Varicose veins: the bulging leg veins and what to do about them
Last updated September 3, 2026.
Varicose veins are enlarged, twisted surface veins, usually in the legs, caused by failing one-way valves that let blood pool backward. They affect up to 1 in 3 adults, they run in families, and for most people they are a cosmetic nuisance with a side order of aching legs. Modern treatment is quick and walk-in, walk-out, so nobody needs to put up with troublesome ones.
What do they look and feel like?
Visible bulging, rope-like blue or purple veins, usually on the calves and behind the knees. Common symptoms: aching, heaviness, and tiredness in the legs, worse after long standing and better with elevation; itching over the vein; ankle swelling by evening; and restless or cramping legs at night. Over years, the skin above the ankle can darken, thicken, or develop eczema (varicose eczema), the sign that the veins are now affecting skin health.
Why do they happen?
Veins return blood up the leg against gravity using one-way valves; when valves fail, blood pools and the vein stretches. Risk factors: family history (the big one), age, pregnancy (hormones plus pressure), prolonged standing at work, and excess weight. Spider veins are the tiny surface version. Varicose veins themselves rarely cause serious harm; the concern is the minority that progress to skin damage, ulcers, or clotting.
What actually helps?
- Daily measures: regular walking (the calf muscle is the pump), leg elevation when resting, avoiding long still standing, and weight management.
- Compression stockings: graduated compression relieves aching and swelling and slows progression; they are management, not a cure, and they only work when worn.
- Definitive treatment: for symptomatic or skin-changing veins, clinic procedures close the faulty vein: endovenous laser or radiofrequency ablation (the modern standard, done under local anaesthetic), foam sclerotherapy, or surgery for selected cases. Success rates are high.
- Skin care: moisturize the lower legs daily; varicose eczema needs a steroid cream before it breaks down.
When is it an emergency?
A hot, hard, red, exquisitely tender cord along a varicose vein is superficial thrombophlebitis: same-week review, sooner if spreading. A leg that becomes suddenly swollen, tight, and painful, especially one-sided and after a long trip or immobility, raises deep vein thrombosis: same-day assessment. Bleeding from a vein over the ankle is dramatic but controllable: lie down, raise the leg high, press firmly, and seek urgent care. A non-healing sore near the ankle needs a wound clinic, not patience. Pymander's escalation routing is built and tested specifically for this class of decision; see the safety architecture working paper.
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Common questions
Are varicose veins dangerous?
Usually not: most are a cosmetic and comfort issue. The complications to know about are a small minority of cases: superficial thrombophlebitis (a painful clotted vein), bleeding from a thin-skinned vein over the ankle, skin damage leading to eczema and ulcers, and a modest association with deep vein thrombosis. Sudden one-sided leg swelling is the sign that earns a same-day DVT check. Everything else is a routine-appointment conversation.
Do compression stockings actually work?
For symptoms, yes: graduated compression reliably reduces aching, heaviness, and ankle swelling, and it slows skin deterioration. The limits: stockings do not remove or shrink existing varicose veins, and benefits last only while you wear them. Fit matters (measured legs, the right compression class), and putting them on before getting out of bed, before veins fill, makes them far easier to apply. Many people wear them for standing-heavy days rather than every day, which is a reasonable compromise.
What does modern vein treatment involve?
The old operation (vein stripping under general anaesthetic) has largely been replaced by endovenous ablation: under local anaesthetic, a thin probe goes into the faulty vein and seals it with laser or radiofrequency heat; you walk in and walk out, back to normal activity within days, wearing stockings for a couple of weeks. Foam sclerotherapy (an injected irritant that closes the vein) suits smaller veins and branches. Success rates are high, though new veins can form over the years, since the valve-failure tendency remains.
Will they come back after treatment?
The treated vein stays closed permanently, but the tendency that produced it (your valves, your genetics, your job) remains, so new varicose veins can develop over the years. Recurrence rates after ablation are roughly 1 in 4 over five years, lower than after old-style surgery. Managing the contributors (weight, long standing, stockings when needed) stretches the interval. Think of treatment as resetting the clock, not stopping it.
Is crossing my legs or standing at work causing them?
Standing all day genuinely contributes: without the calf muscle pumping, blood pools and vein pressure rises, which is why shop, salon, and factory workers get more varicose veins. Crossing your legs is mostly a myth; it does not generate the sustained pressure that matters. Pregnancy is a major real driver (hormones soften vein walls while the uterus presses on pelvic veins), though pregnancy-related veins often improve within a year of delivery.
When do varicose veins need treating rather than watching?
Guidelines point to treatment when veins cause symptoms (aching, swelling, itch) that bother you, when the skin is changing (eczema, darkening, thickening above the ankle), when a vein has bled or clotted, or when an ulcer has developed or threatens. Purely cosmetic spider veins are a private-treatment matter in most systems. If your legs ache every evening or your skin is changing, that is a referral conversation, not something to endure indefinitely.