Do Compression Stockings Help Heal Venous Leg Ulcers? [Evidence-Based Guide]

If you or a loved one are struggling with a venous leg ulcer, you likely have one pressing question: Do compression stockings actually work?

According to medical consensus and recent research, the answer is a resounding yes.

Compression therapy is considered the gold standard for treating venous leg ulcers. This guide breaks down the data, compares stockings against bandages, and explains why compression is vital for both healing and preventing future recurrence.

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The Research Consensus: Yes, They Work

Based on aggregated research data, the vast majority of studies support the use of compression. In a review of expert consensus:

• 75% of sources say Yes

• 17% say No

• 8% say Possibly

Meta-reviews and Cochrane data confirm that compression therapy clearly improves healing rates compared to no compression at all. In fact, the Relative Risk (RR) for healing is approximately 1.5 times higher with compression than without it.

How Fast Do They Heal?

A large prospective study of 252 venous ulcers treated with outpatient compression revealed promising results:

• 57% healed by 10 weeks.

• 75% healed by 16 weeks.

• 96% eventually achieved full healing.

Key Takeaway: High or multi-layer compression systems generally heal ulcers faster and more effectively than low or single-layer compression.

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Stockings vs. Bandages: Which is Better?

Patients are often given a choice between compression stockings (hosiery) and compression bandages. Is one more effective than the other?

The short answer: They are generally similar in effectiveness. The "best" option is usually the one the patient can wear consistently.

Here is a breakdown of the comparative effectiveness:

Comparison	Main Finding
High-compression stocking vs. Short-stretch bandage	Stockings showed more ulcers healed at 3 months.
Low-strength stockings vs. Multilayer bandages	No significant difference in healing rates; both reduced pain.
Bandages vs. Stockings (Meta-review)	No clear difference in healing (RR ~0.95).

While some trials suggest stockings may have a slight edge, many experts note that stockings are often easier to apply than complex bandaging systems, which may improve patient compliance.

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Preventing Recurrence: The Long-Term Benefit

Healing the ulcer is only half the battle; keeping it healed is the other. Ongoing compression therapy is the most effective way to prevent the ulcer from coming back.

• EU Class 3 stockings reduced re-ulceration significantly compared to no compression over a 6-month period (RR 0.46).

• Stronger UK Class 3 hosiery was more effective than Class 2 at reducing recurrence, but it came with a catch: lower adherence. Because the stronger stockings are harder to put on and wear, patients were less likely to use them consistently.

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Important Considerations for Different Ulcer Types

Before starting compression therapy, it is vital to understand the type of ulcer you have.

1. Mixed Arterial-Venous Ulcers

If you have moderate arterial disease alongside venous insufficiency (ABPI 0.5–0.8), high compression can be dangerous. Instead, modified, lower-pressure compression (20–30 mmHg) is recommended to promote healing safely.

2. Non-Venous Ulcers

For ulcers that are not caused by venous disease, evidence is limited. However, experts often still use compression if edema (swelling) or venous insufficiency is present, provided there are no medical reasons to avoid it (contraindications).

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Conclusion: The Bottom Line

Compression therapy—including compression stockings—substantially improves the healing of venous leg ulcers and drastically reduces the chance of them returning.

Whether you choose stockings or bandages, the research suggests that adherence is the major determinant of success. The most effective compression system is the one that delivers adequate pressure and that you can wear consistently and safely.

Note: Always undergo a full vascular assessment (including an ABPI check) by a healthcare professional before starting compression therapy to ensure it is safe for your specific condition.