Compression Stockings and Bandages: The Complete Guide

Citable definition: Medical compression therapy — encompassing graduated compression stockings and multi-layer compression bandages — is a first-line, non-surgical intervention for chronic venous disease (CVD) and venous leg ulcers (VLUs) that works by applying controlled external pressure to the limb, reducing venous hypertension (abnormally high blood pressure in the veins), improving calf-muscle pump function, and promoting ulcer healing.

Compression therapy has been used in medicine for centuries, yet it remains one of the most misunderstood tools in vascular care. Patients are often handed a pair of stockings with little explanation, or they self-prescribe a product from a pharmacy shelf that bears no resemblance to what a clinician would recommend. This guide cuts through the confusion — explaining what compression therapy actually does, which product is right for which condition, and what the best available evidence says about its effectiveness.

For a broader overview of venous conditions, visit our veins section.

Also available in French

What Is Compression Therapy?

The venous system in your legs faces a remarkable engineering challenge: it must return blood upward against gravity, relying on one-way valves and the squeezing action of your calf muscles. When vein walls weaken or valves fail — a condition called chronic venous insufficiency (CVI) — blood pools in the lower leg, causing pressure to build up. This venous hypertension stretches vessel walls, leaks fluid into surrounding tissue, and, over time, can damage the skin enough to create a venous leg ulcer (an open wound on the lower leg caused by poor venous circulation).

Compression therapy works by applying graduated external pressure — strongest at the ankle, progressively lighter toward the knee or thigh. This gradient mechanically supports the vein walls, reduces the diameter of dilated (widened) superficial veins, enhances the efficiency of the calf-muscle pump, and reduces edema (fluid swelling in the tissue). The result is improved venous return and reduced venous hypertension.

Two main delivery formats exist:

• Graduated compression stockings (GCS): Pre-shaped, reusable garments available in different compression classes.
• Compression bandages: Applied layer by layer, usually by a nurse or clinician, offering customizable pressure — particularly important when limb shape is irregular or when treating active ulcers.

Understanding Compression Classes

Not all compression is created equal. Medical compression garments are classified by the pressure they exert at the ankle, measured in millimeters of mercury (mmHg). Different countries use slightly different classification systems, but the European standard (RAL-GZ 387) is the most widely referenced in clinical practice.

An evidence-based consensus statement published by Rabe, Partsch, Hafner, Lattimer, Mosti, and colleagues (2018) provides detailed guidance on the indications for medical compression stockings across venous and lymphatic disorders, confirming that Class 2 stockings are the most commonly prescribed for symptomatic CVI and that higher classes require individual fitting and specialist supervision. [4]

Compression Bandages: A Different Tool for Different Needs

Bandages are not simply an alternative to stockings — they serve a distinct clinical purpose. Because they are applied fresh at each dressing change, the treating clinician can adjust pressure to account for changes in limb volume, wound exudate (fluid from a wound), and patient tolerance.

Partsch, Clark, Mosti, Steinlechner, and colleagues (2008) published a widely cited classification of compression bandages that distinguishes between:

• Short-stretch bandages: High working pressure (active during movement), low resting pressure — well tolerated overnight and preferred in many European centers.
• Long-stretch bandages: Higher resting pressure — more commonly used in the UK and North America.
• Multi-layer bandage systems: Combine padding, cohesive, and elastic layers to achieve sustained, graduated pressure over several days between dressing changes. [3]

The choice between these systems depends on the clinical setting, the clinician’s training, and the patient’s mobility and tolerance.

What Does the Evidence Say?

For Venous Leg Ulcers

The most rigorous evidence comes from a 2021 Cochrane systematic review (a gold-standard summary of all available randomized trials) by Shi, Dumville, Cullum, Connaughton, and Norman, published in the Cochrane Database of Systematic Reviews. The review examined compression bandages or stockings versus no compression for treating venous leg ulcers. The authors found that compression therapy — whether delivered by bandages or stockings — is significantly more effective than no compression for healing venous leg ulcers, with multi-layer high-compression bandage systems showing the strongest evidence for complete ulcer healing. [2] (PMID: 34308565)

This finding underpins the recommendation in both European Society for Vascular Surgery (ESVS) guidelines and NICE (UK) guidelines that compression is the cornerstone of VLU management.

For Deep Venous Insufficiency

A 2021 Cochrane review by Goel, Hardy, and Brown on surgery for deep venous insufficiency notes that conservative management — including compression therapy — remains the reference standard against which surgical interventions are compared, given that surgery for deep venous disease carries significant procedural risk and limited long-term evidence. [1] (PMID: 34591328) This underscores the importance of optimizing compression before considering invasive options.

Graduated Compression Stockings: Mechanism and Evidence

A 2014 review by Lim and Davies in a major vascular journal provides a clear summary of the physiological mechanisms and clinical evidence for graduated compression stockings, confirming their role in reducing symptoms of CVI (heaviness, aching, swelling), preventing post-thrombotic syndrome (long-term complications after a deep vein thrombosis), and reducing the risk of DVT (deep vein thrombosis — a blood clot in a deep vein) in high-risk situations such as long-haul air travel or post-operative recovery. [5]

Symptoms That Compression Therapy May Help

Compression therapy is used across a wide spectrum of venous conditions. Common symptoms and scenarios where it is frequently recommended include:

• Leg heaviness and aching at the end of the day — often the first sign of CVI
• Ankle and lower leg swelling (edema) — particularly after prolonged standing or sitting
• Varicose veins (enlarged, twisted surface veins) — to reduce symptoms and slow progression
• Post-thrombotic syndrome — chronic swelling, pain, and skin changes after a DVT
• Venous leg ulcers — active wounds requiring bandaging, and healed ulcers requiring stockings to prevent recurrence
• Lymphedema — swelling caused by lymphatic system damage, often requiring higher-class garments
• Prevention during pregnancy — where hormonal changes and increased blood volume raise venous pressure
• Travel thromboprophylaxis — reducing DVT risk on long flights or car journeys

How to Use Compression Correctly

Putting On Stockings

Many patients abandon compression stockings because they find them difficult to apply. A few practical tips:

1. Apply in the morning, before getting out of bed, when swelling is at its lowest.
2. Turn the stocking inside out to the heel, place your foot in, then gradually roll the fabric up — never bunch it.
3. Use a donning aid (a smooth plastic frame or silk liner) if you have limited hand strength or flexibility.
4. Check for wrinkles — bunched fabric creates pressure points. Smooth the stocking evenly along the leg.
5. Replace stockings every 3–6 months — elasticity degrades with washing and wear.

Compression Bandaging

Compression bandaging for active leg ulcers should be applied by a trained nurse or clinician. Incorrect application — particularly over a bony prominence (ankle) or with uneven tension — can cause pressure damage. If you are being treated for a leg ulcer at home, ensure your community nurse has received specific compression bandaging training.

Prevention: Who Should Consider Compression?

Compression therapy is not only for people with established disease. It plays an important preventive role for:

• People with a family history of varicose veins or CVI who spend long hours standing or sitting
• Pregnant women — particularly from the second trimester onward
• Travelers on flights over 4 hours — Class 1 stockings are generally sufficient
• Post-surgical patients — hospital-issued anti-embolism stockings (TED stockings) are a specific, lower-pressure product designed for immobile patients; they are not interchangeable with therapeutic compression stockings

For more evidence-based prevention strategies, explore our prevention section.

Contraindications: When Compression Is Not Safe

Compression therapy is not appropriate for everyone. It must not be used — without specialist assessment — in:

• Peripheral arterial disease (PAD) — narrowing of the arteries supplying the legs. Compression can critically reduce arterial blood flow in patients with PAD. An ankle-brachial pressure index (ABPI — a simple bedside test comparing blood pressure at the ankle and arm) must be performed before prescribing compression in any patient with suspected arterial disease.
• Uncontrolled heart failure — rapid fluid mobilization can overload the heart
• Severe peripheral neuropathy — reduced sensation means pressure damage may go unnoticed
• Known allergy to compression garment materials

When to See a Doctor

Consult your physician or a vascular specialist if you experience:

• A leg ulcer that has not healed within 2 weeks, or any new open wound on the lower leg
• Sudden, severe swelling of one leg (possible DVT — seek urgent care)
• Skin changes around the ankle: darkening (lipodermatosclerosis), hardening, or eczema
• Pain when wearing compression that does not resolve within a few days of correct use
• Cold, pale, or painful feet — possible signs of arterial disease requiring assessment before compression is used

Do not self-prescribe compression class 3 or above. Higher-class garments require individual measurement and a clinical indication confirmed by a vascular specialist.

Sources

1. Goel RR, Hardy SC, Brown T. Surgery for deep venous insufficiency. Cochrane Database Syst Rev. 2021 Sep 30;9(9):CD001097. DOI: 10.1002/14651858.CD001097.pub4 | PMID: 34591328

2. Shi C, Dumville JC, Cullum N, Connaughton E, Norman G. Compression bandages or stockings versus no compression for treating venous leg ulcers. Cochrane Database Syst Rev. 2021 Jul 26;7(7):CD013397. DOI: 10.1002/14651858.CD013397.pub2 | PMID: 34308565

3. Partsch H, Clark M, Mosti G, Steinlechner E, et al. Classification of compression bandages: practical aspects. Dermatologic Surgery. 2008;34(5):600–609.

4. Rabe E, Partsch H, Hafner J, Lattimer C, Mosti G, et al. Indications for medical compression stockings in venous and lymphatic disorders: an evidence-based consensus statement. Phlebology. 2018;33(3):163–184.

5. Lim CS, Davies AH. Graduated compression stockings. CMAJ. 2014;186(10):E391–E398.

Medical Disclaimer: This article is produced by the Petit Veinard Editorial Board for informational purposes only. It does not constitute medical advice, diagnosis, or a treatment prescription. Compression therapy carries risks if used incorrectly or in the presence of contraindications such as peripheral arterial disease. Always consult a qualified physician or vascular specialist before starting, changing, or stopping any medical compression treatment. In case of sudden leg swelling, chest pain, or breathlessness, seek emergency medical care immediately.