Varicose veins are enlarged, twisted veins that commonly appear in the lower legs. They arise when the small flaps (valves) inside veins fail to close properly, allowing blood to flow backward and pool. This increases pressure and stretches the vessel wall, producing the visible bulging cords many people notice. While often seen as a cosmetic concern, varicose veins can cause aching, heaviness, cramps and itching, and in some cases lead to complications.

Characteristics and common causes

Varicose veins affect superficial veins of the leg more than deep veins. They tend to be blue or dark purple and may be tortuous or raised above the skin. Multiple factors can contribute: weakening of the vein wall and valve damage over time, genetic predisposition, pregnancy-related circulatory changes, prolonged standing or sitting, obesity and advancing age. Hormonal influences and prior leg injury can also play a role.

Signs, symptoms and possible complications

  • Visible twisted or swollen veins on the surface of the skin;
  • Leg discomfort such as aching, heaviness, burning or cramping, often worse after standing;
  • Itching, dryness, or skin discoloration near affected veins;
  • Swelling of the lower leg and ankle, particularly at day's end;
  • Complications: painful superficial thrombophlebitis, skin changes, and venous ulcers or bleeding from a superficial vein in advanced cases.

Diagnosis

Diagnosis usually begins with a clinical examination and medical history. A detailed inspection while standing helps reveal the pattern of affected veins. Noninvasive imaging—most commonly duplex ultrasound—confirms valve reflux, maps affected veins and distinguishes superficial from deep venous disease. This information guides management choices.

Treatment and management

Treatment aims to relieve symptoms, reduce complications and improve appearance. Conservative measures include leg elevation, regular walking or calf-strengthening exercise, weight management and avoiding long periods of standing. Graduated compression stockings often reduce swelling and discomfort. Medical and procedural options are chosen based on severity and patient preference:

  • Sclerotherapy: injection of a solution or foam to close small to medium veins;
  • Endovenous thermal ablation (laser or radiofrequency): minimally invasive closure of larger refluxing veins;
  • Ambulatory phlebectomy: removal of surface veins through small incisions;
  • Surgical ligation and stripping: an older technique now reserved for selected cases;
  • Management of complications such as ulcers or thrombosis as needed.

History, prevention and when to seek care

Descriptions of dilated leg veins date back centuries; modern treatment has shifted from open surgery to minimally invasive therapies over recent decades. Prevention focuses on reducing modifiable risks: staying active, avoiding prolonged immobility, managing weight and using compression when recommended. Seek medical attention if you experience significant pain, progressive swelling, skin discoloration, nonhealing sores or sudden bleeding from a vein—these signs warrant prompt evaluation.