Leg symptoms of healthy people and their treatment with compression hosiery

Objectives: Occasional leg symptoms, like feelings of heaviness and tension, and occupational or evening oedema are considered typical features of a venous disorder but show low specificity in epidemiological and observational studies. We evaluated the prevalence and nature of such symptoms in subjects with no history or signs of venous disease and investigated the optimal strength that medical compression stockings (MCS) should exert in order to alleviate the symptoms and to prevent leg swelling. Methods: Specifically designed questionnaires were used to assess the symptoms of 40 healthy employees of a factory producing MCS. Lower leg volumes were quantified in the morning and evening. Calf size hosiery providing documented ankle pressures of 4-9 (mean 7.3), 12-18 (mean 14.9) and 18-22 (mean 19.5) mmHg, respectively, were tested in a prospective, open-label, randomized trial lasting three weeks. Endpoints were the relief of symptoms, prevention of vesperal oedema and comfort in wearing the stockings. Results: Sixty-five percent of the participants reported at least occasional leg symptoms and oedema. Somatic-type symptoms (i.e. pain, heaviness, swelling, unattractive legs) were present in two, psychic-type symptoms (i.e. leg-and personality-related unrest and stress) in 17 and both components in seven of the 40 subjects. MCS exerting 15 and 20 mmHg prevented the symptoms and oedema. Stockings providing 10 mmHg were ineffective and those providing > 19 mmHg were not well-tolerated. The effect on the somatic-type symptoms was strongly correlated with the amount of lower leg volume which could be reduced by wearing stockings (P = 0.005). No correlation was found between the efficacy of compression and the emotional component of the symptoms. Conclusion: The cause of occasional pain in the legs of apparently healthy people is unknown. Some features of the syndrome reflect an emotional disorder while others mirror venous insufficiency. MCS of 15 mmHg effectively relieve the symptoms resembling venous insufficiency, prevent oedema and are well-tolerated.