Garment Fitting
The “science” of custom fitting
By Jessica Diamond, Megan Diamond, Claire Ann Deighton, Kim Radford, Dayna Ricard and Jenny Whitlaw
Measuring and fitting compression garments, whether custom-made or ready-to-wear, can be challenging. Learning often comes from experiencing garments that don’t fit and need to be revised.
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hroughout this article, we will discuss measuring techniques that we use, and we will share specific case studies highlighting what we have learned. We have a group of six garment fitters in our retail store, which allows us to collaborate and provide continuity of care. We record measuring techniques, past issues and garment modifications on all customer files, allowing the customer to be served seamlessly if their particular fitter is away. Different fabrics, styles and measuring techniques are used depending on the client’s circumstances. We have over 65 years of experience between us to draw on and use standard protocols for assessing a new or returning client to ensure quality of fitting Assessment
To begin, we determine the appropriate time for the client to be measured for a compression garment. If the patient first needs their limb volume to be reduced, we discuss Manual Lymph Drainage (MLD) and compression bandaging. We provide a letter for clients to share with their physician explaining MLD and short-stretch bandaging and why we suggest this treatment. Other options for reduction are alternative compression systems, kinesio taping and compression pumps. There are two challenges that we often face when measuring after the client has completed compression bandaging.
A) Creases in the leg – Our solution: take measurements above or below the crease.
After the limb has been appropriately reduced in volume, we are ready to measure, taking into consideration compression level, material type and style. Material type
Example of compression bandaging incorrectly applied (too tight & not high enough).
B) Bulging – Our solutions include pulling tight at our last measurement below the knee, or occasionally we reduce by a few cm depending on the severity. We also may add an inside silicone band to help hold the garment in place if the leg has a cone shape.
Flat-knit versus circular-knit (ready-to-wear) options are based on patient history, fluctuation of swelling, and shape of the limb. In some cases, a flat-knit garment is not required and we may choose ready-made garments if the customer is new to compression, has arterial vascular disease, has potential donning issues, financial constraints or is in stage 1 lymphedema, and they fit well into a ready-made product. Below is an example of an individual in a custom circular-knit versus a custom flat-knit garment. It is evident that this customer requires flat-knit compression since the circular-knit is causing a tourniquet effect and binding at the ankles.
Example of bulging from compression bandaging that has slipped down.
If the client requires any lymphedema treatment, we try to communicate with their lymphedema therapist regularly. This communication can help us understand the client’s needs and when they are ready to be measured.
Jessica Diamond, Megan Diamond, Claire Ann Deighton, Kim Radford, Dayna Ricard and Jenny Whitlaw are all custom
fitters at Diamond Athletic Medical Supplies Inc. in Winnipeg, Manitoba. Between the six fitters, they have over 65 years of experience helping clients with the proper compression garments.
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Measuring & choosing garments
Same patient: custom circular-knit (left) versus custom flat-knit (right).
Choosing the manufacturer
If the individual is in the acute reduction phase and continuing with treatment while waiting for their garments, we may choose a company with a quicker turnaround time. Some suppliers produce garments within a week, while others take several weeks. We also may choose manufacturers based on their specific options, materials and warranties. w w w. l y m p h e d e m a p a t h w a y s . c a 17