measuring for lower extremity compression garments

The Ohio State University Comprehensive Cancer 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

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

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?

PAD History of peripheral arterial bypass graft

Severe peripheral neuropathy Allergic to stocking material Pulmonary edema Recent skin graft

Why Not Compression Stockings?

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.

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

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.


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


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

Used for: Mild to severe lymphedema Optimum containment When the limb is irregularly shaped

Not used for: Prophylactic lymphedema

Flat Knit Compression Stockings

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Please see attached handout for decision tree.

Decisions, Decisions

Measuring Form Measuring Tape Pen or Eyeliner Clear Plastic Wrap

Tools Needed for Measuring Custom Compression Garments

Lower Extremity Measurement Points

http://www.juzousa.com/dealer/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)


http://www.juzousa.com/dealer/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

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


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


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

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What type of compression garment for this situation & how to measure for it.

http://www.answers.com/Q/What_is_the_difference_between_primary_lymphedema_and_secondary_lymphedema

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BiaCare Leg Assist- Lobule Compression System

http://biacare.com/product/legassist-lcs/

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BiaCare Leg Assist- Lobule Compression System

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

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measuring for lower extremity compression garments

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