A Toledo Tale: The Story Behind Compression Stockings

Twentieth century inventor, Conrad Jobsts’ most important legacy is the development of the compression stocking. Great inventions are often discovered out of necessity, and compression socks are no exception. Jobst Vascular Institute at ProMedica Toledo Hospital tells us more about how Conrad Jobst initially found relief—in a swimming pool, of all places—leading to the design and implementation of today’s compression stockings.

How did Conrad Jobst begin to discover the concept of compression stockings?
Conrad Jobst suffered from chronic venous disease throughout his life, causing him to have swollen, painful legs and skin breakdown, which is also known as venous ulcers. Conrad was a tall, elegant gentleman and when he was in a swimming pool, the water pressure on his legs made him feel better. Since he was an astute engineer he concluded the pressure applied to his legs reduced his discomfort. He developed a mechanism to apply this same pressure outside of the pool. The result is known today as compression stockings.

How did he make this concept a reality?
Conrad collaborated with a physiologist, Dr. Otto Gauer, to ensure the physiologic principles were correct. They designed compression to be the greatest at the ankle with a gradual decrease in pressure up to the knee. The reason for this specific design is that when a person is standing, the highest venous pressure is at the ankle. Therefore, he wanted to properly counter the internal venous pressure with appropriate external pressure. This design has remained the principle for compression stockings since the time of Conrad.

How do compression stockings help patients?
Since the development of compression stockings it has been shown that patients with chronic venous disease who wear these garments have reduced swelling, reduced risk of skin breakdown (venous ulcers), and an improved healing when ulcers do exist.

Other patients who have lower extremity swelling who are not classified as having chronic venous disease can also benefit from elastic compression stockings. The stockings apple pressure to the outside of the legs and this prevents fluid accumulation in the tissues, thereby decreasing swelling.

People benefit the most from compression stockings when they put them on first thing in the morning, wear them throughout the day and take them off before going to bed. Studies show that compression stockings improve venous return of the lower extremity. As a result of that, many patients see improvements.

What conditions can compression stockings alleviate?
The conditions that the stockings are particularly helpful with are chronic venous disease, sedentary or inactive patients who spend the majority of time with their legs hanging down, patients with congestive heart feature sufferers which results in failure who have lower extremity swelling, and other medical conditions that result in swelling of the legs.

Individuals who are taking long, multi-hour flights, over five hours, where they are sitting still with very little movement can have an increased risk of blood clots and will experience swelling in their lower legs. Compression stockings will help reduce swelling and reduce the risk of blood clots in these individuals taking long flights.

Prior to Conrad Jobst’s invention, what was the alternative?
Conrad suffered with severe venous insufficiency and developed advanced ulceration of his legs. Some physicians recommended amputation since “there is little we can do.”  So before Conrad, there were no commonly available alternatives.  As mentioned earlier, Conrad Jobst recognized that he experienced great relief when in his swimming pool, and reasoned it was due to the external pressure of the water.  He thought that suitable external compression was an excellent argument in favor of combating the congestion in his legs. He reasoned that the essential characteristics of an effective stocking would be:

  1. Perfect fit.
  2. Made exactly for the leg involved.
  3. Provide elastic counter pressure, which cancelled the pressure produced by the diseased veins.
  4. Required a fabric with proper elastic properties
  5. Ultimately developed a pattern to properly construct the stocking.

What was Conrad Jobst’s reputation in the medical community?
His biomedical contributions were becoming recognized in the field of medicine, papers were appearing in medical journals, and compression treatment was gradually being accepted by the medical profession.  Unfortunately, Conrad Jobst died before the custom-made Jobst venous pressure gradient stocking gained general acceptance.  We are indebted to Caroline Jobst for carrying the work of Conrad forward. Caroline grew the Jobst company into one which was nationally and internationally recognized for its excellence in quality and service.

Learn more about Jobst Vascular Institute.