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Do I Need Compression Stockings If I Have Diabetes?

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Q

I have type 2 diabetes, and my feet and ankles sometimes swell a little bit. Should I wear compression stockings?

A

If your swelling bothers you or is painful—or you just don’t like having swollen ankles—compression stockings…aka compression socks or Jobst stockings…can provide relief.

But to be safe, there are a few things you need to know about them if you have diabetes. While people with diabetes might be more prone than most people to swollen feet and ankles—in part because they tend to have circulatory problems—some folks are just genetically predisposed to having swollen lower extremities. In fact, my grandmother, who was a very thin woman with no history of diabetes, had “cankles,” as did my great-grandmother. My dad has them a little, too. I don’t have diabetes, but at the end of a long day of standing in the operating room or after a long airplane flight, my ankles can swell up a little.

Technically speaking, this swelling is called edema, and it’s caused by venous insufficiency—your body isn’t pumping the blood out from the lower extremities back to the heart efficiently enough. There are varying degrees of venous insufficiency, and sometimes it can be quite severe. Unfortunately, venous insufficiency can’t be cured, only treated—mostly by elevating the legs and wearing compression stockings. Once you stop doing these things, the swelling comes back.

Compression stockings help by gently squeezing your ankles and calves to move blood up your legs, or to keep fluids from accumulating in your legs. While over-the-counter versions can provide some relief—for tired feet, for example—those that you get by prescription might be more effective, simply because they might fit better, and a patient might be able to get higher degrees of pressure than they can with over-the-counter products.

If you have diabetes, there can be additional issues. Patients with diabetes are particularly prone to peripheral artery disease (PAD)—partial blockages in the arteries that supply the extremities. So you don’t want stockings to unduly restrict circulation in the lower extremities.

Fortunately, research has shown that in people with diabetes, not-too-tight compression stockings can reduce mild-to-moderate swelling without having a negative effect on circulation. While the pressure that compression stockings exert ranges from 8 mm/Hg to as much as 40 mg/Hg, research has found that stockings in the 18 mm/Hg-25 mm/Hg range may be best for people with diabetes.

Another issue that can complicate things is peripheral neuropathy, the often-painful condition that stems from diabetes-related nerve damage. People with this condition may not be able to tolerate the pressure from particularly tight-fitting stockings. If you have peripheral neuropathy, avoid large seams and folds around the foot and ankle, which put even more pressure on the skin. Try to find stocking without thick seams, and be sure to put them on smoothly, without allowing creases to develop in the stockings. Assess the stockings throughout the day to be sure they aren’t falling down and creating creases. Watch for reddened areas around the toe, ankle and heal after you’ve worn them. If you feel pain, discontinue the use of the stockings, or try stockings with lower compression strength.

Bottom line: If you have diabetes and you want relief from swollen ankles and feet, talk to your doctor about the condition of your lower extremities and circulation so you can get the right kind of compression stocking for you.

Tip: Anyone using compression stockings should watch for gathering/creasing of the material around the ankle. It could mean that the stockings are too big for you. It can also have a negative effect on reduction of edema, essentially by creating a tourniquet effect at the ankle! The same goes for excessive tightness around the calf or folds around the knee (in the case of thigh high stockings). Check the stockings regularly—and pull them up to avoid creasing. And if getting them on proves difficult—they can be pretty tight—try these solutions.

Source: Barbara Bergin, MD, orthopedic surgeon, Texas Orthopedics, Sports & Rehabilitation Associates, Austin. DrBarbaraBergin.com Date: July 19, 2017 Publication: Bottom Line Health
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