Our leg veins have valves in them that make sure blood flows up from the feet toward the body. In venous insufficiency, these valves do not work the way they are supposed to. When these valves do not work properly, pressure builds up in our legs. This pressure can result in heavy legs and in other leg pains. Because pressure tends to build up throughout the day, night leg pain is typical. Other symptoms include leg swelling. Sometimes, venous insufficiency leads to varicose veins and even to wounds.
How do Veins Work?
Veins take blood back from the feet and up toward the heart. This means that veins have to work against gravity. To do this, leg veins have valves inside them that prevent backflow. As we move around, our feet and calves push blood up the leg, and the valves prevent it from going back down.
Symptoms of Venous Insufficiency
Venous insufficiency is another term to describe faulty leg vein valves. Most people who have leaky veins will not have any symptoms at all. When symptoms do exist, they can come in different forms:
- Heavy legs – When the vein valves are notworking properly, the backflow increases the pressure in the lower parts of the legs. This pressure builds up throughout the day. By nighttime, people who have been on their feet all day will complain of heavy legs.
- Aches – For the same reason people experience leg heaviness, they also experience aches. The aches are typically in the lower part of the legs. The cause is the buildup of pressure from the backflow through faulty vein valves.
Signs of Venous Insufficiency
The term “signs” means things you can find by examining the legs. Here are a few signs that we can find in people with faulty vein valves.
- Skin changes – Over the years, the elevated pressure in the lower legs causes skin changes. Many people who suffer from venous insufficiency will complain of dry and itchy skin. In some people, the skin color will change. When this happens we call it stasis pigmentation. The cause is the iron in blood cells tattooing the skin as blood seeps out of the veins because of the elevated pressure.
- Leg swelling – This is also called “edema”. The elevated vein pressure will push some fluid out of the veins and into the skin around them. This fluid will cause swelling. The swelling may or may not be painful. The swelling typically does not involve the foot or toes.
- Spider veins and Reticular veins – These are dilated veins that look like fine red or purple lines under the skin. They can appear in any location along the leg.
- Varicose veins – Varicose veins are dilated veins. Some people are prone to dilated veins. Sometimes, people who have varicose veins will have other family members with the same problem. Probably, this is because in some people, the veins tend to dilate. In any case, the elevated pressure in the veins will slowly dilate veins until they become ropy and visible.
- Venous wounds – The worse outcome for venous insufficiency is when the skin breaks and forms a wound. Venous wounds, or venous ulcers, are usually not dangerous. They usually do not result in limb loss. But they often take a very long time to close. As long as they are open, they hurt and might also get infected. Unfortunately, they are also unsightly.
Venous Insufficiency Diagnosis
A doctor will suspect venous insufficiency if you have typical complaints. Then, they will examine you and look for the typical skin and vein changes. Once they suspect venous insufficiency, they will sometimes order diagnostic tests. Usually, the first test will be an ultrasound examination. The purpose of the ultrasound will be to look at the vein valves and check for the direction of blood flow.
Treatment Options
Basically, there are four levels of treatment: Wait and see, skin care, compression stockings, and procedures.
Because venous insufficiency is a slow process, and because most people don’t have any symptoms, sometimes it is okay to do nothing. That is the “wait and see” approach. Still, because skin changes are common, it is best to at least pay attention to your skin. Practically, this means that if your skin is dry, make sure to use an emollient (moisturize).
The next step up will be compression stockings. Remember, that compression stockings will not cure you. They will not reverse swelling and they will not treat dilated veins. But, compression stockings will offer relief. So if a major symptom for you are heavy legs or aches, compression stockings will probably help. Also, compression stockings control leg swelling. True, they do not cure the edema. But, as long as you are wearing properly fitting compression stockings, the swelling will be under control.
Finally, there are procedures. Most procedure in modern care are “minimally invasive”. This means that surgery such as vein stripping is uncommon. Usually, people who need procedure will have a day procedure and be back to normal within a few days. Basically, procedures involve using energy or glue to close the major leaky veins.
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