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 Frequently Asked Questions for the Custom Lower Legging

1. Patient is not ambulatory to take initial measurements. How should the measurements be taken?  
2. I cannot find the patient’s malleolus to get an accurate reading of the circumference and length measurement. How do I proceed?
3. Skin folds hang down from the thigh and will rub against the legging. How do I protect this skin from rubbing against the garment?
4. Patient is experiencing pain, redness, and swelling in the ankle area. What should I do?
5. The legging is beginning to slide down leg due to substantial reduction. Do I need to order a new garment?

1. Patient needs compression for daytime use, will not bandage, and doesn’t have the strength to pull on elastic stockings, but the Thigh-High 2000 is for nighttime use only. What can I do?
2. Can the length of the garment be adjusted?
3. Can the garment be worn without the foam?
4. Patient’s measurements fall within two sizes of the standard sizing chart. Which size should I use?
5. Patient has stated that the compression is not as tight as bandaging was, and does not feel like (s)he is getting the proper amounts of compression using the Thigh-High 2000. Is this true?

1. Patient has a venous ulcer as well as Lymphedema, which garment should I use?
2. Patient does not fit a T-3 Boot C-3 Wrap for the following reasons:
   • Fleshy shelves or tissue masses
   • Sizes Contradictions
   • Length out of range
   • Too big for standard size
3. Patient has called me every day for a week now indicating the legging slides too much. What do I tell them?
4. Can the length and bands be altered?
5. Does the Ankle-Foot Wrap fit inside a shoe?

1. Does the Measure-Up Arm-Sleeve come in different colors?
2. When measuring the patient with their arm out, large tissue masses are hanging and causing large jumps in circumference on the measuring chart, is this ok?
3. My garment isn’t the exact length I put on the sizing chart, why?
4. Can the length of the garment be adjusted?
5. Patient hand is swelling after a week of wear. What areas should I address with the patient?
6. Patient’s elbow is swelling and arm-sleeve seems too large now. What is happening?
7. How will the patient know when the level of compression needs to change?
8. Can the arm-sleeve be worn for daytime use?

1. Patient lives alone, has no help, and cannot reach their ankles, any suggestions?
2. Patient’s measurements fall within two sizes of the standard sizing chart. Which size should I use?
3. Patient has a limb length of 31cm and the Ready-Fit 2000 is 36cm. Can the length be shortened?
4. Patient has called me every day for a week now indicating the legging slides too much. What do I tell them?
5. Patient has decreased in limb circumference by 2cm. Can the size be decreased?

Patient is not ambulatory to take initial measurements. How should the measurements be taken?

Take the measurements using the best possible method available (i.e., laying down, sitting up, reclining, foot elevated.)

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I cannot find the patient’s malleolus to get an accurate reading of the circumference and length measurement. How do I proceed?

Feel for the boney prominence of the malleolus (if possible) and ask the patient to assist you in finding it.

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Skin folds hang down from the thigh and will rub against the legging. How do I protect this skin from rubbing against the garment?

Assure the patient is folding a two-ply layer of stockinette over the top edge of the legging. Try using thin layers of foam underneath the uncovered shelf.

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Patient is experiencing pain, redness, and swelling in the ankle area. What should I do?

            b. if there is a shelf (tissue mass) insert foam pieces to fill in for missing volume; 

            c. call CircAid Medical for further assistance.

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The legging is beginning to slide down leg due to substantial reduction. Do I need to order a new garment?

In most cases, no. Refer to the instruction video included with the custom legging and/or consult with CircAid Medical Products.

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Patient needs compression for daytime use, will not bandage, and doesn’t have the strength to pull on elastic stockings, but the Thigh-High 2000 is for nighttime use only. What can I do?

Consider if your patient is ambulatory. The Thigh –High 2000 is recommended for nighttime use due to the full-foam insert, and its one-piece construction. Your patient would have a limited range of motion if worn during the day.

If compliance is not an issue, your patient has undergone CDT, and you believe (s)he is a good candidate for the Ready-Fit 2000 Upper Legging, you may want to evaluate their qualifications for this garment 

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Can the length of the garment be adjusted?

• By way of altering it – no.
• By slightly re-positioning it, either up or down - yes

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Can the garment be worn without the foam?

No – the patient’s measurements are taken into consideration based on the allowance of the foam insert.

Yes – Provided therapist/patient understand garment is then considered a custom garment, and must be processed as such, including indication that foam will not be used with cover.

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Patient’s measurements fall within two sizes of the standard sizing chart. Which size should I use?

When on the borderline between sizes, consider the amount of edema present and anticipated reduction. If significant edema is present and reduction is anticipated, select the smaller size, if edema is minimal select the large size.

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Can the arm-sleeve be worn for daytime use?

No, the arm-sleeve involves the elbow joint so range of motion is limited. For active patients, the arm-sleeve is disruptive during day wear and high levels of activity. For inactive patients it may work; however, a therapist or clinician will need to be involved in the final decision to wear the garment during the day.

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Does the Measure-Up Arm-Sleeve come in different colors?

No, it is available with a black compression shell with red neoprene measuring strip, and a covered removable foam padding in red.

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When measuring the patient with their arm out, large tissue masses are hanging and causing large jumps in circumference on the measuring chart, is this ok?

Typically this is ok because someone from CircAid Medical will contact you to work this situation out. Generally, if you find that masses are soft enough that they will redistribute to other areas while in the garment, we will ask you to re-do the measurements with arm resting on a table to help simulate this.

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My garment isn’t the exact length I put on the sizing chart, why?

Because the garment is made of a series of 2” straps and corresponding d-rings, the garment’s length can only change in 2” (5cm) increments. This limits us from manufacturing to specific lengths without altering the consistency of the strap spacing.

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Patient has stated that the compression is not as tight as bandaging was, and does not feel like (s)he is getting the proper amounts of compression using the Thigh-High 2000. Is this true?

The Thigh-High 2000 does feel different than bandaging feels. There are not as many layers, and the level of compression is based on a method that feels both firm and comfortable. To this end, make sure the patient has gone over the instructional video and in particular, understands the band engagement, adjustment, and tightening sections, as well as La Place’s Law.

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Patient has a venous ulcer as well as Lymphedema, which garment should I use?

Habit changing alternative #1: This garment is the perfect answer for patients that are "on board" – want to heal their ulcer, lead independent lives, take care of their legs; but can’t pull on stockings and want another option to add to their bandaging skills. Although patient with Lymphedema conditions fair better in the Ready-Fit^TM 2000 (see alternative #2), a fresh perspective on an easier method may be the answer they’re looking for. The three band legging the T-3 Boot / C-3 Wrap is a good introduction for transitional patients like these.

Habit changing alternative #2: You may be treating a patient that has a broad perspective about their condition and their healthcare arrangements. You, the therapist/fitter, and patient may envision a garment that will last longer than three months (like the T-3 Boot and C-3 Wrap) that addresses long-term needs. The recommended garment would be the Ready-Fit 2000 with a minimum life of one year.

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1. Size under the Ready-Fit 2000
2. Custom legging may be required

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Patient has called me every day for a week now indicating the legging slides too much. What do I tell them?

It’s working! It may work more effectively if the patient showers in the evening and applies the legging prior to rising from bed in the morning. This will alleviate the constant need to adjust the bands, as they become loose due to the calf muscle pump working against the garment. In this way, the patient has not given gravity the opportunity to allow fluid to fill in the lower extremity.

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Can the length and bands be altered?

No, this compromises the fabric’s stitching and delicate nature of the mesh material. If you are considering alterations based on your comparison of measurements vs. the sizing charts, take additional measurements as referenced on the Ready-Fit 2000 sizing chart to avoid the cost of a custom-made garment.

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Does the Ankle-Foot Wrap fit inside a shoe?

In some cases – yes. Each patient situation is different, as we have discovered. The majority of patients we have talked to enjoy the use of the ankle-foot wrap inside a shoe that had to be sized too large for their foot due to pre-existing edema.

In other cases – not much edema may be present begin with so the ankle-foot wrap is reserved for nighttime use.

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Can the length of the garment be adjusted?

Yes, its length (only) can be altered by up to 1" (2.5cm). Refer to written and video instructions.

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How will the patient know when the level of compression needs to change?

See your patient after one month of wear to check and adjust the compression levels if necessary. Your patient may indicate sometime in the future that not enough compression is being felt. This is an indication to check the sleeve to assure the proper amount of compression is being used.

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Patient hand is swelling after a week of wear. What areas should I address with the patient?

• Assure sleeve’s edge does not extend over the wrist bone and onto the hand.
• Is the compression level set to a firm and comfortable compression?  Re-check the level and assure patient is applying and setting the bands properly.
• Make sure patient understands how to use measuring card and that the compression level is not too high.
• Evaluate how patient is wrapping hand. Hand should be covered or wrapped prior to setting any of the arm-sleeve bands in place.
• Consult with physician to dispel possibility of infection

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Patient’s elbow is swelling and arm-sleeve seems too large now. What is happening?

Make sure the elbow crease of the sleeve is lining up with the elbow. Also, check the length of the arm-sleeve to assure it does not ride up into the axilla, and alter the length as indicated in item #4.

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Patient lives alone, has no help, and cannot reach their ankles, any suggestions?

Consider alternatives outside of the CircAid garment and revisit the possibility when at least one of the above issues has changes.

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Patient has a limb length of 31cm and the Ready-Fit 2000 is 36cm. Can the length be shortened?

Yes, one- two bands can be trimmed from the bottom of the legging. Refer to both written instructions and the instructional video for further details.

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Patient has decreased in limb circumference by 2cm. Can the size be decreased?

Yes, the circumference of the bands can be decreased by up to 2.5cm by slitting between the bands. Refer to both written instructions and the instructional video for further details.

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