Mild Compression Socks Safe, Effective for Diabetic Limb Edema

June 12, 2015

BOSTON — Use of mild compression socks can safely reduce lower-limb edema in patients with diabetes, a new double-blind randomized controlled trial has shown. The results were presented by Michelle Branigan, from Scholl College of Podiatric Medicine at Rosalind Franklin University, Chicago, Illinois, here at the American Diabetes Association (ADA) 2015 Scientific Sessions.

The findings are important because there has previously been concern that compression socks, a low-cost intervention, may be harmful in this patient population, who often have concomitant peripheral arterial disease, session chair James Wrobel, DPM, from the University of Michigan Medical School, Ann Arbor, told Medscape Medical News.

Ms Branigan reported that lower-extremity edema was reduced in the active group wearing the compression stockings in her trial. "There was a significant decrease in calf and ankle circumference, without vascularity being compromised," she observed.

In addition, skin-perfusion pressure significantly increased in the group treated with the compression socks, indicating that "microvascular circulation may have improved with mild compression," she added.

This is "an interesting study that adds more clarity in this area," noted Dr Wrobel, who said the results would encourage him to use mild compression socks more frequently in patients with diabetes with clinically significant peripheral arterial disease.

"Using compression stockings can help with fatigue and cramping associated with edema in the lower extremities and may also help with long-term venous health," he added.

Edema Is a Risk Factor for Venous and Diabetic Foot Ulcers

Edema is a risk factor for venous and diabetes-related foot ulcers among patients with diabetes, as well as being implicated in reducing healing for existing diabetes-related foot ulcers, Dr Wrobel explained to Medscape Medical News.

But although the standard treatment for lower-extremity edema is compression therapy, at a graded pressure of 35 to 45 mm Hg, this has traditionally been avoided in people with diabetes, Ms Branigan told meeting attendees. Instead, noncompression stockings have been advocated for such patients.

A prior pilot study of mild compression diabetic stockings (18 to 25 mm Hg) used in 20 subjects with diabetes and lower-extremity edema, published in 2012, indicated that this approach significantly reduced calf and foot circumference and significantly improved the ankle-brachial index, Ms Branigan explained. In addition, cutaneous edema was significantly decreased and overall lower extremity edema was reduced without compromising vascularity.

In this larger randomized, double-blind clinical trial, Ms Branigan and colleagues recruited 80 subjects with either type 1 or type 2 diabetes and mild to moderate lower-extremity edema from two sites: the Rosalind Franklin University Health Clinic and the Madigan Army Medical Center in Tacoma, Washington.

People who had previously undergone compression therapy or who had active wound infections, untreated osteomyelitis, or gangrene were excluded, as were those with any widespread malignancy or systemically immunocompromising disease.

Patients were also excluded if they had severe edema with calf circumference of 24 inches or more or deep and/or large ulcers requiring copious bandaging, as that could affect the efficacy of the socks. In addition, those with Parkinson's disease, restless-leg syndrome, or any other condition causing involuntary movement were not enrolled either.

The participants were randomly assigned to wear either noncompression diabetic socks (control group) or mild compression socks (18 to 25 mm Hg; Sigvaris). The patients were evaluated at baseline and then were given four pairs of each respective stocking and told to wear them during all waking hours.

They were then assessed at weekly intervals for 4 consecutive weeks; each time, foot, ankle, and calf circumference were measured and cutaneous water content was assessed to monitor lower-extremity edema.

Ankle-brachial index and toe-brachial index were measured to assess macrovascular circulation, and skin perfusion pressure was performed at three angiosomes (three-dimensional anatomic units of tissue fed by a source artery) to assess microvascular circulation.

Reductions in Calf and Ankle Circumference With Compression Socks

There was no significant change in ankle-brachial index, toe-brachial index, or the dorsal pedis artery angiosome or anterior tibial artery angiosome in any of the patients.

However, the skin perfusion pressure of the posterior tibial artery angiosome was significantly increased in the active group, indicating possible improvement in microvascular circulation, Dr Branigan explained.

In addition, lower-extremity edema was significantly reduced, as evidenced by a reduction in calf and ankle circumference, in the active group compared with in the control group, which is "consistent with the build of the sock," she noted.

In the control group, there was only a significant decrease in skin dielectric constant values, consistent with a reduction in cutaneous edema, she said.

Dr Branigan concluded that "mild compression diabetic socks may be safely used in diabetes patients with mild to moderate lower-extremity edema."

Ms Branigan and coauthors reported no relevant financial relationships. Funding for the study was provided by Sigvaris, manufacturer of the diabetic compression socks, but the sponsor played no role in the collection, analysis, or interpretation of the study data.

American Diabetes Association 2015 Scientific Sessions; June 6, 2015: Boston, Massachusetts. Abstract 142-OR

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