Compression Socks for People with Down Syndrome

Key Points

• Many people with Down syndrome have increased lower leg and foot swelling.

• People with Down syndrome appear to have varicose veins more commonly than people without Down syndrome. 

• Wearing knee length compression socks can help with these conditions.

• Wearing knee length compression socks may also help decrease leg pain.

What are compression socks?

Compression socks (sometimes called compression stockings) are a type of tall socks that fit more snugly than typical socks and can be worn for a variety of purposes. They are often long socks that go up over the calf and fit snugly from the toes all the way up to the knee.

CAUTION: If worn incorrectly, compression socks can “bunch up” at the ankle and cause rubbing and even a sore (ulceration of the skin). It is important to check the fit and check that the socks are not getting stretched out and potentially sagging around the ankles which can contribute to abnormal rubbing and sores.

Use of compression socks

People often use compression socks to help with different conditions like varicose veins and/or swelling of the feet or lower legs. People who need compression socks usually present with any of these conditions:

• Venous insufficiency - increased pooling (of fluid/blood) with swelling and discoloration through the gaiter area (darker coloring of the area around the lower leg from the mid-calf to just below the ankle).

• Varicose veins - veins that stick out more, usually on the back of the legs along the calves. They may or may not cause pain.

• Increased swelling through the toes, foot, and ankle.

For a person with any of the conditions listed above, their feet may get “sock lines” (like those shown in the photos below) when wearing low socks or ankle socks that cut into the skin. The individual may report feelings of swelling, stiffness, or even pain, and varicose veins may be more prominent or visible. The individual may have swelling through the toes, ankles, or calves.

Clinically, we have noted that people with these concerns who wear compression socks tend to see improved circulation, decreased discoloration, decreased swelling, decreased report of pain, and decreased prominence of varicose veins.

When to use compression socks

Sitting times

Active times

Compression socks can also be worn by individuals during active times and when participating in exercise. There are no studies evaluating this use in people with Down syndrome. Studies done in people without Down syndrome mostly found no benefit in athletic performance, but there is some evidence of shorter recovery time (e.g., shorter time to easing discomfort after exercise). Theoretically, one may be able and willing to exercise or be active again sooner with less discomfort. 

Also, some research found that individuals (without Down syndrome) perceived that exercise was more comfortable when wearing compression socks. We have found that some individuals with Down syndrome report increased vigor while exercising. Since some people with Down syndrome do not typically report pain, it can be difficult to know if there is a reduction in pain. However, individuals with Down syndrome have reported that wearing compression socks helps them feel like a "superhero" or "football star" and will often move in a very energetic way that suggests increased comfort.

Tips on using compression socks

There are many brands and several types of compression socks available in stores and online. Compression socks come in a variety of lengths (e.g., up to just below the knee or up to the waist or hips). There are also a variety of strengths of compression (e.g., 10-20 mm Hg, 20-30 mm Hg – mm Hg means “millimeters of mercury” and is how they measure the pressure level of compression socks.)

If a person with Down syndrome decides to wear the socks, how do they choose which ones?

• We have found that wearing socks that go just below the knee work very well. Typically, those to just below the knee are better tolerated than the longer ones.

• The best brands are the brands that you will wear. You may have to try a few different ones to find the one that works best for you.

• 10-20 mm Hg compression often works well because it provides benefit, it is not too tight, and people can still get the socks on independently. Some describe socks with 10-20 mm Hg compression as "not too much, more like a nice hug!"

• Most people with Down syndrome have smaller feet (men's size 8 or smaller). The average foot size for men and women with Down syndrome is women's size 6.5. That makes the women's compression socks a little better fit for both men and women.

  • Before ordering socks, we recommend that the individual gets his or her foot measured!

  • If the foot measures between a youth size 4 and a women's size 8, it is appropriate to order a women's sock that is for a size 5-8 women's shoe.

  • Men's shoes start at size 7, which is a women's size 9. However, most men with Down syndrome have a women's 6.5 to 7.5 size shoe so the sock for a size 5-8 women's shoe will work for those men as well.

  • Ordering larger socks can decrease the efficacy of the compression and increase the risk of the sock sliding and rubbing.

• There are also options for people with larger calves or larger legs (e.g., plus size compression socks ).

• For individuals with more moderate calf size and who can be flexible with a little more pressure (20-30 mm Hg), there are many fun patterns that can make using compression socks much more stylish! One individual with Down syndrome who loves Captain America recommended these compression socks .

*Please note: We are sharing information about these products for educational purposes only. We do not receive financial support or compensation for sharing information about these products. 

Thank you to Mann Method PT and Fitness for taking the photos used in this resource and to the individuals in the photos for giving permission for them to be shared.

Resources

• Venous disease in people with Down syndrome (article from the Adult Down Syndrome Center).

• Mann Method PT and Fitness website  (more information on Sarah Mann's work) 

References

Brophy-Williams N, Driller MW, Kitic CM, Fell JW, Halson SL. ​Effect of compression socks worn between repeated maximal running bouts . Int J Sports Physiol Perform. 2017;12(5):621-627. doi:10.1123/ijspp.2016-0162

da Silva CA, Helal L, da Silva RP, Belli KC, Umpierre D, Stein R. Association of lower limb compression garments during high-intensity exercise with performance and physiological responses: A systematic review and meta-analysis . Sports Med. 2018;48(8):1859-1873. doi:10.1007/s40279-018-0927-z

Fletcher L, Raab S, Sanderson S, Vargo L. Efficacy of compression socks to enhance recovery in distance athletes . Int J Hum Mov. 2014;2(2):15-18. doi:13189/saj.2014.020201

Montoye AHK, Mithen AA, Westra HL, Besteman SS, Rider BC. The effect of compression socks on maximal exercise performance and recovery in insufficiently active adults . Int J Exerc Sci. 2021;14(7):1036-1051. 

Sigel B, Edelstein AL, Savitch L, Hasty JH, Felix WR Jr. Type of compression for reducing venous stasis. A study of lower extremities during inactive recumbency . Arch Surg. 1975;110(2):171-175. doi:10.1001/archsurg.1975.01360080037005