Why Wear Open Toe Compression Socks vs. Closed Toe?

Doctors often prescribe compression stockings or socks to treat medical conditions, including lymphedema, leg fatigue, peripheral edema, deep vein thrombosis (DVT), phlebitis, varicose veins, spider veins, venous ulcers, and other vascular concerns. 

Since fashionable compression socks are available online, you may be left wondering what factors you should consider before choosing your new compression socks. Are the socks you buy from a medical supplier similar to the ones you can purchase from fashion retailers? 

To answer that question, we'll look at some of the key elements of compression socks: style, size, strength, and material. The scientific literature should guide your decision-making, so we'll share the current research about what matters (and what doesn't) when it comes to selecting compression socks. 

Most importantly, we'll look at open toe compression stockings and explain how they’re different from closed toe compression stockings. 

Choosing a Sock Style

Compression socks and stockings come in a variety of styles. 

You may see the following options advertised:

The length of the sock does matter for its function, so it's best to stick to the length prescribed by your doctor. If you wear compression socks for athletic performance and recovery or to prevent vascular problems, we recommend opting for a knee-length style. This length gives you medical benefits while remaining easier to put on than thigh-high or full-length garments. 

Next, you'll want to decide between open- and closed-toe compression stockings. Footless compression sleeves do not offer the same ankle support as either closed- or open-toe options, so we do not recommend them. 

Both open- and closed-toe styles have benefits, so you'll have to consider your lifestyle and how you'll be wearing the socks or stockings as you make your decision. 

The benefits of closed-toe styles are:

  • Reduced risk of blisters.
  • Less chance of fabric bunching.
  • Reduced joint pain in the foot.
  • Less toe swelling.

On the other hand, toeless socks:

  • Can be worn with sandals and flip flops.
  • Allow for greater freedom of motion. 
  • Keep feet cool in warmer months.
  • Won't exacerbate bunions, ingrown nails, and hammertoes.

In the British Journal of Community Nursing, clinical nurse specialist Marie Todd weighs the options, writing, "Open-toe garments may be slightly easier to apply and can be, to some extent, cooler in the hot weather but are more likely to ride up the foot and cause toe swelling." She goes on to explain the benefits of full foot coverage, adding, "In the author’s experience, open-toe stockings can also exacerbate painful joints in the distal foot, for example, hallux valgus or inflammation at the fifth metatarsal base" (318).

Like traditional socks, closed-toe compression socks cover the entire arch of the foot, including the ball of your foot and the base of your toes. Compressing these areas helps to prevent injury to the plantar fascia and the arch of your foot. 

On the plus side, both open and closed-toe styles provide full heel coverage, ensuring that your ankle veins are supported. For the most part, both styles offer similar functional benefits to the ankles and lower legs. 

If you're likely to wear your compression garments with a closed toe shoe, closed-toe socks will probably offer you the most practical coverage. Additionally, if you know that you're prone to joint pain in the distal foot, closed-toe socks or stockings may be a better option for you. 

Choosing the Right Size

When you select a pair of socks or stockings, it's essential that you buy the correct size. In a review of the scientific literature, researchers Chung Sim Lim and Alun H. Davies stress that, "When used, graduated compression stockings need to be measured and fitted properly (E397)".  This typically involves two measurements: the pair of socks must fit your foot size and your calf circumference. 

Of course, the foot size measurement is extremely important for closed-toed socks and stockings. Whereas open toes may leave you with some room for error, socks with a toe cap must fit snugly without pinching the toes. With both styles, the heel cup of the sock should line up with your natural heel. 

For maximum comfort, it's important to pull the sock flat against your skin so that the tightest part of the sock fits the narrowest part of the ankle. To secure the perfect fit, Comrad offers socks that fit women's shoe sizes 4-10 and men's shoe sizes 4-15. 

The second measurement, calf width, should be taken with a measuring tape at the widest part of the calf muscles. 

By wearing the correct width, you ensure that the sock applies the intended compression strength. With the wrong calf size, you risk excessive tightness that cuts off the circulation to your lower legs and feet. At Comrad, we provide extra-wide options to accommodate calf sizes up to 20".

Choosing the Best Strength

When a doctor recommends compression socks, he or she will typically provide guidance on the appropriate strength. Compression is measured in millimeters of mercury (mmHg), and most medical compression garments display a pressure range on the label. 

That's because medical compression is usually delivered on a gradient, with more pressure at the ankle and less at the calf. The technical term for this gradient compression is graduated compression. 

For example, Comrad's best-selling Companions provide 15-25 mmHg of True Graduated Compression. This means that each sock exerts 25 mmHg near the ankle bone and 15 mmHg at the widest part of the calf. We label our socks based on precise measurements, and each individual sock is tested for accuracy using an industry-standard machine.

If your doctor has not recommended a particular compression level, you can choose the compression strength that's best for your needs. For help selecting the right strength, check out this article: "What Level of Compression Socks Do I Need?" In general, most over-the-counter compression socks provide 15-20 mmHg. Companions provide an additional 5 mmHg of compression at the ankle, which allows you to take advantage of extra medical benefits without sacrificing comfort.

Does Material Matter?

In a brand new pair of compression socks, the material does not impact the compression strength. After all, every sock or stocking that receives an mmHg label has been measured for compression accuracy. 

For that reason, you can choose a sock made of any kind of fabric—nylon, spandex, cotton, wool—and expect to receive the compression level described on the label. 

You may want to consider any skin sensitivities you have when you select the fabric for a new support garment. Todd points out, "Some patients may develop skin sensitivity and allergy to the fabric components of the garments..." But, ultimately, she concludes, "...There is currently no empirical evidence supporting the choice of hosiery..." (320). 

A 2013 study of sports compression garments confirms this assessment. Researchers underscored that fabric did not influence the functional compression: "There is no clear relationship between percentages of material composition with the pressure delivery generated" (Troynikov 162).

That said, all compression socks eventually lose elasticity over time. Anything you can do to reduce the number of times that you need to launder your socks should improve their lifespan. 

That's why we make Comrad socks with silver ions bonded to the thread. SmartSilver technology keeps your socks fresh and free from odor longer, increasing the number of wears you get between each wash. 

The Downside of an Open Toe Option

The only way to get the medical benefits from compression socks and stockings—which include reduced risk of deep vein blood clots and relief from achy legs—is to wear them regularly. And that's the problem with stockings made from beige compression hose material. Because they look bland, you might be less likely to wear them.

As it turns out, researchers Lim and Davies cite lack of patient compliance as one of the main challenges to effective compression therapy.  They note that, "...Changing the stocking material or lowering the degree of compression usually helps improve compliance" (E391). 

Since most open-toe styles are made from stocking material, they're less likely to come in bright colors and bold designs. Plus, if you want to wear an open-toe stocking with a regular shoe, you'll need to double up by wearing a second pair of socks. Both of these factors may make you less likely to reach for an open-toe stocking. 

When you select a sock, be sure to think about your style preference and your habits. Are you more likely to pair a stocking with flip flops or a sock with regular shoes? If you’re more interested in a classic sock-and-shoe combination, be sure to take a look at all the designs we offer. We're sure you’ll find a pair (or two) that will keep you reaching for your sock drawer in the morning. 

Sources:

Lim, Chung Sim and Alun H. Davies. “Graduated compression stockings.” CMAJ, Vol. 186, Iss. 10, pp. E391-E398, 2014, https://www.cmaj.ca/content/cmaj/186/10/E391.full.pdf.

Todd, Marie. "Compression hosiery choices for managing chronic oedema," British Journal of Community Nursing, Vol. 20, No. 7, pp. 318-320, 2015, https://www.researchgate.net/profile/Marie-Todd/publication/279727068_Compression_hosiery_choices_for_managing_chronic_oedema/links/570ba42e08aea660813b0ae2/Compression-hosiery-choices-for-managing-chronic-oedema.pdf. 

Troynikov, Olga, et al. “Influence of Material Properties and Garment Composition on Pressure Generated by Sport Compression Garments.” Procedia Engineering, vol. 60, 2013, pp. 157–162. ScienceDirect, https://www.sciencedirect.com/science/article/pii/S1877705813011053.