Varicose veins are swollen, twisted blood vessels that bulge just underneath the skin’s surface, typically appearing blue or purple. They often look like thick, rope-like cords running along the legs, and they can develop alone or in clusters. About 19% of adults worldwide have them, with rates slightly higher in North America (23%) and Europe (21%).
The Classic Appearance
The most recognizable feature of a varicose vein is its raised, gnarled texture. Unlike the flat, faintly visible veins you can trace on your wrist, varicose veins push outward against the skin. They look twisted and bulging, sometimes forming visible knots or ropy ridges you can feel with your fingertips. The color ranges from dark purple to blue, though on darker skin tones they can appear closer to your natural skin color, making them harder to spot visually but still easy to feel.
They show up most often on the legs, particularly the calves and inner thighs, because standing and walking put extra pressure on the veins in your lower body. The veins responsible for this are the ones closest to the surface, and when their internal valves stop working properly, blood pools and stretches the vein walls outward.
Varicose Veins vs. Spider Veins
People often confuse varicose veins with spider veins, but the two look quite different. Spider veins (also called telangiectasias) are tiny, flat, web-like networks of red or purple lines that sit right at the skin’s surface. They don’t bulge. They’re typically less than a millimeter wide and spread outward in fan or starburst patterns.
Varicose veins are substantially larger. They’re raised above the surrounding skin, at least 3 millimeters in diameter, and have that distinctive twisted, cord-like shape. If you run your hand over the area and feel a soft, squishy ridge under the skin, that’s a varicose vein. Spider veins are completely flat to the touch.
How They Change Over Time
Varicose veins don’t always stay the same. In the early stages, you might notice a single vein that looks slightly more prominent than usual, especially after standing for long periods. It may flatten when you elevate your legs. Over time, more veins can become visible, the bulging becomes more pronounced, and the surrounding area may start to show other changes.
Swelling around the ankles is one of the first signs that the underlying vein problem is progressing. Your legs may feel heavy or achy by the end of the day, and you might notice that socks leave deeper indentations than they used to. If you press a finger into a swollen area near your ankle and the skin holds the dent for a few seconds before bouncing back, that’s called pitting edema, and it’s a sign of fluid buildup from poor vein function.
Skin Changes That Signal Progression
When varicose veins go untreated for years, the skin around them can start to change in ways that look quite different from the veins themselves. The area around the ankles and lower calves may develop a yellowish-brown or reddish-brown discoloration. This happens because red blood cells leak out of the struggling veins and break down in the surrounding tissue, leaving behind iron pigments that stain the skin.
You might also notice patches of dry, flaky, itchy skin on your lower legs. This is sometimes called venous eczema, and it can look like a red, scaly rash. The skin may feel tender or thickened. In more advanced cases, the skin and tissue beneath it can become hardened and tight, making the lower leg feel woody or stiff to the touch. The skin in this area often looks shiny and taut.
These skin changes are important to recognize because they indicate the vein problem is affecting the tissue, not just the veins themselves. Left alone, this progression can eventually lead to venous ulcers: open, shallow wounds that typically develop on the inner leg between the knee and ankle. They’re slow to heal, often taking more than two weeks, and the surrounding skin is usually discolored and hardened.
When a Varicose Vein Looks Different Than Usual
A varicose vein that suddenly becomes red, warm, hard, and painful to the touch looks different from a typical one. Instead of a soft, squishy, bluish bulge, you’ll see a firm red cord under the skin that hurts when you press on it. This is a sign of superficial thrombophlebitis, which means a blood clot has formed in the vein along with inflammation. The redness and warmth distinguish it clearly from an ordinary varicose vein, which is painless to touch and stays its usual blue or purple color.
Sudden swelling of the entire leg, with tenderness and pain, looks different still. This can indicate a clot in a deeper vein rather than a surface one. The leg may appear noticeably larger than the other side, and the skin might look stretched and slightly reddish. This is a more urgent situation than a typical varicose vein flare.
What They Look Like on Different Body Types
On lighter skin, varicose veins are easy to spot because the blue or purple color contrasts sharply with the surrounding skin. On medium to darker skin tones, the color difference is subtler. The veins may appear dark brown, deep purple, or simply match the skin color, making the bulging and texture more reliable identifiers than color alone.
Body weight also affects how varicose veins present. On thinner legs, even mildly enlarged veins are visible, and you can often trace the full path of a twisted vein from thigh to calf. On heavier legs, the veins may be hidden by a layer of subcutaneous fat, so you feel them more than you see them. The symptoms (heaviness, aching, swelling) are the same regardless of whether the veins are visible on the surface.
Pregnancy often makes varicose veins more prominent because of increased blood volume and hormonal changes that relax vein walls. They can appear on the legs, vulva, and around the pelvis. Many of these improve within a few months after delivery, though they don’t always disappear completely.