Why Extra-Firm Compression for Advanced Venous Disease

Extra-firm 30–40 mmHg compression represents prescription-strength therapeutic pressure reserved for treating severe venous conditions including advanced chronic venous insufficiency, severe varicose veins with complications, post-thrombotic syndrome, and significant lymphedema. This compression level requires physician prescription and professional fitting, as the high pressure demands careful medical evaluation to ensure patient safety and appropriateness. The graduated compression applies maximum pressure at the ankle (40 mmHg) and decreases progressively up the thigh, creating powerful venous return assistance that can manage severe swelling, prevent venous ulcers, and support recovery from major venous procedures. Thigh-high length provides comprehensive lower extremity coverage essential when venous disease affects the entire leg or when knee-high compression proves insufficient for symptom management.

Key Features & Benefits

• Extra-firm 30–40 mmHg graduated compression for prescription-strength therapeutic support
• Thigh-high length provides comprehensive coverage from toes to upper thigh
• Opaque knit fabric offers superior durability and professional appearance
• Women's ML (Medium-Long) sizing designed for longer leg lengths
• Smooth, non-sheer finish suitable for professional and daily wear
• Comfortable top band with silicone grip keeps stockings securely positioned
• Black color provides versatile, discreet appearance
• Reinforced heel and toe areas withstand frequent wear
• Graduated compression maximizes at ankle, decreases up leg
• Prescription-strength support manages advanced venous conditions

Clinical Applications

Appropriate for women with:

✓ Advanced chronic venous insufficiency (CVI) with severe symptoms ✓ Severe varicose veins with skin changes, ulceration, or complications ✓ Post-thrombotic syndrome following deep vein thrombosis (DVT) ✓ Significant leg edema (swelling) unresponsive to lower compression ✓ Active or healed venous leg ulcers requiring maximum compression ✓ Moderate to severe lymphedema under medical supervision ✓ Post-surgical recovery after major vein procedures (ablation, stripping) ✓ Severe venous reflux documented by ultrasound ✓ Lipodermatosclerosis or severe skin changes from venous disease

Important: 30–40 mmHg compression REQUIRES physician prescription and professional fitting. Do not use without medical evaluation. Contraindicated in severe arterial disease, acute DVT without anticoagulation, severe peripheral neuropathy, or untreated congestive heart failure.

Usage & Application - User Guidance

For Prescription Compression Stockings Under Physician Direction: These extra-firm compression stockings are medical devices requiring physician prescription. Use only as directed by your healthcare provider with professional fitting and ongoing medical supervision.

Understanding 30–40 mmHg Compression:

• Extra-firm compression: Highest standard prescription level
• Physician prescription REQUIRED: Not available over-the-counter
• Professional fitting MANDATORY: Ensures safety and effectiveness
• Medical condition treatment: For severe venous disease only
• Regular monitoring essential: Provider follow-up critical

Medical Conditions Requiring This Level:

• Advanced chronic venous insufficiency with severe symptoms
• Severe varicose veins with complications (bleeding, ulceration, skin changes)
• Post-thrombotic syndrome after blood clot
• Severe leg swelling unresponsive to 20–30 mmHg compression
• Active or recently healed venous ulcers
• Severe lymphedema (combined with other therapies)
• Post-surgical vein procedure recovery requiring maximum support

Absolute Contraindications:

• Severe peripheral arterial disease (ankle-brachial index <0.5)
• Acute DVT without anticoagulation therapy
• Severe peripheral neuropathy with sensory loss
• Untreated congestive heart failure
• Known allergy to compression garment materials
• Dermatitis or weeping skin lesions (unless medically supervised)

Professional Fitting Requirements:

• MUST be fitted by certified compression garment fitter
• Multiple precise measurements required (ankle, calf, mid-thigh, thigh, leg length)
• Fitting should occur in morning before legs swell
• Women's ML size for medium leg circumference with long leg length
• Re-fitting every 3–6 months or with significant body changes
• Home measurement NOT recommended for 30–40 mmHg compression
• Improper fitting can cause serious complications

Understanding ML Sizing:

• "M" = Medium leg circumference (calf and thigh measurements)
• "L" = Long leg length (floor to gluteal fold)
• Designed for women with longer-than-average leg length
• Prevents bunching or excessive length if legs shorter
• Check manufacturer sizing chart for exact measurements
• Professional fitter verifies appropriate size selection

Physician Prescription Requirements:

• Documentation of venous insufficiency diagnosis
• Arterial assessment to rule out contraindications
• Ankle-brachial index testing if arterial disease suspected
• Compression level specification (30–40 mmHg)
• Length specification (thigh-high, knee-high, or pantyhose)
• Specific sizing measurements
• Duration of therapy and follow-up schedule

Preparing to Apply:

• Apply in morning before legs begin swelling
• Consider showering first for clean, dry skin
• Allow 15–20 minutes initially—this is difficult compression
• Have donning aids ready (essential for 30–40 mmHg)
• Rubber gloves for grip absolutely recommended
• Sit in sturdy chair with excellent lighting
• Consider requesting training from certified fitter

Application Technique - Thigh-High Extra-Firm:

• Turn stocking completely inside out to heel pocket
• Insert foot carefully, positioning heel precisely
• Pull stocking over foot and ankle with steady pressure
• Work gradually up calf—fabric will be very tight
• Stand to continue pulling up over knee to thigh
• Use rubber gloves for better fabric grip
• Pull to full thigh-high position (2–3 inches below gluteal fold)
• Ensure silicone top band lies flat against thigh
• Smooth all wrinkles thoroughly—folds compromise effectiveness
• Allow time to adjust—this is challenging compression

Essential Donning Aids:

• Rubber household gloves: Provide critical grip on tight fabric
• Donning butler/aid devices: Metal or plastic frame assists application
• Sock aid tools: Specifically designed for compression stockings
• Application gloves: Special textured gloves for compression
• Donning cone: Helps insert foot and pull up leg
• Professional instruction: Request demonstration from fitter

Checking Proper Fit:

• Should feel extremely firm but not unbearably painful
• Silicone top band shouldn't cut into thigh
• No bunching or wrinkles anywhere
• Toes should retain feeling and normal color
• Heel aligned properly in heel pocket
• Compression strongest at ankle, gradually less up leg
• No numbness, severe pain, or tingling
• Can tolerate for prescribed wear duration

Throughout the Day:

• Monitor for any signs of circulatory compromise
• Check that top band hasn't rolled or slipped
• Smooth wrinkles as they develop
• Remove immediately if severe pain, numbness, or discoloration
• Elevate legs when possible to enhance benefits
• Stay well-hydrated
• Contact provider if intolerable despite proper fit

Wear Duration:

• Typically 8–12 hours daily
• Put on in morning, remove at bedtime
• Some conditions require 24-hour wear—follow provider orders only
• Never exceed prescribed wear time
• Do not sleep in unless specifically prescribed
• Consistency important—wear daily as directed

Removing Extra-Firm Compression:

• Remove at end of day or as prescribed
• Sit comfortably with good access to legs
• Peel silicone top band down gently
• Work down leg slowly—do not rush
• Gather fabric as you go
• Turn inside out as removing from foot
• Expect this to take several minutes
• Inspect legs after removal for pressure marks

Signs Requiring Immediate Removal:

• Severe pain or cramping
• Numbness or complete loss of feeling
• Skin color changes (blue, purple, gray, white)
• Severe skin irritation or breakdown
• Toes becoming cold or losing circulation
• Increased swelling rather than decreased
• Severe burning or stinging sensation

Daily Care and Maintenance:

• Hand wash daily in lukewarm water with mild detergent
• Gentle machine wash in mesh bag if approved
• No bleach, fabric softener, or harsh chemicals
• Air dry flat or hang—NEVER use dryer heat
• Do not wring—gently press out excess water
• High compression requires 2 pairs to alternate
• Maintain elasticity through proper washing
• Replace every 3–6 months or when compression weakens

Monitoring Treatment Effectiveness:

• Track reduction in leg swelling and pain
• Document improvement in venous ulcer healing
• Note decrease in skin changes or discoloration
• Monitor ease of putting on (indicates reduced swelling)
• Keep symptom diary for provider appointments
• Measure leg circumferences periodically if instructed
• Report any worsening symptoms immediately

Managing Application Challenges:

• Cannot get stockings on: Request professional donning training
• Too painful to wear: Contact provider—may need adjustment period or different level
• Top band rolls down: May need different size or style
• Stockings slide down: Ensure proper size, check silicone band condition
• Skin breakdown: See provider immediately—may need wound care
• Toe discomfort: Verify proper sizing, consider open-toe style

Adjustment Period:

• First 1–2 weeks challenging—this is normal
• May need to build up wear time gradually
• Start with 4–6 hours if full day intolerable initially
• Work up to prescribed duration over 1–2 weeks
• Skin shows temporary fabric impressions initially
• Consult provider if cannot tolerate after adjustment period

When to Contact Physician Immediately:

• Severe pain, numbness, or circulation problems during wear
• Increased swelling despite compression
• Skin breakdown, ulcers, or infections
• Signs of new blood clot (sudden pain, warmth, swelling, redness)
• Cannot tolerate compression despite proper fit and adjustment
• Worsening venous symptoms despite compliance
• Any concerns about safety or appropriateness

Regular Follow-Up Required:

• Schedule provider appointments as directed
• Typically every 3–6 months minimum
• More frequent if active ulcers or complications
• Arterial reassessment periodically
• Compression level adjustment if needed
• Size changes with weight fluctuation
• Prescription renewal as necessary

Product Specifications

• Product Type: Women's Thigh-High Compression Stockings
• Brand: Essential Opaque
• Compression Level: 30–40 mmHg (extra-firm, graduated)
• Prescription: REQUIRED by physician
• Length: Thigh-High (extends from toes to upper thigh)
• Size: ML (Medium leg circumference, Long leg length)
• Gender: Women's specific sizing
• Color: Black
• Fabric: Opaque knit (durable, non-sheer)
• Top Band: Comfortable with silicone grip
• Toe Style: Closed toe with reinforcement
• Heel: Reinforced for durability
• Professional Fitting: MANDATORY
• Best For: Advanced/severe venous conditions
• Wear Time: 8–12 hours daily or as prescribed
• Care: Hand wash, air dry
• Replacement: Every 3–6 months
• Medical Supervision: Ongoing required
• Unit of Sale: Pair