UNDER PRESSURE
other problems . According to Helane Fronek , MD , FACP , FACPh , reflux is a major cause of symptoms and ulceration of the leg .
“ Reducing the amount of reflux , either by closing off or removing the diseased veins or by applying gradient compression , helps to diminish symptoms and long-term complications of varicose veins ,” said Dr . Fronek .
Medical compression provides a gradient of pressure against the leg . The pressure is highest at the foot and ankle and gradually decreases as the garment rises the leg . This pressure gradient makes it easier for the body to pump blood up towards the heart ( the normal direction ) and more difficult for gravity to pull blood downward .
Compression also increases the pressure in the subcutaneous tissue , thereby helping to reduce and prevent swelling by moving excess fluid back into the capillaries .
Gradient compression is expressed in millimeters of mercury , or mmHg . It is the measurement of how much compression or squeeze that is placed on the leg : the higher the number , the greater the compression .
Stockings are graded based on the strength of the compression at the ankle . Dr . Fronek described commonly prescribed strengths , which include 15-20 mmHg for spider veins , or patients with varicose veins but only mild symptoms or swelling ; 20-30 mmHg for mild to moderate varicose veins ; and 30-40 mmHg for patients with varicose veins associated with symptoms such as pain and swelling .
For patients who have had venous ulceration ( venous stasis ulcer ) or DVT , a 30-40 mmHg stocking is best . For conditions such as lymphedema , 50-60 mmHg stockings or inelastic bandages are best .
GETTING A GOOD FIT
These days , compression stockings are fashionable , comfortable , and come in a wide variety of styles and colors . There is a stocking for everyone , but it takes time to find one that fits a patient — and his or her lifestyle — well .
Susan Price believes that a good fit isn ’ t just important it ’ s essential . “ If you don ’ t have a good fit , the garment can be too tight and actually cut off your circulation , the opposite of what it ’ s designed to do ,” she said .
Price is a Certified orthotic fitter ( Cfo ) at Maine Orthotic and Prosthetic , an ABCaccredited facility in Portland , Maine . She fits burn garments and other bracings , but about 85 % of the patients she sees are for compression . Most of those people need garments for post-surgery vein procedures .
Every patient who schedules a fitting requires a doctor ’ s prescription detailing the diagnosis , style ( knee-high , thigh-high , or pantyhose ) and level of compression . When Price fits for compression garments , she starts with a standard evaluation , which includes medical history and a review of the referring doctor ’ s orders .
Though fittings can be scheduled throughout the day , morning is the ideal time , because swelling worsens throughout
18 Pedorthic Footcare Association | www . pedorthics . org