Compression socks are specialized garments that apply gentle, graduated pressure to the lower legs to improve blood flow. For individuals managing diabetes, standard compression guidelines must be adapted due to the heightened risk of circulation and nerve damage in the extremities. Using the correct type of sock and adhering to a specific wear schedule is paramount to safely manage swelling while avoiding serious complications.
Why Compression is Necessary for Diabetics
Diabetes frequently compromises the health of the circulatory system, often leading to a condition called chronic venous insufficiency. This occurs when the veins struggle to effectively return blood from the legs and feet back toward the heart, allowing blood and other fluids to pool in the lower limbs. The pooling of blood and other fluids results in swelling, known as peripheral edema, which can cause discomfort, heaviness, and fatigue in the legs.
The mechanical pressure from compression socks assists the body’s natural mechanisms by gently squeezing the vein walls. This external pressure helps the valves inside the veins work more efficiently, encouraging the flow of deoxygenated blood upward against gravity. By preventing fluid accumulation, compression helps reduce swelling and may support the delivery of oxygen to tissues.
Selecting the Correct Compression Level
The choice of compression level, measured in millimeters of mercury (mmHg), is a safety distinction for people with diabetes. Unlike the higher pressures often used for other conditions, diabetic patients typically need mild to moderate compression. Mild pressure, such as 8–15 mmHg, is suitable for preventing minor swelling and promoting circulation without excessive constriction.
Moderate compression, generally ranging from 15–20 mmHg, is often recommended to manage more noticeable swelling, mild discomfort, or early signs of varicose veins. Patients should avoid over-the-counter high-compression socks (20–30 mmHg or higher) unless explicitly prescribed by a healthcare professional. Medical guidance is necessary because higher pressures can dangerously restrict arterial blood flow in an already compromised circulatory system.
Guidelines for Daily Wear and Duration
The most effective and common practice is to wear compression socks for the entire duration of the day, during all waking hours. The standard schedule involves applying the socks first thing in the morning upon waking, before any significant swelling has occurred. Edema is minimal when the legs are elevated during sleep, making this the optimal time to put the socks on to prevent fluid accumulation throughout the day.
Socks should be removed before going to bed at night, unless a doctor has given specific instructions for overnight use. Wearing them continuously overnight is generally discouraged because the horizontal position of the body reduces the need for compressive assistance. Furthermore, higher-pressure socks worn overnight can potentially restrict blood flow and cause discomfort or skin irritation. Compression is beneficial during periods of immobility, such as long flights or extended sitting, to maintain proper circulation.
When Compression Socks Must Be Avoided
The primary safety concern requiring avoidance of compression socks is the presence of Peripheral Artery Disease (PAD). PAD causes a narrowing of the arteries, reducing the blood flow to the extremities. The external pressure from compression socks can further restrict this compromised arterial flow, potentially worsening ischemia and causing severe tissue damage.
Individuals must be screened for PAD before starting compression therapy; a vascular specialist often uses an ankle-brachial index (ABI) test to assess arterial health. Compression socks should also be avoided by those with:
- Existing open wounds
- Active infections
- Unhealed ulcers on the legs or feet
- Severe diabetic neuropathy, which causes a loss of sensation
Neuropathy is a contraindication because the patient may not feel if the sock is too tight or causing pressure injuries, which can rapidly lead to skin breakdown.