In a sense, Julia Overstreet, MD, wants to make some of her skills and services obsolete. It is an odd way for an entrepreneur to operate, but as a certified wound care specialist and a podiatric physician and surgeon for 12 years, Overstreet wants to educate patients so they can take better care of themselves, particularly their legs and feet.

“A huge population in this country has swollen feet or legs to one degree or another,” she says. “If anyone has that for a prolonged period of time, the swelling blocks the blood flow to the legs and to the feet so the skin does not receive good nutrition. That makes the skin very vulnerable to injuries that does not heal. We call those ‘wounds’ or ‘ulcers.’ You can actually lose a leg because of them.”

To help prevent such drastic outcomes, Overstreet started speaking with patients about the dangers of swollen legs and how medical compression hosiery could help them. That educational aspect of her work has translated into a 2-year-old, profitable, medical hosiery retail business.

Custom-fitted or ready-to-wear medical hosiery—also known as compression hosiery, compression stockings, support stockings, support socks, and compression socks—prevents swelling by massaging fluids out of the calves, which reduces the blood pressure within the veins and improves blood circulation.

As a wound care specialist, Overstreet sees many patients with vein problems who need compression socks or medical compression wrap before their wounds can heal. “I get them used to the idea right away that the preventive measure for a recurrence of their wound is edema [swelling] control,” she says.

Diuretics and elevation of the legs are not appropriate, Overstreet tells her patients. It is better for patients to put on medical hosiery first thing in the morning to prevent gravity from keeping fluids in their legs and limiting the nutrients to their skin.

“This kind of swelling is a gravity issue,” she says. “First thing in the morning, you have a minimal amount of swelling. By the time you have been up for an hour, it is back to full steam.”

Online Success
Overstreet’s compression hosiery business began when she started selling medical hosiery in her clinic—Overstreet Health Center in Bellevue, Wash. Because she was prescribing the products, she took care to provide her patients with a list of local retailers and make clear that they could also go to them to purchase hosiery. Eventually, she was able to open a location in Seattle unconnected to her clinic and set up a Web site to attract customers from areas outside the Northwest.

Because the Web site was always an integral part of her business plan, Overstreet named her store SockDoctor.com after the Web site, which is www.sockdoctor.com. But even she did not predict the response she would get online, especially the number of international orders. “We get them from South Africa, China, Nigeria, Guam, Yugoslavia,” she says. “We have a world map on the wall and keep putting up little dots. We are just amazed.”

Of the 10 orders a day, two of them might be foreign customers, Overstreet says. “Americans tend to be heavier, but apparently people all over the world have varicose veins.”

With the online orders, follow-up is a must. “You are supposed to get medical hosiery replaced in 6 months if you wear it every day,” she says. “We send a little postcard at 6 months, asking if they need to reorder. That works pretty well.”

Still, the majority of the online orders are not repeat customers. “I would say two thirds of them are new,” Overstreet says. She attributes the increase in new customers to a more health-conscious environment in the United States and more Internet access among seniors.

Educational Approach is Key
Despite her encouraging experiences, Overstreet says there is a tremendous amount of resistance to purchasing and wearing medical hosiery, especially among seniors. “It is a hard sell,” she says.

When told by their physicians to purchase compression stockings, most customers imagine thick, beige hose worn by old ladies. Overstreet and her staff reassure customers that they actually have many attractive options. “It is totally different than it used to be,” she says. Multiple choices now exist in terms of thickness (ultrasheer, sheer, and opaque), length (ankle, knee-high, thigh-high, and waist-high), designs, and colors.

“When people see that [medical hosiery] looks like normal socks, that helps with their resistance quite a bit,” Overstreet says.

Her medical background, her coworkers’ knowledge and certification in sock-fitting, and everyone’s educational slant on the product also help overcome customer concerns and are a big part of why Sockdoctor.com has been a retailing success, she adds. “[Selling medical hosiery] does take more than a normal product approach,” she says. “We do a lot of training of our employees on all the issues—the vascular supply, the specifics of how the tissue is nourished, the different health problems that people can have—as well as the specifics on the socks themselves.”

The educational approach also helps them overcome customers’ concerns about the cost of compression stockings. “All the different manufacturers make a basic line that is more economical,” Overstreet says. The less-expensive types look like Grandma’s stockings, but the cost is about half of that for the more fashionable styles, which is just fine with some patients.

Another way to save money is to pick a man’s knee-high sock, which can be sturdier than a sheer or opaque stocking. Most of Overstreet’s customers are women over 40 and among this group opaque hosiery and men’s socks are the most popular styles. “Many women wear slacks, so the knee-high styles are fine and you just can’t wreck the men’s socks,” she says. “You can put your finger through the opaque and the sheer styles, because they’re not run-proof. The men’s socks don’t run.”

The one cost-cutting measure Overstreet does not recommend is purchasing an inexpensive brand at a drugstore without checking the level of compression and confirming that the compression is graduated—tighter at the ankle and looser along the calf. Some inexpensive stockings sold in drugstores offer the same level of compression at the top and the bottom, which is less effective at massaging fluid out of the legs, she says.

Finally, even if customers feel reassured about the appearance and the cost of medical hosiery, they might still be concerned about their abilities to put on the tight-fitting garments. Weight problems, hip or knee surgeries, arthritis, lack of strength in their hands, and back pain can make putting on the hosiery very difficult. “We train people to get it on properly, and we work with their spouses or roommates to help them,” Overstreet says.

Supplying medical hosiery application aids can help patients reduce problems with pulling on and wearing medical hosiery. For example, one product uses a wire frame to hold the sock open while the person slips a foot into it. Another item uses nylon parachute material to help eliminate friction while pulling on the sock. Water-based skin glue can help keep thigh-high stockings from sliding down the legs.

Goals for the Future
With an increasing percentage of the population becoming overweight or obese, Overstreet expects the demand for medical hosiery will remain strong and likely increase. “It is just astronomical how many people are going to need these,” Overstreet says.

But unless she and other providers help people with circulation problems to understand the benefits of medical hosiery, the demand for her services as a wound care specialist could also go up. To prevent that, Overstreet wants to give medical lectures to more patients, especially diabetics of any age and seniors. “Patients are so eager now for all kinds of knowledge,” she says. “Those two groups are the ones that really need help interpreting all the information out there.”

Amy K. Hooper is a contributing writer for Dealer/Provider.