Compression therapy uses elastic garments, bandages, or devices to apply controlled pressure to a limb, improving circulation and reducing swelling for conditions like chronic venous insufficiency, lymphedema, and deep vein thrombosis (DVT) prevention. While generally safe when used correctly, it is not without risks. Understanding and recognizing potential complications is key to a positive outcome.
Common and Mild Side Effects
These are the most frequently encountered issues, typically caused by a poor fit, sensitive skin, or improper wear.
Skin Irritation and Discomfort
- Itching and Redness: This often results from friction between the garment and the skin, especially in warmer or humid conditions where moisture gets trapped. Using poor-quality, non-breathable materials can also be a factor.
- Dry Skin and Chafing: The constant pressure can lead to dry skin, especially in individuals with sensitive skin, which can, in turn, cause itching. Excessive rubbing can cause chafing or blisters.
- Temporary Indentations: It is common to see mild, temporary pressure marks on the skin where the garment ends, but deep or painful indentations could indicate an improper fit or that the compression is too tight.
- Discomfort or Pain: While some snugness is expected, outright pain or a feeling of being squeezed too tightly is a sign of an issue.
Improper Wear and Hygiene Issues
- Uneven Pressure Distribution: If a stocking is wrinkled or bunched up, it can create a tourniquet effect, restricting blood flow instead of improving it.
- Fungal or Bacterial Infections: The warm, moist environment created by compression garments can increase the risk of fungal infections like athlete's foot if not cleaned properly.
Rare but Serious Complications
While infrequent, severe side effects can occur, particularly in individuals with pre-existing conditions or with gross misuse of compression therapy.
Restricted Blood Circulation (Ischemia)
If the compression is too tight, it can restrict rather than improve blood flow. In severe cases, this can lead to ischemia, where tissue does not receive enough oxygenated blood. Symptoms include numbness, tingling, cold limbs, or skin discoloration (pale, blue, or red).
Nerve Damage (Neuropathy)
Excessive or misplaced pressure, especially near sensitive areas like the fibular head, can cause nerve compression. This can be more of a risk for people with diabetes or pre-existing neuropathy. Symptoms include numbness, tingling, or muscle weakness.
Skin Ulcers and Necrosis
In rare instances of severe, prolonged, and improperly applied compression, especially on individuals with fragile skin or severe arterial disease, pressure can cause skin breakdown, leading to ulcers or tissue necrosis.
Worsened Swelling
If the compression level is too high or the garment is the wrong size, it can impede proper fluid movement and paradoxically worsen swelling.
Preventing Side Effects: Best Practices for Use
Most side effects can be avoided by ensuring proper use and addressing any issues immediately. The benefits of compression therapy far outweigh the risks when it is applied correctly.
- Get a Professional Fitting: The single most important step is to have your legs properly measured by a healthcare professional or a trained staff member at a medical supply store. They will determine the correct size, length, and compression level (mmHg) needed.
- Follow Doctor's Orders: Always follow the instructions from your healthcare provider, particularly regarding the appropriate compression level and how long to wear the garment. Higher compression levels (e.g., 20-30 mmHg or more) are often prescription-based.
- Practice Daily Skin Care: Remove garments daily to wash your skin and apply a fragrance-free, lipid-replenishing lotion to combat dryness. Avoid greasy lotions that can damage the garment's elastic fibers.
- Check Skin Regularly: Inspect your skin for redness, dents, chafing, or blisters between each wear. If a problem area is developing, give your skin a break from the garment.
- Wash Garments Properly: Wash compression socks daily according to the manufacturer's instructions to maintain their elastic properties and prevent the buildup of bacteria and oils.
- Replace Worn-Out Garments: Compression garments lose their effectiveness over time. They should be replaced approximately every six months or sooner if they lose their stretch.
- Do Not Wear Overnight: Unless specifically directed by a physician, compression garments should be removed before sleeping.
Side Effects of Compression: Comparison of Severity
| Feature | Common/Mild Side Effects | Rare/Serious Side Effects |
|---|---|---|
| Symptom Type | Skin irritation, itching, redness, discomfort, mild pressure marks. | Numbness, tingling, pain, worsening swelling, skin discoloration, tissue breakdown. |
| Underlying Cause | Improper fit (too tight or loose), wrong compression level, moisture buildup, material sensitivity. | Severe underlying conditions (PAD, neuropathy), gross misuse of high-compression garments. |
| Treatment | Remove garment, rest skin, improve hygiene, apply moisturizer, get re-fitted, switch materials. | Stop use immediately, seek urgent medical evaluation to rule out nerve or arterial damage. |
| Associated Risk | Annoyance, temporary discomfort, potential for minor skin breaks. | Permanent nerve damage, tissue necrosis, restricted blood flow, cardiac decompensation. |
Conclusion
Compression therapy is a powerful tool for managing circulatory and lymphatic conditions, but like any medical intervention, it requires careful consideration and proper application. The majority of side effects, such as skin irritation and minor discomfort, are preventable through proper fitting, daily hygiene, and vigilance. In rare cases, improper use, especially with high-compression garments or in individuals with specific health conditions, can lead to serious risks like nerve damage or circulation issues. Always consult a healthcare professional before starting compression therapy to determine if it is appropriate for you, especially if you have a history of heart disease, diabetes, or arterial problems. By understanding the potential risks and following best practices, you can safely and effectively reap the numerous benefits compression has to offer. For more information, the Cleveland Clinic offers further details on the types and benefits of compression therapy.
