Medicine For People!

March 2018: Calf Sleeves

airline passengers
By Austrian Airlines (, CC BY-SA 2.0

Calf Sleeves

  • A Supposedly Fun Thing They'll Never Do Again
  • Gravity and the Legs
  • The Lymphatic System
  • Solutions
  • Not Just for Athletes
  • Additional Note

A Supposedly Fun Thing They'll Never Do Again

The Smiths were excited to be able to fly directly from Seatac to Hong Kong. After a hectic day finishing up their packing and go-away tasks, they hopped on Delta flight 39 about 1:15 in the afternoon bright-eyed and bushy-tailed. Flying into the setting sun, the golden afternoon stretched on and on. They began to wiggle in their seats. They were scheduled to fly into the retreating sunset (which lasted a long time) and land in Hong Kong later that evening about 6:30 pm.

Due to the magic of the International Date Line, the calendar would jump forward to the next day of the week. As they twisted in their seats, still hours before landing, they understood something about that Date Line. It was an artificial line on a great big Earth, and their Airbus 330 took a long 14 hours to get over and past it.

As they fidgeted in their 18-inch-wide seats, they wondered how they could have failed to imagine how this would feel. They had to remain in and try to sleep in those seats from a Seattle lunch-time until 3 am the next morning, the time on their Seattle watches when they landed in Hong Kong. They recalled stories of people developing blood clots in their legs during similar long flights, so they rubbed their aching legs and kept wiggling.

Somehow the flight ended, and like released prisoners they staggered off the airplane.

Gravity and the Legs

Neither age nor a sedentary life are kind to our legs. Either one alone can cause fluid to collect leading to swelling and varicose veins.

It's easy enough for us to pump blood from our heart down to our feet. Gravity does the work. Getting it to come back up is the problem. The long veins in our legs have one-way valves which, especially when we are young, effectively help keep the blood moving up. The movement of the muscles and fibrous tissue in our legs acts as a kind of pump to keep the blood moving and not put too much back pressure on the lightly built venous valves.

The Lymphatic System

The other fluid system in our legs is the lymphatic system.

The arteries carry the blood down into the legs, splitting into smaller arteries and eventually arterioles which feed millions of tiny capillaries. These lightly built microscopic tubes have the thinnest of walls in order to allow oxygen, carbon dioxide, nutrients and waste products to be exchanged between the tissues and the bloodstream. Blood cells must squeeze through these capillaries along with the fluid portion of the blood. Some of that fluid squeezes through these walls into the tissues and becomes lymph.

This lymph enters lymphatic channels (even more diaphanous than capillaries) which coalesce to carry it back up the legs to the groin, or along the arms to the armpit, or from the head down into the neck. Just below the neck these lymphatic channels join and empty into the great veins heading for the heart. Along the way these lymph channels pass through lymph nodes which sample the passing lymph to monitor for bacteria, viruses, fungi and other bad actors. When a lymph node detects an invader, it grows more immune tissue and we can usually feel the swollen node.

Lymphatic System

Youth is like a new car; everything works. Give time a few decades to work her magic, however, make us a little more sedentary, and that lymph can collect in the legs. If you see an indentation from the elastic in your socks at the end of the day, that's because your system is not moving the lymph up the legs fast enough.

When we have increased venous pressure in our legs, our capillary pressure is elevated and we produce even more lymph. Guess how that plays out!


Check with your doctor to see if this leg swelling heralds problems with the heart, liver, kidneys, or something else. Sometimes we are happy to find another cause, and sometimes we aren't.

In the usual case however, the culprit is time and reduced activity.

You can try pressure stockings. You need them tight enough to push the fluid up and yet loose enough to get them on without an Olympian effort. They cost more than you might imagine, and they need to be replaced when the elastic weakens.

While some people require such stockings that go up to the waist, most people find the below knee version adequate.

A newer option, called "calf sleeves", comes to us from the athletic world.

Calf Sleeves

Image used by permission Bevisible Sports

These were developed to alleviate shin splints and cramps in runners and bicyclists. Some people claim they help speed recovery from the fatigue of exercise.

My major experience with these has been for leg edema. It turns out that the foot portion of a support stocking can be dispensed with for many individuals. The sleeves do not need washing as often, are less expensive, and are easier to get on and off. Sizing is still important but easier to achieve.

Not Just for Athletes

Now that you know yet another downside to spending too much time indoors, let me encourage you to get some calf sleeves and take them out for exercise every day!

You can find them also useful when:

  • You work all day on your feet.
  • You take a long automobile or airline trip.

Calf sleeves—something the Smiths will definitely be wearing if they ever step onto a long air-flight again!

Additional Note

The same companies that make these produce elbow sleeves, arm sleeves, knee and ankle sleeves and maternity compression stockings. I can think of no reason not to use these if you find them helpful. Call them low-tech bionic devices!

Thanks to Jody Bower and Michael Rienstra for their invaluable help editing this newsletter.



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Medicine for People! is published by Douwe Rienstra, MD at Port Townsend, Washington.