Home The Book Dr Articles Products Message Boards Journal Articles Search Our Surveys Surgery ESWT Dr Messages Find Good Drs video

Curious minds want to know - why

Posted by Lara % on 1/15/03 at 13:22 (105523)

Went to the pod this week with lots of questions (and got lots of answers : ). In the course of our discussion I mentioned this message board, and that most people didn't seem to find compression socks very helpful, which I found surprising. She thought that was curious, as she finds them helpful with lots of her TTS patients (and she sees 1-2 TTS/week).

I ask this question more out of curiosity than anything - my best justification is that sometimes answers to questions that don't seem critical lead to a better understanding of the disease/syndrome/illness, which then makes it easier to consider new information as it becomes available.

I have a few thoughts on why compression socks aren't that popular:
1. My pod has an unusual group of patients
2. People for whom they work don't tend to visit this message board.
I'd be surprised. Before compression socks I was MISERABLE, and I still live with it and would like to be better.
3. Most doctors aren't prescribing them for some reason - what?
4. Compression socks are most useful for TTS caused by _________, and most people on this message board had TTS for other reasons?

Re: Curious minds want to know - why

Sharon W on 1/15/03 at 13:39 (105525)

Lara,

I was told by my own podiatrist, and have seen comments by a couple of doctors on these foot boards, that compression hose will sometimes help with TTS if you have varicose veins in the tarsal tunnel area. From what I've read, varicose veins may be present in the tarsal tunnel in as many as 25-33% of TTS cases.

In my research, I have found very few references to compression hose as a treatment for TTS, and my guess is that the main reason more people are not helped by them is that most foot and ankle specialists are not prescribing them for this condition because they aren't considered one of the usual treatments.

Perhaps they SHOULD be, however. After all, there IS no one reliable treatment for TTS that helps EVERYONE, and doctors don't really seem to know what will or will not work for a given patient. Compression hose ARE expensive, but really no more so than a new pair of shoes, so if they stand ANY chance of making someone better -- what harm is there in giving them a try?

Sharon

Re: . Compression hose ARE expensive - sort of

Lara T on 1/15/03 at 14:04 (105526)

You're right, compression socks are expensive - as socks go ($20/pair for mild anklets, somewhat more for moderate, I believe the panty hose are close to $100.00). I try to not think of it as buying socks, but rather as paying for a treatment - a successful one at that (in which case they aren't much more than my co-pay and last for a couple of years). And like you said, then there's the cost of shoes that we all buy.

During my recent visit my podistrist also agreed with you that many cases of TTS for which no known cause can be ascertained are caused by varicose veins.

One of the doctors I visited for a second opinion (an orthopedist doing research in the area of TTS) was reported by a reliable source as doing something the equivalent of 'putting his nose in the air' for compression socks - something the podistrists might do, but not fine medicine that an orthopedist would be caught doing. This would fit with your explanation, but I don't understand it.

Re: Curious minds want to know - why

Marty on 1/15/03 at 15:08 (105531)

My vote is for #4. If I had a pair available to try I would but I can't wear normal socks at all as it is and my experience with just normal socks and the burning they cause me makes me not willing to spend the money on any kind of a sock. Bummer too it's cold here in Salt Lake City and they just might help. Never know.

Marty

Re: Curious minds want to know - why

Ed Davis, DPM on 1/15/03 at 18:05 (105540)

Sharon:
Custom compression hose are very expensive although it it worthwhile to try non-custom hose first if one has a fairly 'average' foot anf leg shape.
Ed

Re: Curious minds want to know - why

Sharon W on 1/15/03 at 18:38 (105551)

Dr. Ed,

I know; the ones I use cost about $80 each.

Do you think more people with TTS could benefit from compression hose if they were prescribed more often?

Sharon

Re: Curious minds want to know - why

Ed Davis, DPM on 1/15/03 at 18:46 (105553)

Lara:

Compression hose are liked by docs but often not by patients because....
they can be hard to get on, they are often hot in the summer, appearance is not pleasing...
Ed

Re: Curious minds want to know - why

Lara % on 1/15/03 at 19:31 (105555)

I have to admit that compression socks aren't the sexiest looking things I've ever seen (right up there with flannel nightgowns and curlers). But then neither is grimacing, being irritable, or being sedentary. I can't imagine not wearing compression socks cuz they look ugly (I believe you, I just find it stupid)- I'd rather be ugly and have a life than pretty sitting in a chair.

They can be hard to get on and I worry if I will be able to put them on in twenty years when my arthritis is worse (I'm hoping/optimistic we have even more and better treatments for arthritis). However, they aren't as hard as when I first started - it does take some learning as to the easiest way to put them on. The anklet version (only available in mild) is relatively easy to get on and can be covered up with socks. : )

I just thought I'd add a comment about cost for those following this thread - my mild compression socks are really relatively reasonably priced - $20.00/pair (approx.) - and in my case insurance covers much of the cost. So if cost is the issue, start with mild anklets. You should be able to get them from any medical supply store (with a prescription) as each time I go they often have to order it from somewhere else and I have to come back - so presumably they can be shipped to anywhere in the U.S.

I'm glad to hear docs in other parts of the country like compression hose for TTS. Around here that's not what I hear.

Re: Curious minds want to know - why

Ed Davis, DPM on 1/18/03 at 15:22 (105820)

Lara:
I appreciate your comments and wish we could get more patients to take your point of view on hose. Cosmesis is a big issue with many individuals and the importance tends to vary somewhat with geography.
As far as the issue of how docs view use of compression hose in TTS, I think that there is simply not that much information available on that subject. One must first have done enough research to realize that varicosities cause up to 25% of TTS -- then one can understand that hose can be effective in that type of case.
Ed

Re: Curious minds want to know - why

Sharon W on 1/15/03 at 13:39 (105525)

Lara,

I was told by my own podiatrist, and have seen comments by a couple of doctors on these foot boards, that compression hose will sometimes help with TTS if you have varicose veins in the tarsal tunnel area. From what I've read, varicose veins may be present in the tarsal tunnel in as many as 25-33% of TTS cases.

In my research, I have found very few references to compression hose as a treatment for TTS, and my guess is that the main reason more people are not helped by them is that most foot and ankle specialists are not prescribing them for this condition because they aren't considered one of the usual treatments.

Perhaps they SHOULD be, however. After all, there IS no one reliable treatment for TTS that helps EVERYONE, and doctors don't really seem to know what will or will not work for a given patient. Compression hose ARE expensive, but really no more so than a new pair of shoes, so if they stand ANY chance of making someone better -- what harm is there in giving them a try?

Sharon

Re: . Compression hose ARE expensive - sort of

Lara T on 1/15/03 at 14:04 (105526)

You're right, compression socks are expensive - as socks go ($20/pair for mild anklets, somewhat more for moderate, I believe the panty hose are close to $100.00). I try to not think of it as buying socks, but rather as paying for a treatment - a successful one at that (in which case they aren't much more than my co-pay and last for a couple of years). And like you said, then there's the cost of shoes that we all buy.

During my recent visit my podistrist also agreed with you that many cases of TTS for which no known cause can be ascertained are caused by varicose veins.

One of the doctors I visited for a second opinion (an orthopedist doing research in the area of TTS) was reported by a reliable source as doing something the equivalent of 'putting his nose in the air' for compression socks - something the podistrists might do, but not fine medicine that an orthopedist would be caught doing. This would fit with your explanation, but I don't understand it.

Re: Curious minds want to know - why

Marty on 1/15/03 at 15:08 (105531)

My vote is for #4. If I had a pair available to try I would but I can't wear normal socks at all as it is and my experience with just normal socks and the burning they cause me makes me not willing to spend the money on any kind of a sock. Bummer too it's cold here in Salt Lake City and they just might help. Never know.

Marty

Re: Curious minds want to know - why

Ed Davis, DPM on 1/15/03 at 18:05 (105540)

Sharon:
Custom compression hose are very expensive although it it worthwhile to try non-custom hose first if one has a fairly 'average' foot anf leg shape.
Ed

Re: Curious minds want to know - why

Sharon W on 1/15/03 at 18:38 (105551)

Dr. Ed,

I know; the ones I use cost about $80 each.

Do you think more people with TTS could benefit from compression hose if they were prescribed more often?

Sharon

Re: Curious minds want to know - why

Ed Davis, DPM on 1/15/03 at 18:46 (105553)

Lara:

Compression hose are liked by docs but often not by patients because....
they can be hard to get on, they are often hot in the summer, appearance is not pleasing...
Ed

Re: Curious minds want to know - why

Lara % on 1/15/03 at 19:31 (105555)

I have to admit that compression socks aren't the sexiest looking things I've ever seen (right up there with flannel nightgowns and curlers). But then neither is grimacing, being irritable, or being sedentary. I can't imagine not wearing compression socks cuz they look ugly (I believe you, I just find it stupid)- I'd rather be ugly and have a life than pretty sitting in a chair.

They can be hard to get on and I worry if I will be able to put them on in twenty years when my arthritis is worse (I'm hoping/optimistic we have even more and better treatments for arthritis). However, they aren't as hard as when I first started - it does take some learning as to the easiest way to put them on. The anklet version (only available in mild) is relatively easy to get on and can be covered up with socks. : )

I just thought I'd add a comment about cost for those following this thread - my mild compression socks are really relatively reasonably priced - $20.00/pair (approx.) - and in my case insurance covers much of the cost. So if cost is the issue, start with mild anklets. You should be able to get them from any medical supply store (with a prescription) as each time I go they often have to order it from somewhere else and I have to come back - so presumably they can be shipped to anywhere in the U.S.

I'm glad to hear docs in other parts of the country like compression hose for TTS. Around here that's not what I hear.

Re: Curious minds want to know - why

Ed Davis, DPM on 1/18/03 at 15:22 (105820)

Lara:
I appreciate your comments and wish we could get more patients to take your point of view on hose. Cosmesis is a big issue with many individuals and the importance tends to vary somewhat with geography.
As far as the issue of how docs view use of compression hose in TTS, I think that there is simply not that much information available on that subject. One must first have done enough research to realize that varicosities cause up to 25% of TTS -- then one can understand that hose can be effective in that type of case.
Ed