By Dr. Daniel Shafran, MD, FRCPC · Updated October 2026
Swollen ankles by supper time, legs that feel heavy and achy, brownish staining around the shins — I see these every week, often in patients who've been told it's "just getting older." Many have venous insufficiency, and many have never been offered the simplest, best-studied treatment. Here's how common it is, what to look for, and how compression helps.
How common is it?
Very. In the Edinburgh Vein Study, about a third of adults had varicose veins.2 In the Bonn Vein Study, which examined more than 3,000 randomly selected adults, most had at least some visible vein changes — and about 1 in 6 had the more advanced stages, with swelling, skin changes or an ulcer.1 It becomes more common with every decade of age.
What's happening in your veins
Your leg veins carry blood uphill, back to the heart. Two things make that possible: your calf muscles squeeze the veins every time you walk, and one-way valves inside the veins stop blood from sliding back down.
When those valves are stretched or damaged — from age, genetics, pregnancy, a past blood clot or years on your feet — blood leaks backward and pools in the lower leg. Pressure in the veins stays high, fluid seeps into the tissues, and over time the skin is damaged.3,4
Common signs and symptoms
Venous insufficiency usually creeps up over years. These are the signs I look for, roughly from earliest to most advanced:
Legs that feel wrong
- Heavy, tired or aching legs
- Ankle swelling by the end of the day
- Itching, cramps or restless legs at night
- Spider veins around the ankles
Changes you can see
- Bulging, twisted varicose veins
- Swelling that doesn't fully settle overnight
- Brown or rust-coloured staining around the shins
- Dry, red, itchy skin — venous eczema
Skin under strain
- Hard, tight skin above the ankle
- Pale, scar-like patches
- An open sore, usually near the inner ankle — a venous leg ulcer, which needs wound care
The tell-tale pattern: symptoms build through the day, especially after standing, and ease when you put your feet up.
You're more likely to develop it if you have:
Why it matters: leg ulcers
Venous leg ulcers are the most serious result of venous insufficiency. They're slow to heal, painful and often come back — in the ESCHAR trial in the BMJ, more than half of people treated with compression alone had an ulcer return within four years.6 Open ulcers are treated in our wound care clinic with compression wraps. Once an ulcer heals, compression stockings are the main way to keep it from coming back.
How compression stockings work
Medical compression stockings are graduated: tightest at the ankle and gradually looser up the leg. That pressure gradient does three things:
Compression levels
Compression is measured in millimetres of mercury (mmHg) at the ankle. Higher isn't always better — the right level depends on your legs, your skin and your circulation.
Tired, achy legs and mild swelling. Long flights, long days on your feet, pregnancy.
The most common medical level. Varicose veins, daily swelling and early venous insufficiency.
More advanced disease. Skin changes, venous eczema and preventing a healed ulcer from coming back.
Do they work?
- They keep ulcers from coming back. A Cochrane review found compression cuts the risk of a healed venous ulcer returning by about half compared with no compression.5
- They ease everyday symptoms. Compression reduces swelling, heaviness and aching, and helps protect skin that's already damaged.3,4
- The best pair is the one you wear. Many people stop wearing their stockings. A comfortable, well-fitted pair you'll put on every day beats a stronger pair left in the drawer.5
If you've had a venous ulcer, ask your doctor whether a vein assessment is right for you. In the ESCHAR and EVRA trials, treating the faulty vein lowered recurrence and helped ulcers heal faster.6,7
Getting fitted at our clinic
Our certified foot care nurses do medical pedicures — and they also measure and fit compression stockings, so most patients are fitted during a foot care visit. No referral is needed.
We carry two of the most trusted names in medical compression:
We fit knee-high stockings, and your nurse will help you find a pair that's comfortable enough to wear every day. More about our compression fittings →
AADL coverage
We're an Alberta Aids to Daily Living (AADL) vendor
If you qualify, AADL pays most of the cost of your compression stockings.
- Your share is capped at $500 per person or family per year across all AADL benefits.8
- Low-income Albertans and people on income assistance pay nothing.8
- Coverage is usually for people with skin changes from venous insufficiency — brown staining, venous eczema, hardened skin, pale scar-like patches — or a healed venous ulcer.
Who shouldn't wear compression stockings?
Compression isn't safe for everyone. It can harm a leg with poor arterial blood flow, so your circulation should be checked before you're fitted. Talk to your doctor first if you have:
- Peripheral artery disease, or weak or absent pulses in your feet
- Severe heart failure
- Severe neuropathy (numbness) or very fragile skin
- An active skin infection
Tips for wearing them
- Put them on first thing in the morning, before swelling builds, and take them off at bedtime.
- Get measured — size is based on your ankle and calf, not your shoe size.
- Use a donning aid or rubber gloves if they're hard to pull on.
- Replace them every 3 to 6 months, as they lose their stretch.
- Keep moving — walking works your calf pump, and raising your legs helps too.
When to get help right away
- Sudden swelling, pain or redness in one leg can be a blood clot (DVT). Go to urgent care or the emergency department.
- An open sore on your leg or foot needs wound care before stockings. Ulcers are treated with compression wraps as part of wound care, which requires a referral from your doctor or nurse practitioner.
- Spreading redness, warmth or fever may mean infection. See a doctor promptly.
The bottom line
Venous insufficiency is common and tends to get worse without treatment. Well-fitted compression stockings ease swelling and aching, protect your skin, and lower the chance of a leg ulcer coming back — and AADL may cover most of the cost.
Have your Alberta Health card ready — or call (780) 409-5673 to book.
Common questions
What is venous insufficiency?
It's when the one-way valves in your leg veins stop closing properly, so blood pools in the lower legs. It causes swelling, aching, skin changes and sometimes leg ulcers.
How common is venous insufficiency?
Very common. About a third of adults have varicose veins, and about 1 in 6 has swelling, skin changes or an ulcer from venous insufficiency. It becomes more common with age.
Do compression stockings actually work?
Yes. They reduce swelling and aching, and a Cochrane review found they cut the risk of a healed venous ulcer coming back by about half compared with no compression.
Will AADL cover my compression stockings?
If you qualify, Alberta Aids to Daily Living covers 75% of the cost, and your share is capped at $500 a year. Low-income Albertans pay nothing. Coverage is usually for people with skin changes from venous insufficiency or a healed venous ulcer. Our nurses can check at your fitting.
Which brands do you carry?
We carry Sigvaris and Jobst knee-high stockings, from mild to firm compression, in a range of colours and materials.
Do I need a referral for a compression fitting?
No. You can book a fitting online — have your Alberta Health card ready — or call (780) 409-5673. Many patients are fitted during their medical pedicure.
References
- Rabe E, Pannier-Fischer F, Bromen K, et al. Bonner Venenstudie der Deutschen Gesellschaft für Phlebologie (Bonn Vein Study). Phlebologie. 2003;32:1–14.
- Evans CJ, Fowkes FGR, Ruckley CV, Lee AJ. Prevalence of varicose veins and chronic venous insufficiency in men and women in the general population: Edinburgh Vein Study. Journal of Epidemiology and Community Health. 1999;53:149–153.
- Eberhardt RT, Raffetto JD. Chronic venous insufficiency. Circulation. 2014;130:333–346.
- Bergan JJ, Schmid-Schönbein GW, Coleridge Smith PD, et al. Chronic venous disease. New England Journal of Medicine. 2006;355:488–498.
- Nelson EA, Bell-Syer SEM. Compression for preventing recurrence of venous ulcers. Cochrane Database of Systematic Reviews. 2014;(9):CD002303.
- Gohel MS, Barwell JR, Taylor M, et al. Long term results of compression therapy alone versus compression plus surgery in chronic venous ulceration (ESCHAR): randomised controlled trial. BMJ. 2007;335:83.
- Gohel MS, Heatley F, Liu X, et al. A randomized trial of early endovenous ablation in venous ulceration. New England Journal of Medicine. 2018;378:2105–2114.
- Government of Alberta. Alberta Aids to Daily Living: what is covered. alberta.ca/aadl-benefits-covered.