Are you noticing that your legs feel tired or heavy and ache at the end of the day?
This is a common experience which some attribute to “old age” even though some will develop these symptoms as young adults. As time goes by, the symptoms worsen or one may notice enlarging veins in the ankles or legs, throbbing discomfort in the calves or thighs, swelling at the ankles, or a fine rash or discoloration at the ankles. All of these are frequent symptoms or findings due to progressive failure of the one-way valves in the veins of the legs. As more valves fail, venous blood which should be moving from the legs toward the heart starts to flow in reverse down the leg when we sit or stand. The pressure which builds up in the leg veins due to the reversed flow stretches the veins. No wonder the legs are uncomfortable at the end of the day!
Most of us who live a normal life span eventually will develop problems with our leg veins. Genetics are the most important factors in development of varicose veins and failure of valves in the veins, called “venous insufficiency”. The inheritance pattern is complex, but Mom’s and Dad’s legs (and the underlying genetics) have a great deal to do with how much trouble we will have with our legs. Pregnancy accelerates the venous problem as hormonal changes allow stretching of many tissues including leg veins and the pressure of the enlarged uterus compresses the veins in the pelvis which drain the legs.
Fortunately, we do have some influence over our leg veins! Abdominal obesity compresses the veins in the pelvis and worsens the venous pressures in the leg veins. Weight management clearly is important to manage or reduce the severity of leg vein problems. Exercise, especially exercise which involves us of the calf muscles, improves muscular pumping of blood out of the legs. Frequent walking and avoidance of prolonged sitting or standing lowers the pressures in the leg veins. Periodic elevation of the legs higher than the heart may help with swelling or discomfort by using gravity to assist movement of venous blood and fluids out of the legs.
Graduated elastic compression hose provide a boost to pumping the blood out of the legs and they limit the stretch of the veins and skin that occurs during the time that our legs are lower than our heart. Compression hose vary considerably in degree of compression and the fit and fabric often determine success or failure in initial efforts to wear compression hose. Some patients with minor venous problems will do well with light compression hose that are readily available. Others need to be evaluated to sort out the best degree of compression and to prescribe and fit the patient with hose that are likely to be of the most benefit to the patient. Some patients require little teaching to wear compression hose, but others need teaching and/or devices to assist in donning the hose. Many symptomatic patients who have been properly fitted in compression hose find that their symptoms are much improved when they wear the hose.
As useful as compression hose may be, they do not solve the underlying problem of venous insufficiency. The evaluation and treatment of varicose veins and venous insufficiency has undergone revolutionary changes over the past 15 years and the revolution continues with better minimally-invasive office treatments for most venous problems. Individuals who have unexplained swelling of the legs, soft tissue leg pain or tenderness, enlarging varicose veins, new rashes in the lower calf or ankle, or leg wounds that are difficult to heal should be evaluated by a specialist in management of venous disorders to look for correctable problems which will only get worse with time if not identified and treated.
Progressive limitation in life due to leg vein problems is NOT inevitable. Much can be done for most to prevent complications and limitations of activity, but only if you seek help. While some treatment of veins is cosmetic, when symptoms develop, the problem no longer is cosmetic.