Heavy, swollen legs in the evening — a feeling that millions of people in Germany experience every day. According to the Bonn Vein Study conducted by the German Society of Phlebology, nearly one in four adults in Germany has true varicose veins, and only around ten percent of people aged 18 to 79 have completely unchanged leg veins. Venous disorders have therefore long since become a widespread disease — and one of the most effective and scientifically well-established conservative treatments has a simple yet compelling name: compression therapy.
This handbook explains in clear terms how the therapy works, who benefits from it, which materials are truly important — and why the padding underneath a compression bandage in particular can determine the success or failure of the treatment.
What is compression therapy — and how does it work?
Imagine the veins in the legs as a hose that has to pump water uphill. Healthy venous valves ensure that the blood does not flow backward. In varicose veins — medically known as varices — these valves are weakened or damaged. Blood pools, pressure in the venous system rises, and fluid leaks into the tissue: edema, heaviness, pain, and, in the worst case, chronic wounds develop.
Compression therapy starts precisely here: Targeted external pressure applied to the leg reduces the diameter of the superficial veins, accelerates venous return, and normalizes tissue pressure. It is therefore not merely a symptomatic treatment in the strictest sense — but rather a method that directly intervenes in the pathophysiological mechanisms of venous disease and slows or halts its progression.
The principle of the muscle pump
Movement is crucial to the success of the treatment. Blood returning to the heart is supported by the so-called "muscle pump," which becomes active when the calf muscles contract and relax. Walking, climbing stairs, or doing simple foot exercises while seated activates this pumping mechanism — the compression bandage or stocking reinforces this effect and keeps the veins compressed. That is precisely why wearing compression while moving produces significantly better results than wearing the same stocking while watching television in an armchair.
What compression therapy does in the body
Properly administered compression therapy increases venous blood return, reduces volume overload in the venous system, decreases edema, and relieves pain. It also improves microcirculation in the skin — which is especially important for patients with chronic venous wounds, skin changes, or lipodermatosclerosis. In short: The leg swelling goes down, the feeling of heaviness subsides — and the skin receives better blood flow again.
Who needs compression therapy? - Indications at a glance
Compression therapy is not a niche product for special cases. According to the S2k guideline of the German Society of Phlebology, all patients with venous symptoms should receive compression therapy to relieve their symptoms . This applies to a wide range of conditions and situations - from harmless travel-related swelling to severe chronic venous insufficiency. The following overview shows the most important fields of application and provides guidance on cases in which medical evaluation is particularly urgent.
Varicose veins (varices) and chronic venous insufficiency (CVI)
The classic field of application. In cases of pronounced varicose veins and progressive venous insufficiency, compression therapy is the fundamental treatment - often lifelong. The aim of the therapy is to slow the progression of the disease and significantly reduce the risk of dangerous complications such as a venous ulcer - the so-called "open leg." In Germany alone, more than 200,000 people suffer from an active leg ulcer, and in 80 percent of cases it has a venous cause. When started early, compression therapy can prevent the condition from reaching this stage at all.
Edema and lymphedema
Fluid retention in the legs - whether caused by venous insufficiency, heart disease, or lymphatic vessel disorders - responds extremely well to compression bandages. During the so-called decongestion phase, bandages with high application pressure are used to actively reduce the edema. For lymphedema, compression is typically combined with manual lymphatic drainage - this combination is known as Complex Decongestive Therapy (CDT) and is considered the international gold standard in lymphedema treatment.
After vein surgery and sclerotherapy
Anyone who has varicose veins operated on or treated with sclerotherapy must consistently wear compression garments afterward. Compression reduces swelling and bruising and demonstrably improves the surgical outcome. Depending on the procedure and the individual situation, specialists recommend wearing the compression stocking or bandage for several weeks after the procedure - initially around the clock, and later only during the day.
Thrombosis prevention
On long-haul flights, after surgery, or during prolonged bed rest, Class I compression stockings are part of standard prophylaxis against deep vein thrombosis (DVT). They keep blood flowing and prevent dangerous clots. Wearing a compression stocking on long-haul flights lasting four hours or more is now considered an evidence-based recommendation and is expressly endorsed by the German Society of Phlebology.
When Is Compression NOT Permitted - Contraindications
As effective as the therapy is, it is not suitable for everyone. According to the AWMF guideline, the following conditions are considered contraindications in which compression must not be used without medical evaluation:
- Advanced peripheral arterial occlusive disease (PAOD) - with an ankle-brachial index (ABI) below 0.5, ankle artery pressure below 60 mmHg, or toe pressure below 30 mmHg
- Decompensated heart failure (NYHA stages III and IV)
- Pronounced weeping dermatoses or known intolerances to compression materials
- Severe sensory disturbances in the limb, such as those associated with advanced diabetes mellitus
Important: Always consult your doctor before starting compression therapy, especially if you have heart disease, diabetes, or circulatory disorders.
Compression classes: Which level is right?
Not all compression is the same - and this is one of the most common misconceptions among patients encountering the subject for the first time. Medical compression stockings and bandages are divided into four classes, with pressure strength measured in millimeters of mercury (mmHg) - the same unit used to measure blood pressure. The higher the class, the stronger the therapeutic pressure and the more specific the medical indication.
Important for understanding: For medical compression stockings, the pressure values of Classes I to IV refer to the resting pressure in the ankle area - measured in millimeters of mercury (mmHg) while lying down. Phlebological compression bandages with short-stretch bandages use different parameters: a distinction is made between resting pressure (low) and working pressure (high during muscle contraction), which significantly enhances the therapeutic effect of the muscle pump. The class information below is based on the RAL-GZ 387 standard for medical compression stockings, the binding quality standard in Germany.
Class I, with an applied pressure of 18 to 21 mmHg, is the lightest level and is suitable for people with tired, heavy legs, mild swelling from prolonged sitting or standing, travelers on long-haul flights, and the prevention of varicose veins during pregnancy. It is available without a prescription and is well suited for self-care in everyday life.
Class II, with 23 to 32 mmHg, is by far the most frequently prescribed compression class in Germany. It covers the broad range of clinically relevant venous disorders: pronounced varicose veins, edema, wearing them after vein surgery or after healed phlebitis. Those who receive a compression stocking by prescription will usually get exactly this strength.
Class III, with 34 to 46 mmHg, is used for severe venous disorders, after deep vein thrombosis in the leg, and in pronounced chronic venous insufficiency (CVI). Applying it often requires assistance from nursing staff or special donning aids, as the stocking provides considerable resistance.
Class IV, with a pressure of 49 mmHg or more, is reserved exclusively for pronounced lymphedema, lipolymphedema, and severe tissue hardening. This class is used exclusively with a specialist prescription and usually after custom fitting - ready-made products are the exception here.
The treating physician always decides which class is right for you based on an examination. Compression stockings in classes II to IV are available only by prescription and are reimbursed by statutory health insurance when there is an appropriate diagnosis. You can find the complete bandaging materials and accessories in the Medicalcorner 24 range - with all standard sizes for upper- and lower-leg treatment.
How to apply a compression bandage correctly: Step-by-step instructions
A phlebological compression bandage (PCB) is not simply a tightly wrapped bandage. Applying it correctly is a learnable technique that must be carried out precisely and systematically - and that is performed incorrectly surprisingly often in practice. Studies show that even experienced nursing staff regularly make mistakes when applying bandages, significantly reducing the therapeutic benefit. A bandage applied incorrectly may not only lose its effectiveness, but can also actively cause harm through uncontrolled pressure in the wrong places: pressure points, skin lesions, and even a paradoxical deterioration of venous return are documented consequences of incorrect technique. This makes it all the more important to understand the process step by step - whether you are a patient, relative, or healthcare professional.
What you need to prepare - the basic materials
For a proper compression bandage on the lower leg, you need the following materials in the correct order:
- Tubular bandage — direct skin protection, applied as the first layer
- Padding bandage / underpadding — protects against pressure points and evens out irregularities
- Short-stretch bandage — the actual compression bandage, generates the therapeutic pressure
- Fixation material — adhesive strips or cohesive bandage for securing
The quality of each individual material affects the overall result. Anyone who economizes on the padding bandage or chooses the wrong material is not only putting the patient's skin at risk — they are undermining the entire therapy. More on this in the next section.
Step 1 — Skin inspection and positioning
Before you begin: Carefully check the condition of the skin. Redness, open areas, blisters, or pronounced swelling must be documented and medically assessed. Dry, flaky, or cracked skin should be treated with a replenishing cream before applying the bandage — but sparingly, as greasy skin can cause the bandage to slip. Elevate the leg briefly before applying the bandage so that the edema can settle and the bandage is in place under optimal conditions from the outset. The foot is held at a 90-degree angle throughout the entire application — this prevents the finished bandage from causing an equinus deformity.
Step 2 — Applying the tubular bandage
The tubular bandage forms the first protective layer directly on the skin. It prevents the padding and bandage from rubbing directly against the epidermis, protects against skin irritation caused by the bandage material, and makes removing the bandage later considerably easier — especially in elderly patients with sensitive or fragile skin. It is applied from the foot to at least two finger widths below the kneecap, without wrinkles and without tension.
Step 3 — Underpadding: the often-underestimated key step
This step is more medically crucial than many people realize — and will be discussed in detail in the following section. A bandage made of foam or padding wool is unrolled over the tubular bandage along the leg. Such a padding bandage protects the skin of the leg from constriction marks, pressure damage, and allergic reactions to the bandage material. Particularly vulnerable areas — ankles, shinbone, bony prominences — are additionally padded with a little more material.
The underpadding begins on the inner top of the foot, including the metatarsophalangeal joint. Each turn of the bandage overlaps by one third to one half and is wrapped in circular turns without tension up to two finger widths below the popliteal fossa. No pulling, no tension — the padding bandage should lie softly against the skin, not compress it.
Step 4 — Applying a compression bandage using the Pütter technique
The Pütter technique is the most widely used application method for phlebological compression bandages and is considered the reference standard in German phlebology. The first short-stretch bandage is wrapped upward from the base of the toes to just below the knee. The second bandage is started at the ankle and applied in the opposite direction — from top to bottom — over the first bandage. This opposing wrapping process creates a double layer of material with an even, stable pressure gradient over the entire lower leg and prevents localized undercompression or overcompression.
Here is how to do it step by step:
- Begin below the metatarsophalangeal joint of the big toe with two circular securing turns
- Guiding the bandage over the instep, Achilles tendon, lateral malleolus, and heel
- The heel is fully enclosed to ensure even compression — an open or only partially covered heel often leads to localized edema and pressure damage
- Wrap in spiral turns with approximately 50 percent overlap to just below the kneecap
- The second bandage is wrapped in the opposite direction to the first and closes any gaps
A correctly applied bandage fits firmly, but never constrictingly. It should not cause constrictions, white or bluish skin discoloration, or numbness. The rule of thumb: Two fingers should still fit under the bandage — but only with noticeable resistance.
An additional practical test: Have the patient walk a few steps after application. The toes should remain pink and warm even after brief weight-bearing. If they turn bluish or become cold, the bandage is too tight and must be loosened immediately.
Step 5 — Checking and documentation
After application, check systematically: toe color (pink, not whitish or blue), toe temperature (warm), sensation (no numbness or tingling), and mobility (the foot can be flexed and extended without pain). In a professional care setting, document these findings — time, person applying the bandage, materials, and patient response. If the patient experiences symptoms such as tingling, numbness, increasing pain, or visible skin discoloration within the first hour after the bandage is applied, the bandage must be loosened immediately or removed completely, and the doctor must be informed. Safety always takes priority over adherence to the treatment plan here.
Why underpadding is so important for a compression bandage
When people first explore the subject of compression bandaging, they usually think of the compression bandage itself - the pressure, the technique, and the direction of wrapping. The underpadding is often regarded as a mere formality, an optional addition for particularly sensitive patients. This misconception is widespread - and medically dangerous. The padding bandage is not a comfort extra but a functional component of the composite system, without which compression therapy cannot achieve its full effect - and may even cause harm in the worst case.
What happens when padding is omitted?
The answer is provided by a controlled clinical observational study: In bandages without padding, 82% of cases showed a pressure drop of more than 9 mmHg after just one hour. At the same time, constriction marks (100%), severe redness (77%), and pressure points (42.6%) developed. The result is medically paradoxical: Without padding, the bandage intended to heal causes harm itself - while simultaneously losing its therapeutic pressure. Two negative effects at once, both of which can be avoided through a simple measure.
What padding materials specifically do
Padding bandages serve several functions simultaneously in compression bandaging. They protect the skin from constriction marks and pressure points, compensate for bony prominences and anatomical irregularities, and ensure that the pressure of the compression bandage is distributed more evenly across the entire surface of the leg. The latter is particularly important because, when wrapped, a short-stretch bandage naturally exerts more pressure at convex areas than at concave ones - the padding bandage compensates for this physical unevenness and makes the bandage therapeutically precise in the first place. In addition, padding materials significantly improve patient adherence: A well-padded bandage is more comfortable, causes less discomfort - and is therefore worn more consistently.
Synthetic vs. natural cotton - which is better?
Both materials have their merits, and the choice depends on the individual application context. Natural cotton padding bandages can be shaped well to fit the contours of the body and are generally well tolerated biologically - however, they absorb moisture, which increases the risk of skin maceration and fungal infections when worn for longer periods. Synthetic padding bandages made of viscose or polyester fibers, on the other hand, absorb significantly less moisture, dry faster, and considerably reduce the potential for maceration. For most patients in outpatient and home care settings, the synthetic option is therefore the more practical and hygienic choice - it is also generally latex-free and well suited to sensitive skin.
What should you look for when buying a padding bandage?
When looking for padding material for compression bandages, pay attention to the following properties:
- Width suited to the application area - 6 cm for the ankle and foot area, 8-10 cm for the lower leg, 12-15 cm for the thigh
- Latex-free - important for allergy sufferers and patients with sensitive skin
- Synthetic material - does not absorb moisture, reducing the risk of maceration
- Sufficient length - at least 3 m per roll for complete lower-leg treatment
- Value pack - regular changes require an adequate supply
The synthetic wadding padding bandage from Medicalcorner 24 is available in various widths and as a practical 5-roll value pack - ideal for home care as well as care facilities with regular material requirements.
The three phases of compression therapy
Compression therapy is not a one-time intervention or a product that you buy once and then consider the matter settled. It is a structured, phase-based treatment process that can extend over weeks, months, or years, depending on the stage of the disease, the individual response, and the therapeutic goal. Understanding these three phases is essential - because each phase involves different materials, different intensities, and different priorities. Knowing the phases enables you to communicate actively with your treatment team and manage your own therapy more effectively.
Phase 1: Decongestion phase - active edema reduction
During the decongestion phase, the aim is to actively mobilize accumulated fluid from the tissue. Phlebological compression bandages with short-stretch bandages are used here - applied fresh every day or changed as needed, because the leg changes daily: the edema decreases, the leg contour changes, and a bandage that fit perfectly yesterday may already be too loose today to have a therapeutic effect. During this phase, the use of padding material is particularly important, as the intensive pressure on still-swollen tissue places especially high demands on skin protection. At the same time, manual lymphatic drainage by qualified professionals is recommended where available to provide additional support for lymphatic fluid drainage.
Phase 2: Maintenance phase - stabilizing the result
As soon as the leg has been decongested and reached a stable shape, patients generally switch to medical compression stockings. These are designed for long-term use, are more comfortable to put on, and allow patients to lead a largely normal everyday life without daily bandaging by healthcare professionals. The stocking is put on in the morning before getting out of bed - because the leg is least swollen when lying down, allowing the stocking to fit optimally from the outset. For most products, the replacement interval is three to six months, depending on material quality and frequency of wear.
Phase 3: Prevention and long-term care
The third phase is the longest - and for many patients the most important. Consistently wearing compression stockings or regularly applying compression bandages has been shown to reduce the risk of the condition recurring, prevent new thromboses, and keep the legs free of symptoms over the long term. During this phase, the patient's personal responsibility is crucial: Those who consistently continue the therapy, even when their legs seem free of symptoms, protect themselves from relapses. Many people who have struggled with venous disorders for years report after several months of consistent compression therapy that they would no longer want to be without it - because the difference in everyday life is simply too noticeable.
Everyday life with compression therapy: Practical tips for home
Therapy is one thing - everyday life is another. Even the best medical care can only achieve its full effect when it is consistently integrated into the daily routine. The following tips help maintain compression treatment over the long term - not as a tiresome obligation, but as an effective routine that noticeably restores quality of life.
Exercise is therapy - not an add-on
The combination of compression therapy and regular exercise is significantly more effective than either measure alone. Simple exercises such as flexing and extending the feet while seated, deliberately taking the stairs instead of the elevator, or going for regular walks activate the calf muscle pump and significantly enhance the therapeutic effect of compression. Even with predominantly sedentary activities, short activation exercises can be incorporated every 30 to 45 minutes - two minutes of ankle circles or standing on tiptoe are enough to get the muscle pump going. Those who wear compression and move at the same time are actively treating their condition. Those who only wear it and sit still are treating it passively - with a correspondingly weaker result.
Do not forget skin care
The skin beneath a compression bandage or stocking often suffers: Mechanical stress, restricted ventilation, and the daily process of putting it on and taking it off make it drier, flaky, and more prone to cracks and micro-injuries. In the evening after removing it, the skin should therefore be thoroughly cleansed and moisturized with a lipid-replenishing cream, preferably containing urea - urea binds moisture in the tissue and is particularly recommended by dermatologists for leg care in patients with venous disorders. In the morning before applying it, the cream should have been fully absorbed, as a greasy surface can cause the bandage to slip and impair its hold.
Elevating your legs - simple and effective
When lying down - while reading, watching television, or at night - it is advisable to keep your legs slightly elevated on a firm pillow. A height difference of just 15 to 20 centimeters is enough to noticeably improve venous return and reduce nighttime swelling. Those who consistently elevate their legs start the day with less edema in the morning - which in turn helps make the compression stocking easier to put on and ensures a better fit from the outset.
When should you see a doctor immediately?
Some symptoms require immediate medical attention and must not be waited out:
- Sudden severe swelling of one leg, especially in connection with calf pain (possible deep vein thrombosis)
- Redness, warmth, and pain along a vein (vein inflammation / thrombophlebitis)
- Open, oozing, or enlarging wounds on the lower leg
- Numbness, tingling, paleness, or bluish discoloration beneath an applied bandage
Conclusion: Compression therapy - effective, evidence-based, and often underestimated
Compression therapy is one of the most effective and, at the same time, most underestimated treatment methods in modern medicine. It is not a makeshift measure, a temporary solution, or an aid for people who “have no other choice” - it is evidence-based first-line therapy for millions of people affected in Germany, recommended by the leading medical societies and supported by decades of clinical research.
What this handbook has shown: The therapy only works really well when all the components are right. The correct diagnosis and compression class provide the foundation. The correct application technique - whether a Pütter bandage or a compression stocking - determines the pressure that is actually applied. And the underpadding, which is surprisingly often neglected in clinical practice, not only protects the skin but also makes the entire bandage therapeutically more precise and better tolerated in the long term.
Consistency is particularly important. Compression therapy is not a measure for bad days - it works through continuous use. Anyone who only puts on the stockings occasionally, becomes careless when changing the bandage, or leaves out the padding because “this time it has to be quick” undermines the entire treatment success. At the same time, the therapy is remarkably practical for everyday life once you understand how it works and which steps need to be performed correctly.
The second crucial factor is medical supervision. Venous disorders are progressive conditions - they change over time, and the treatment must evolve accordingly. Regular check-ups, adjustments to the compression class and material, and the early detection of complications are not bureaucratic obligations, but active protection against deterioration that often develops unnoticed over the course of months.
Use the insights from this guide as a basis for an informed conversation with your treatment team. Those who understand what lies behind the therapy wear the stocking more consistently, apply the bandage more carefully - and benefit noticeably more in the long term.
Frequently Asked Questions About Compression Therapy (FAQ)
How long do I need to wear a compression bandage?
The duration of wear depends directly on the underlying condition and the current treatment phase - there is no universal answer that applies to all patients. During the decongestion phase, when active edema is being reduced, the compression bandage is generally reapplied daily. Depending on the initial findings, this phase lasts anywhere from several days to several weeks. Once the leg has reached a stable shape, most patients move to the maintenance phase with compression stockings, which are put on in the morning and taken off in the evening. For chronic venous conditions such as CVI or after deep vein thrombosis, wearing compression garments is often a permanent measure - sometimes lifelong. Your doctor will determine the exact duration of wear and changing interval on an individual basis. Always follow the instructions on the product label and consult a doctor if needed.How often does the padding bandage need to be changed when using a compression bandage?
A padding bandage is a single-use material - it must be replaced every time the dressing is changed. During the active decongestion phase, when the bandage is changed daily or every two days, this results in a correspondingly high demand for material. This makes medical sense: A padding bandage that has already been worn has lost its structure, absorbs moisture, and can no longer ensure even padding. For hygienic and therapeutic reasons, it should never be reused. Patients undergoing long-term therapy or care facilities with regular demand are therefore advised to buy multipacks - this not only saves costs but also ensures continuous care without supply gaps.Can I apply the compression bandage myself?
Basically, yes - but with one important qualification: Proper application of a phlebological compression bandage requires careful instruction from qualified medical or nursing staff, followed by regular practice. The technique can be learned, but it is not trivial - the pressure, degree of overlap, and wrapping direction must be correct for the bandage to work without causing harm. Many outpatient nursing services in Germany offer relevant training for patients and relatives, often as part of home health care. Anyone who is uncertain or has physical limitations - such as restricted hand mobility or vision problems - should have the bandage applied by a professional instead. Compression stockings are generally much easier to manage for self-care at home and are the more practical long-term solution for many patients.What is the difference between a padding bandage and a compression bandage?
This question comes up frequently - and confusing the two materials is one of the most common mistakes in self-care. A padding bandage is a soft, non-elastic padding material with no compressive effect whatsoever. Its purpose is purely protective and cushioning: it cushions bony prominences, prevents pressure points, and ensures even pressure distribution from the compression bandage applied afterward. The compression bandage - usually a short-stretch bandage - is the material that generates the actual therapeutic pressure. The two materials are inseparably linked and fulfill completely different functions: padding first, then compression - in that order, without exception.Where can I buy padding bandages and dressing supplies online in Germany?
Medical dressing materials such as padding bandages, short-stretch bandages, tubular bandages, and fixation materials are available in Germany from pharmacies, medical supply stores, and increasingly from specialized online retailers. Buying online offers clear advantages: no trip into town, direct price comparisons, a larger selection, and convenient home delivery - especially practical for patients with limited mobility. At Medicalcorner 24, you will find a large selection of padding bandages in various widths, compression bandages, tubular bandages, and other dressing materials - with fast delivery to Germany, Austria, and Switzerland.What width do I need for the padding bandage on the lower leg?
The correct width of the padding bandage depends on the area to be treated. For the ankle and foot area, where more precise and tighter wrapping is required, narrower 6 cm bandages are suitable. For standard treatment of the lower leg, widths of 8 to 10 cm are optimal - they cover enough area with each wrap and are easy to handle. For treating the thigh, wider 12 to 15 cm bandages are recommended to efficiently cover the larger circumference. Some patients combine two different widths in one dressing - a narrower one for the foot and ankle and a wider one for the lower leg - to achieve an optimal fit to the anatomy.Does health insurance cover the cost of dressing materials?
In Germany, compression bandages and the associated dressing materials are reimbursable under certain conditions. Medical compression stockings and phlebological compression bandages may be covered by statutory health insurance with an appropriate doctor's prescription. Compression therapy is a billable medical service, and the required materials - including short-stretch bandages and padding bandages - are explicitly considered dressing materials and can therefore generally be prescribed at the expense of statutory health insurance funds. As a patient, you only pay the legally regulated co-payment of 10 percent, up to a maximum of 10 euros per medical aid. For home self-care and regular repurchase of consumables - for example, when the need exceeds the prescribed quantity - convenient online purchasing without a prescription and without waiting is worthwhile.
Please follow the information on the product label and consult a doctor if necessary.
