhose, etc), with open or closed toes, and can have 2 layers (inner and outer). For treatment or prevention of venous ulcers, generally knee-high gradient compression stockings will suffice. They come in sizes pre-determined by manufacturers or can also be customized to your body to ensure proper fit.

Gradient compression stockings can apply different levels of compression, meaning they can feel tighter or not as tight. Gradient compression stockings are classified according to the pressure applied by the stocking at the ankle level. Graduated compression stockings can be generally classified as:

  • Class I: <20 mmHg
  • Class II: ≥20-30 mmHg
  • Class III: >30-40 mmHg
  • Class IV: >40 mmHg (feels tighter)

For treatment or prevention of venous ulcers, the recommended pressure level is 30-40mmHg or above.


WHY do I need to wear gradient compression stockings? 

While there are other indications for use of gradient compression stockings, the main ones are to:

Help heal venous ulcers

Gradient compression stockings are a type of medical-grade stocking that can be used to help heal venous ulcer in patients with small, simple venous ulcers. They are a viable option if you wish to have more autonomy with dressing changes, find bandages that are traditionally used to treat venous ulcers too hot or bulky, are able to don the stockings by themselves, and do not have any contraindications to wearing gradient compression stocking. These factors should be discussed with your clinician.

Prevent a new venous ulcer from developing

After a venous ulcer heals, you will need to continue to use gradient compression stockings as the underlying factors that caused it to begin with have not been addressed. If you are a good candidate for vascular surgery, some of the factors may be addressed surgically. However, if you prefer or are not able to undergo vascular surgery to correct the underlying structural causes, gradient compression stockings are a definite, life-long treatment.

Gradient compression stockings should not be used if you have...

  • Severe peripheral arterial disease
  • Acute deep venous thrombosis
  • Cellulitis
  • Unstable congestive cardiac failure
  • Allergy to stocking material
  • Local skin or soft-tissue condition, including recent skin graft, fragile “tissue paper” skin, gangrene, oozing dermatitis and severe cellulitis
  • Extreme deformity of the leg, or unusual leg shape or size preventing correct fit

WHAT are the potential adverse effects related to gradient compression stockings?

Complications may include pain, pressure damage, loss of calf muscle and skin problems

HOW do I wear gradient compression stockings? 

Putting on your gradient compression stockings

  • Put on stockings first thing in the morning before you get out of bed. Your legs have the least amount of swelling early in the morning.
  • Hold the top of the stocking and roll it down to the heel.
  • Put your foot into the stocking as far as you can. Put your heel in the heel of the stocking.
  • Pull the stocking up. Unroll the stocking over your leg.
  • After the top of the stocking is in place, smooth out any wrinkles.
  • DO NOT let the stockings bunch up or wrinkle.
  • Knee length stockings should come to 2 fingers below the knee bend

Gradient Compression Stockings Can Be Hard to Put on

  • If you use lotion on your legs, let it dry before you put on the stockings.
  • Use a little baby powder or cornstarch on your legs. This may help the stockings slide up.
  • Put on rubber dishwashing gloves. Use your hands to adjust the stocking and smooth it out.
  • Use a special gadget called a stocking donner to slide the stocking over your foot. You can buy a donner at a medical supply company or online.
  • Wash your stockings every day
  • Hand wash or machine (delicate cycle) wash the stockings each day with mild soap and water. Fabric softener may not be used. Rinse and air dry.
  • If you can, have two pairs. Wear one each day. Wash and dry the other pair. 
  • Replace your stockings every 3 to 6 months so that they maintain their support

Video 1. Donning compression stockings at home

Video 2. How to apply compression stockings

WHEN do I call my clinician?

  • You have difficulties in putting on and removing the garment, pain, discomfort, sensation of warmth and worsening of any previous itch associated with venous eczema
  • You are concerned about wearing them due to any reason (e.g., cost, appearance, pain etc) and are not able to wear them as directed. 

Does MEDICARE cover gradient compression stockings?

  • Only 30-40 or 40-50 mmHg below knee gradient compression stockings (HCPCS A6531 and A6532) and 30-50 mmHg below knee gradient compression wraps (A6545) are covered by Medicare part B.
  • Coverage requirements: the patient needs to have an active venous ulcer that has been treated by a physician or other healthcare professional requiring medically necessary debridement. Medicare considers gradient compression stockings as a surgical dressing that is needed to secure a primary dressing
  • Frequency of replacement allowed by Medicare: 1 unit per leg every 6 months
  • Gradient compression stockings/wraps are not covered for the conditions below:
    • Venous insufficiency without stasis ulcers
    • Prevention of stasis ulcers
    • Prevention of the reoccurrence of stasis ulcers that have healed
    • Treatment of lymphedema in the absence of ulcers

HOW do I take care of gradient compression stockings?

  • Hand or machine-wash with warm water and mild soap or detergent. No chlorine bleach. Warm water rinse. Hang or lay flat to air-dry. May dry in a dryer on low heat or delicate setting. Placing your stockings in a mesh laundry bag will help protect them during the wash cycle.
  • The elastic fibers of your compression garment stockings will break down with wear. Proper care will increase the life-span of your stockings, but you will need to replace your stockings or sleeve at about every 3-6 months depending on how often you are wearing and how you are caring for your garment. As a general rule, if your garment becomes easy to put on, it probably needs to be replace

WHAT brands are there and WHERE should I buy them?  

  • Several brands are available. You can choose a brand that matches your needs by visiting WoundReference Product Navigator and the Gradient Compression Stocking Interactive Feature Matrix.
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NOTE: This is a controlled document. This document is not a substitute for proper training, experience, and exercising of professional judgment. While every effort has been made to ensure the accuracy of the contents, neither the authors nor the Wound Reference, Inc. give any guarantee as to the accuracy of the information contained in them nor accept any liability, with respect to loss, damage, injury or expense arising from any such errors or omissions in the contents of the work.


  1. Ti, Dongdong; Hao, Haojie; Xia, Lei; Tong, Chuan; Liu, Jiejie; Dong, Liang; Xu, Shenjun; Zhao, Yali; Liu, Huiling; Fu, Xiaobing; Han, Weidong et al. Controlled release of thymosin beta 4 using a collagen-chitosan sponge scaffold augments cutaneous wound healing and increases angiogenesis in diabetic rats with hindlimb ischemia. Tissue Engineering. Part A. 2015;volume 21(3-4):541-549.
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