Foot leg and ankle swelling (oedema)

By: Dr. Helgi H. Sigurðsson.                                                                   

The role of Graduated Compression Stockings in prevention and treatment of the dreaded “Swollen Ankle Syndrome“ amongst other things.

Many people are familiar with and have experienced foot, leg and ankle swelling following long flights or journeys. Such symptoms are not necessarily a sign of illness but are usually more pronounced in individuals with underlying venous problems e.g. varicose veins and/ or other types of venous insufficiency.

Photo: Bryndís Arnardóttir
Photo: Bryndís Arnardóttir

What can I do?    

If you cannot avoid sitting or standing for extended periods of time, as is often the case during a flight or other long journeys and swelling occurs despite mobilizing at intervals, then I would recommend the use of graduated compression stockings.


How does graduated compression stocking therapy work ?

While walking the calf muscle alternately contracts and relaxes and as such squeezes the deep veins like a pump, emptying these veins of blood. Because of the one-way venous valves, the blood can only go “up” or back toward the heart. Thus, the calf muscles and the veins within them form a calf muscle pump. The calf muscle pump provides upward propulsion to overcome the downward hydrostatic pressure and send venous blood back to the heart.

Graduated compression stockings are in effect like an extra external layer of muscle that, compresses the limb. This reduces the diameter of distended veins and fluid compartments especially when the the calf muscle pump is inactive e.g. during long periods sitting down or standing still.

This causes an increase in venous blood flow velocity and valve effectiveness. Graduated compression therapy helps decrease venous pressure, prevents venous stasis and impairments of venous walls, and relieves heavy and aching legs.


What is the difference between graduated compression stockings and other types of compression stockings such as flight stockings ?

Graduated compression therapy refers to the benefits gained from the use of specialized stockings that deliver a gradient compression of at least 15 – 20 mmHg (Compression Class 1) to the leg that is tightest at the ankle. The amount of squeezing or compression gradually decreases up the leg.

Some types of compression stockings “flight stockings” have lesser compression properties and are not graduated, i.e. they have the same compression throughout and are often sold according to size without a fitting. These can be useful for many but are often insufficient for individuals with underlying venous problems e.g. varicose veins and / or other types of venous insufficiency. In addition, they are of little use and sometimes harmful if not fitted properly.

It is vital that all compression stockings are measured and worn correctly and therefore I recommend that you buy them from a source where staff are trained to fit them properly and can also provide useful information and advice There are many quality brands available such as Mediven, Sigvaris, Bauerfeind, Jobst , just to name a few that I recommend to my patients


Who benefits from wearing graduated compression stockings?

Anyone’s legs can feel better while wearing graduated compression stockings, especially:

  • Those who need to stand or sit for extended periods each day due to their profession.
  • Those who travel and are therefore confined for long periods of time during a flight.
  • Those with a history of blood clots (deep vein thrombosis – DVT) and those who, for    other reasons, wish to prevent such blood clots.
  • Those who experience tired aching heavy legs in their daily life.
  • Those who suffer from varicose veins and/or telangiectasia (spider veins). Such stockings prevent venous congestion which accounts for the leg complaints, swelling, and skin changes common in persons with venous problems . They can also limit further formation of varcosities.
  • Pregnant women who have a tendency to suffer from oedema and develop varicose veins. Pregnancy is one of the biggest accelerating factors in the formation of varicose veins.


Mr Helgi H Sigurðsson MD, FRCSED (Gen), EBS-Vasc, Consultant General and Vascular Surgeon. 

Klíníkin Ármúla 9, 108 Reykjavík, Tel: 519 7000.