Compression Therapy for Venous Leg Ulcers: Who Can Use It, Who Cannot

What is compression therapy?

Compression therapy uses carefully applied pressure to the lower leg to support venous blood flow. When the one-way valves in leg veins fail, blood pools and pressure builds, causing swelling, skin damage, and eventually venous leg ulcers. Compression squeezes the leg from outside, helping blood return to the heart and reducing swelling.

A venous ulcer can stay open for months. Dressings treat the wound surface, but they cannot fix the underlying vein pressure. That is why compression is the foundation of venous ulcer treatment.

Before you start: the ABI test

Before anyone begins compression, a clinician must check your arterial blood supply using a simple test called the Ankle Brachial Index, or ABI. This test compares blood pressure at the ankle with pressure in the arm. It tells the clinician whether your legs have enough blood flow to safely tolerate compression.

The ABI test is quick, painless, and essential. Never start compression without this assessment.

Three simple categories

Good blood supply

If your ABI shows good arterial blood flow, compression is usually suitable and can help the ulcer heal. This is the most common situation for people with venous leg ulcers.

Reduced blood supply

If blood flow is reduced, modified compression may be suitable, but only after specialist assessment and with close monitoring. The pressure will be lighter than standard compression.

Poor blood supply

If blood flow is poor, compression should not be started. It could further reduce blood flow and damage the leg. In this case, you will be referred to a vascular specialist for further assessment.

When the ABI can mislead

In people with diabetes or kidney disease, the ABI reading can look normal despite poor circulation. This happens because stiff, calcified arteries do not compress easily during the test. If you have diabetes or kidney disease, your clinician may order additional checks, such as toe pressures, before starting compression.

When to seek assessment first

Do not start compression if you have any of the following without first seeking medical assessment:

• A leg infection
• A suspected blood clot (deep vein thrombosis)
• Worsening or decompensated heart failure
• Numb feet or peripheral neuropathy

These conditions do not always mean compression is impossible, but they require a clinician to assess the situation first.

Warning signs: remove compression immediately

Once compression is in place, watch for these warning signs:

• Cold toes
• Pale or blue toes
• Numbness or tingling
• New or worsening pain

If any of these occur, remove the compression immediately and seek urgent medical help. For people with numb feet who cannot feel these signs, regular visual checks of the toes and skin are essential.

How compression is applied

Open ulcers usually need a clinician-led compression plan, which may include multi-layer bandages applied by a trained nurse or other qualified healthcare professional. Once the ulcer has healed, daily prescribed compression stockings help prevent recurrence. Venous ulcers can come back, and ongoing compression is the most effective way to keep them closed.

Never choose your own compression pressure or wrap your own leg unless your care team has specifically taught you how. Compression is a clinical prescription, not a one-size-fits-all product.

Frequently asked questions

Can I buy compression stockings over the counter?

Light support stockings are available without prescription, but medical-grade compression for venous ulcers requires proper assessment and fitting. Using the wrong pressure can be harmful.

How long do I need to wear compression?

For active ulcers, compression is worn until the ulcer heals. After healing, lifelong daily compression is usually recommended to prevent recurrence.

Does compression hurt?

Compression should feel firm but not painful. New or worsening pain is a warning sign that something is wrong.

Can I shower with compression bandages?

Most compression bandages are not waterproof. Your nurse will advise on how to keep them dry and when they can be removed for washing.

Key takeaway

Compression therapy is the most effective treatment for venous leg ulcers, but it must be prescribed and monitored by a healthcare professional. Always have an ABI test first, watch for warning signs, and never self-prescribe compression pressure.

Reviewed by a board-certified wound care nurse. This article is for educational purposes and does not replace professional medical advice.