Medical compression stockings (MCS) are widely used to treat venous and lymphatic disorders of the lower limb. Their mechanical behaviour results from a knitted architecture that combines a ground weft knit, ensuring comfort, with inlay yarns that provide circumferential stiffness and compression. Finite element (FE) simulations are increasingly used for pressure prediction, but most existing models rely on homogenization and neglect the mesoscopic fabric structure. This study proposes a hybrid FE model of MCS based on a representative unit cell. Shell elements were used to model the loop structure, and axial connectors to model the inlay yarn. Mechanical parameters were identified from tensile tests on fabrics without inlay yarn, and on extracted inlay yarns. Structural parameters, including zone-specific inlay yarn density, were introduced directly into the model. Simulations of garment placement over rigid cylinders predicted interface pressures from two compression zones, ankle and calf. The predictions were compared against Laplace’s law, with deviations of 0.10 kPa for the ankle and 0.06 kPa for the calf, corresponding to less than 7% relative error. The proposed framework explicitly integrates structural and mechanical properties into FE models. Despite the current assumption of a rigid leg, it provides a consistent basis for future simulations including anatomic leg shapes.