Poor fit has become one of reasons for high non-compliance in the use of garments made of compression textiles in venous deficiency treatments. A novel methodology to categorize lower body shapes and sizes has been established via three-dimensional digital anthropometric technology in this study based on 208 Hong Kong subjects aged 40–60 years. Three new parameters were introduced to classify body shapes, namely the “A-angle” for assessing the “alignment” of lower extremities, the “cosine values of the key angle” at the turning point for below-knee shape determination, and “gradient” for above-knee shape categories. The mathematical simulation via the interpolation function was employed to explore the characteristics of shape variation trends with the involvement of dynamic interactions of both circumferences ( Cir) and heights ( Hei) of lower extremities. The clustering analysis quantitatively segmented the sample population into three stratified leg morphologies (i.e. diamond, inverted trapezoid, and balanced leg shapes) in terms of the determined anthropometric landmarks along the lower extremities, in which the C ir( s) of the brachial ( cB1), calf ( cC), and thigh ( cF) exhibited most obvious differences among the clustered lower limbs. The created stratified shape-driven sizing system and methodologies further involved the body shape classifications into the Cir-based size categories to cater for diverse body morphologies in product size selection, thus improving dimensional fitness and accurate treatment using compression textiles in practice.