By Cari Utendorf, PT, DPT, MBA, LMT, CLT-LANA OSUCCC - James The Ohio State University

1. The Ohio StateUniversity ComprehensiveCancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute
Measuring for Lower
Extremity Compression
Garments
Presented by: Cari Utendorf, PT, DPT, MBA, LMT, CLT-LANA

2.  1. The audience will understand how to determine which compression
stocking is most appropriate for their patient.
 2. The audience will understand the difference between flat knit and
circular knit compression garments.
 3. The audience will understand the boney landmarks for measuring
custom lower extremity compression garments.
 4. The audience will learn how to measure an asymmetrical limb.
 5. The audience will practice measuring for a custom lower extremity
compression garment.
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Objectives

3.  Compression stockings “can reverse venous hypertension, augment skeletal-
muslce pump, facilitate venous return and improve lymphatic drainage.”1
 Can be used in edema, lymphedema, CVI, pregnancy, and venous ulcers.
Can also be used to prevent DVT. 1
Why Compression Stockings?

4.  PAD
 History of peripheral arterial bypass graft
 Severe peripheral neuropathy
 Allergic to stocking material
 Pulmonary edema
 Recent skin graft
Why Not Compression Stockings?

5. How they work
Lim C, Davies A. Graduated compression stockings. CMAJ: Canadian Medical Association Journal [serial online]. July 8,
2014;186(10):E391-8 1p. Available from: CINAHL Plus with Full Text, Ipswich, MA.

6.  The technology used for circular knit produces a tube that requires minimal
steps to create the final product.3
 There are a fixed number of needles used during production, which
decreases the accommodation variability3
Circular Knit Compression Stockings

7. Circular Knit Compression Stockings

8.  They are available in a variety of colors and style.
 Sold as Ready to Wear products, but can be custom
 Not as good at containing the fluid as flat knit.
Circular Knit Compression Stockings

9.  Used for:
 Prophylactic garment for patients at risk for lymphedema
 Although there is some evidence to suggest it is not effective for prophylactic use5
 Mild lymphedema
 For those patients who can’t afford flat knit
 Not used for:
 Moderate-Severe lymphedema
 If the leg doesn’t fit into the garment per the sizing chart
Circular Knit Compression Stockings

10.  The technology creates a flat piece of fabric, that is then sewn together along a
seam.
 Can better accommodate irregularly shaped limbs
 More dense or coarse fabric
 Reduces the induration in the skin folds
 Less likely to cause tourniquet effect
Flat Knit Compression Stockings

11.  Used for:
 Mild to severe lymphedema
 Optimum containment
 When the limb is irregularly shaped
 Not used for:
 Prophylactic lymphedema
Flat Knit Compression Stockings

12. 12
 Please see attached handout for decision tree.
Decisions, Decisions

13.  Measuring Form
 Measuring Tape
 Pen or Eyeliner
 Clear Plastic Wrap
Tools Needed for Measuring Custom Compression Garments

14. Lower Extremity Measurement Points
http://www.juzousa.com/deal
er/PDF%20Files/measbr.pdf
c-circumference, l-length
cA- Across the metatarsal joints (weight bearing)
cY- Heel instep with maximum dorsiflexion
cB- the smallest circumference of the ankle (found just above the
malleoli)
cB1- Where the Achilles meets the calf muscle (have patient
plantarflex)
cC- greatest calf circumference
cD- smallest circumference below the knee, but above the calf
(usually the fibular head)

15. Lower Extremity Measurement Points
http://www.juzousa.com/deal
er/PDF%20Files/measbr.pdf
c-circumference, l-length
cE- mid patella with slight knee flexion
cF- mid thigh
cG- top of the groin, below the inseam
cK-same location as G, but around both legs and the buttocks
cH-largest circumference around the hips
cT- waist circumference above the hip bones
lA-length from A to posterior heel
lZ- total length of foot

16.  cC-largest calf circumference
 For the knee high, this is the anchor point, and should have a bit of tension on
the tape measure
 cD- fibular head
 Should be measured gently, especially for knee-high garments
 cE- mid patella
 Should be measured with about 45° knee flexion
 However, lE- should be measured with knee extension
 cF-mid thigh
 For thigh high, this is the anchor point, and should have a bit of tension on the
tape measure
Lower Extremity Measurement Points

17.  cG- upper thigh
 Measuring in standing, below the gluteal fold at the widest part of the leg. There
should be slight to no tension with this measurement. This should lay evenly
over the skin.
 cH and cT should be measured without tension
Lower Extremity Measurement Points

18. Where is the correct place to measure cE (mid patella)
http://www.lipedemasurgery.com/tag/new-york-doctors-treating-
lipedema/
C
B
A
C
B
A

19. 19
What type of compression garment for this situation & how to
measure for it.
http://www.answers.com/Q/What_is_the_difference_between_primar
y_lymphedema_and_secondary_lymphedema

20. 20
BiaCare Leg Assist- Lobule Compression System
http://biacare.com/product/legassist-lcs/

21. 21
BiaCare Leg Assist- Lobule Compression System

22. References
1. Lim C, Davies A. Graduated compression stockings. CMAJ: Canadian Medical Association Journal
[serial online]. July 8, 2014;186(10):E391-8 1p. Available from: CINAHL Plus with Full Text, Ipswich,
MA.
2. Lymphoedema Framework. Template for Practice: compression hosiery in lymphoedema. London:
MEP Ltd, 2006.
3. Tidhar D, Hodgson P, Shay C, Towers A. A Lymphedema Self-Management Programme: Report on
30 Cases. Physiotherapy Canada [serial online]. October 2014;66(4):404-412 9p. Available from:
CINAHL Plus with Full Text, Ipswich, MA.
4. Szolnoky G, Molnar G, Nemes-Szabo D, Varga E, Varga M, Kemeny L. Comparison of knee-high
Mediven ulcer kit and Mediven Plus compression stockings: measurement of leg volume, interface
pressure and static stiffness index changes. Veins and Lymphatics . 2013;2 (13). 39-41.
5. Stuiver, M, et al. No evidence of benefit from class-II compression stockings in the prevention of
lower-limb lymphedema after inguinal lymph node dissection: results of a randomized controlled trial.
Lymphology. September 2013.46 (3), p. 120.
6. Successful Management of Severe Unilateral Lower Extremity Lymphedema in an Outpatient
Setting. Physical Therapy [serial online]. September 2015;95(9):1295-1306 12p. Available from:
CINAHL Plus with Full Text, Ipswich, MA

23. Thank You
To learn more about Ohio State’s cancer
program, please visit cancer.osu.edu or
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