Vein disease in the legs, most commonly called chronic venous insufficiency, is a condition where the veins in your legs can’t efficiently pump blood back up to your heart. It affects roughly 1 in 5 adults to some degree, ranging from cosmetic spider veins to painful varicose veins to open wounds near the ankles that won’t heal. The underlying problem is almost always the same: the tiny one-way valves inside your leg veins stop working properly, allowing blood to pool and pressure to build.
How Leg Veins Normally Work
Your leg veins face a unique challenge. They have to push blood upward against gravity, sometimes across three or four feet of distance, to return it to your heart. To manage this, veins contain a series of one-way valves, small flaps shaped like swinging doors that open to let blood flow upward and snap shut to prevent it from sliding back down. Your calf muscles act as a pump, squeezing the veins with every step you take and forcing blood toward the heart in stages.
This system works well when the valves seal tightly and the vein walls maintain their shape. Problems start when either one fails.
What Goes Wrong: Valve Failure and Reflux
Vein disease begins when valves become incompetent, meaning they no longer close completely. Blood leaks backward through the faulty valve and pools in the vein below, a process called reflux. That pooling increases pressure inside the vein, which stretches the vein wall, which damages the next valve down, creating a cascade effect.
Valve failure can happen in three different vein systems in your legs, each with different consequences. In the superficial veins (the ones closer to the skin surface), valve failure is often caused by a pre-existing weakness in the vein wall or valve leaflets. Hormonal changes, inflammation, or simple overstretching of the vein can trigger it. This is what produces visible varicose veins. In the deep veins (buried within the leg muscles), valve damage most often follows a previous blood clot. The clot scars the valve leaflets, leaving them permanently unable to close. Deep vein valve failure is more serious because it can reduce the total volume of blood leaving the limb with each muscle contraction.
There’s also a third set of valves in the perforator veins, which connect the superficial and deep systems. When these fail, the powerful pressure generated by your calf muscle pump gets redirected backward into the superficial veins, essentially blasting high-pressure blood into a low-pressure system. This is a common driver of skin damage and ulcers near the ankle.
Who Gets Vein Disease
Epidemiological data suggests about 19% of adults develop varicose veins, and roughly 0.4% to 1% will experience a venous leg ulcer at some point. Several factors raise your risk, but one of the strongest and most modifiable is prolonged standing.
Standing at work for more than four hours a day is an independent risk factor for developing vein disease. Research across multiple studies found that people who spend three-quarters or more of their work time standing or walking have significantly elevated risk, with women facing an adjusted relative risk of 2.63 and men at 1.85 compared to those who don’t. The occupations most studied include nurses, factory workers, hairdressers, kitchen staff, cleaners, and surgeons. Interestingly, sitting is a weaker risk factor than standing. One study found that seated work actually had a protective effect compared to standing (reducing odds by about 33%).
Other well-established risk factors include age, obesity, pregnancy, family history, and previous blood clots. Male gender is associated with a higher likelihood of progressing to ulceration once vein disease is present.
Symptoms at Each Stage
Vein disease is progressive, and symptoms tend to follow a predictable path from mild to severe over months or years.
Early on, you may notice aching, heaviness, or a tired feeling in your legs, especially after long periods of standing. Your legs may swell toward the end of the day, particularly around the ankles. Spider veins (tiny red or purple lines near the skin surface) or bulging, ropy varicose veins are often the first visible sign. Some people experience itching, throbbing, or a restless, crampy sensation at night.
As the disease progresses, skin changes develop. The skin around your lower legs and ankles may darken, turning reddish-brown or purple. This discoloration reflects chronic inflammation and the breakdown of red blood cells that have leaked out of pressurized veins. The skin can become dry, flaky, and intensely itchy.
Advanced Skin and Tissue Changes
In more advanced cases, a condition called lipodermatosclerosis develops. The fat layer beneath the skin hardens, making the skin feel thick, firm, and tight. In its acute phase, this causes sudden pain, warmth, and discoloration, usually on the inner leg. The chronic form is more distinctive: the skin becomes permanently tightened and darkened, and the leg can actually change shape. The area near the ankle narrows while the foot and upper calf remain swollen, producing what’s often described as a “champagne bottle” appearance.
The most severe stage is venous ulceration, where the skin breaks down entirely and open sores develop, typically just above the ankle on the inner leg. These ulcers are notoriously slow to heal and prone to recurring. They represent the end point of years of unchecked venous pressure damaging the skin and underlying tissue.
How Vein Disease Is Diagnosed
The primary diagnostic tool is a venous duplex ultrasound, a painless, non-invasive scan that combines standard ultrasound imaging with Doppler technology to visualize blood flow direction in real time. During the test, a technician compresses your calf and then releases it while watching the screen. In healthy veins, blood flows upward during compression and the valves close within a fraction of a second after release. In diseased veins, blood flows backward (refluxes) for a measurably longer time.
The diagnostic thresholds are precise. In most leg veins, backward flow lasting longer than half a second after release of compression is considered abnormal. For the larger veins near the groin and behind the knee, the cutoff is one second. For perforator veins, it’s 0.3 seconds. These measurements help determine which specific veins are failing and how severely, which directly guides treatment decisions.
Managing Vein Disease
Treatment depends on the stage. For mild to moderate disease, conservative measures can significantly slow progression and relieve symptoms.
Compression stockings are the cornerstone of conservative treatment. They work by applying graduated pressure to your legs, tightest at the ankle and gradually loosening toward the knee or thigh, which helps push blood upward and reduces pooling. For mild symptoms like occasional swelling or achiness, stockings in the 15 to 20 mmHg range are typically sufficient. Moderate to severe disease usually calls for medical-grade compression in the 30 to 40 mmHg range, which requires a bit more effort to put on but delivers substantially more support.
Beyond compression, regular movement matters. Walking activates the calf muscle pump and is one of the most effective ways to move blood out of the legs. If your job requires prolonged standing, shifting your weight, doing calf raises, and taking walking breaks can reduce venous pressure. Elevating your legs above heart level for 15 to 30 minutes several times a day also helps drain pooled blood. Maintaining a healthy weight reduces the overall pressure your venous system has to work against.
Procedures for More Advanced Disease
When conservative treatment isn’t enough, or when veins are significantly damaged, several minimally invasive procedures can close off or remove the faulty veins. These are typically done in an outpatient setting and involve sealing the damaged vein using heat energy, a medical adhesive, or a chemical solution. Once the diseased vein is closed, blood reroutes through healthy veins nearby. Recovery is usually quick, with most people returning to normal activity within days.
For venous ulcers, treatment focuses on both healing the wound (usually with specialized dressings and sustained compression) and correcting the underlying vein problem to prevent recurrence. Without addressing the source of high venous pressure, ulcers have a recurrence rate that can exceed 50%.