Varicose Veins: Spider Veins in the Lower Legs?HM

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Varicose veins are enlarged, bulging blue-purplish veins underneath the surface of the skin. They usually form on the thighs, calves, or the inside of the legs near the ankles and feet. Varicose veins are a common health condition and affect more women than men. Varicose veins can occur without causing any health problems and remain a cosmetic issue. However, if not treated properly, varicose veins can develop into blood clots or other serious vascular problems. Keep reading to find out everything you need to know about varicose veins.

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What are Varicose Veins?

Varicose veins are abnormally enlarged, swollen, and twisted veins that often appear as bulging, blue blood vessels beneath the skin. They can occur anywhere in the body, but are most commonly found in the lower legs. Varicose veins affect almost twice as many women as men in fact, most common in pregnant women, elderly, and people who sit or stand for long periods of time.


Spider veins are the milder form of varicose veins, in which dilated blood vessels are visible through the skin without bulging. They are typically less than 1mm in diameter, purplish in colour, and look like branches or a spider web right below the skin surface. They are usually asymptomatic and painless without leg swelling.


Varicose veins are a common medical condition that may lead to discomfort and serious complications if not treated properly. Some patients may develop emotional distress due to the unattractive features of varicose veins.

Causes of Varicose Veins

Veins are blood vessels that carry blood back to the heart from the body. Veins contain one-way valves that keep blood flowing forward. Normally, these valves close to prevent blood from flowing backward, however, varicose veins develop when these small valves fail to function properly. When these valves fail, blood flows back down the vein, causing blood to build up. The accumulation of blood raises the blood pressure in the vein and causes it to stretch out, resulting in the visible and palpable swollen, twisted veins through the skin.


Veins of the lower limbs are furthest away from the heart, hence venous blood from legs travel a long distance against gravity to return to the heart. Calves and other leg muscles relax and contract as you walk or run. These muscle contractions act as pumps in the lower leg, and elastic vein walls and proper venous valves help blood return to the heart. If these valves are weak or damaged, blood may flow backward and collect in the vein. As a result, legs’ veins are the most common site of varicose veins as compared to other parts of the body.

Risk Factors of Varicose Veins

Apart from the above-mentioned causes of varicose veins, there are several other risk factors that contribute to a higher risk of varicose veins, including:

  • Age: The risk of varicose veins increases with age as blood valves wear out and blood vessels become less elastic and more brittle.
  • Sex: Women are twice as likely as men to develop varicose veins. This could be due to female hormones relaxing vein walls, causing the valves to leak. Women are more likely to develop varicose veins during pregnancy or menopause.
  • Pregnancy: Pregnant women bear more weight in the pelvis, which puts pressure on veins. Pregnant women are more likely to develop varicose veins in the inner thigh, lower pelvic area, and buttocks.
  • Family history: People with a family history of varicose veins and venous insufficiency have a higher chance of developing varicose veins.
  • Prolonged standing or sitting: Your blood doesn’t flow as well and accumulates in the extremities if you remain in the same posture for long periods.
  • Overweight and obesity: Being overweight adds pressure on the veins, making it even harder for blood to return to the heart.

Signs and Symptoms of Varicose Veins

Varicose veins may not be visible until the veins have stretched, but they may accompany other symptoms. If you develop such symptoms, your legs can be extremely tired, heavy, or achy. After sitting or standing for an extended period of time, these symptoms may worsen.

These are common signs and symptoms caused by varicose veins:

  • Large, bumpy veins that look like snakes / spider web
  • Swelling of ankles and feet
  • Muscle cramps, particularly at night
  • Dry, itchy and thin skin over the affected vein
  • Tiredness or heaviness of the legs
  • Aching and uncomfortable legs
  • Burning or throbbing in your legs
  • Itching near the ankles

Changes in hormone levels have an influence on the above symptoms. Thus, you may experience more symptoms at certain times of your menstrual cycle, during pregnancy, or during menopause.

Complications of Varicose Veins

Varicose veins can cause complications as normal blood flows are disturbed. Although complications are usually rare in the early stage, complications of varicose veins may develop years later.


Some complications of varicose veins include:

  • Bleeding: Superficial veins may occasionally burst, resulting in minor bleeding. Lie down, raise your leg, and apply direct pressure to the wound. If this does not stop the bleeding, seek medical attention right away.
  • Ulcers: Painful ulcers may develop on the skin around varicose veins, especially near the ankles. A discolored spot on the skin usually appears before an ulcer forms. Immediately consult your doctor if an ulcer is suspected.
  • Blood clots: Occasionally, deep veins become enlarged. The affected leg may become painful and swollen in such cases. Any persistent leg pain or swelling should be evaluated by physicians because it may indicate a blood clot, medically known as thrombophlebitis. Sometimes, varicose veins may come together with blood clots and deep vein thrombosis. Immediate medical attention is recommended for such cases.

If left untreated, varicose veins may develop into vascular diseases that threaten one’s health, such as thrombosis (formation of blood clots in blood vessels) or chronic venous insufficiency.

Stages of Varicose Veins

When varicose veins last for a long time, venous pressure can further weaken valves’ functions. This develops into chronic venous insufficiency. Varicose veins can be divided into multiple stages:

  • Stage 1 – Reticular veins: Also known as ‘spider veins’ or telangiectasia, tiny reddish-purple veins can be seen on the legs, face or other parts of the body. Spider veins are typically visible beneath the skin, but they do not cause the skin to bulge out.
  • Stage 2 – Varicose veins: Sometimes called ‘ropey veins’, these veins are swollen and have a twisted appearance. Symptoms like itching, burning or numbness along the veins, as well as tiredness, ache and weakness of the legs can all interfere with daily life. At the first sign, it is best to seek medical treatment.
  • Stage 3 – Swelling or Edema without Skin Changes: Legs and ankles swell as the circulatory system’s ability to reabsorb fluid is impaired. Elevating the limbs may help alleviate symptoms, but will not cure the disease or significantly reduce swelling. 
  • Stage 4 – Skin Discoloration: As vein disease progresses, venous congestion and poor circulation can lead to changes in skin colour and texture, along with skin thinning. During this stage, the affected skin becomes reddish-brown or white. Such skin will be more easily injured and heal slower.
  • Stage 5 – Skin Changes with Healed Ulceration: In this stage, scratches or injuries may heal with treatment and often leave scars.
  • Stage 6 – Skin Changes with Active Ulceration: In this final stage, skin injuries and leg ulcers will not heal even with treatment.

Diagnosis of Varicose Veins

Varicose veins are diagnosed mainly by their appearance. Your doctor will examine your legs and look for bulging veins while you are standing. In addition to the clinical signs and symptoms, diagnosis of varicose veins can be made by duplex ultrasound. A duplex ultrasound scan can be taken to listen to the blood flow, and hence, detect any blockage caused by blood clots and to locate any damaged valves.


If your varicose veins are serious, showing severe pain, ulcers or other complications, your doctor may refer you to a vascular specialist.

Treatment of Varicose Veins

Varicose veins are rarely a serious condition and treatment may not be necessary sometimes. Medical treatments are usually unnecessary for stage 1&2 varicose veins. Physicians may recommend the following treatments for relieving symptoms.

  • Varicose veins compression stockings: Compression stockings are very useful in the treatment of varicose veins. Wearing elastic varicose veins compression socks that gently squeeze your veins adds pressure on the veins in your legs, promoting blood flow and reducing swelling. It is most effective if you wear them every day.
  • Elevate your legs: Put your legs up above your heart for around 10 minutes 3 to 4 times a day so that gravity can pull blood from your legs to other parts of your body. Lie down and rest your feet against a wall, or place your legs on a stack of cushions or pillows in bed. Try to rest with your feet up to reduce swelling after prolonged standing and sitting.
  • Maintain a healthy body weight: If you are overweight, shed the extra weight you are carrying to combat varicose veins. Losing weight can ease the pressure on the veins in your legs and feet, therefore improving blood flow.
  • Pump those muscles: Muscle contraction helps to keep the blood flowing. Actively moving your muscles can help push blood back up towards the heart. If you are sitting, try to get up and walk around every 30 minutes (and avoid crossing your legs!). Bend and flex your knees from time to time if you have to stand for long periods of time at work. Regular exercise improves muscle tone, blood circulation, and helps you maintain a healthy weight.

If lifestyle changes and varicose veins compression stockings don’t help your symptoms, your physician may recommend some advanced measures to treat severe varicose veins.

  • Sclerotherapy is one of the best treatments for varicose veins. During sclerotherapy, your doctor will inject medicine into the affected veins to cause them to shrink.
  • Endothermal ablation involves inserting a catheter into the vein and using heat to seal off affected veins.
  • Vein ligation and stripping are surgical removals of veins.
  • Cyanoacrylate glue occlusion is a procedure that involves injecting a special type of glue into a vein to close it.

Varicose vein creams, lotions and other products are very common in the market. You should know these creams will not cure varicose veins; instead, they contain ingredients that can minimize symptoms of varicose veins, namely inflammation, swelling, itching and help soothe the skin.

Prevention of Varicose Veins

There are many simple ways to reduce the risk of developing varicose veins or getting additional ones. They apply similar approaches to varicose veins treatments. 

  • Exercise regularly: Regular exercise can improve your circulation and muscle tone to promote blood flow and prevent blood clot formation.
  • Avoid prolonged standing or sitting: Change your sitting or standing postures regularly and try to move around every 30 minutes.
  • Walk, walk and walk! Some might say your calves are your second heart! The body is engineered so that when you walk, your calf muscles pump venous blood back toward your heart. That’s right, stay out of your chair or comfy bed and walk around!
  • Raise your legs regularly throughout the day
  • Maintain a healthy weight
  • Avoid high heels and tight hosiery


Do varicose veins go away on their own?

Mild varicose veins and spider veins may fade away over time, especially if they are caused by pregnancy or certain medications. Elevating the legs and engaging in regular exercise may help alleviate the signs and symptoms of varicose veins.

How to prevent varicose veins?
What are the treatments for varicose veins?
Do varicose vein creams work?

This article was medically reviewed by Dr. Gordon Chak Man Cheung from the London Medical Clinic, Central, Hong Kong. Dr. Cheung is a General Practitioner in HK who received his medical degree from King’s College London, University of London. Before completing his General Practice specialist training in UK, Dr. Cheung had worked in various hospitals in London and South East England in Cardiology, Endocrinology, Oncology, Paediatrics, Obstetrics and Gynaecology. He holds numerous postgraduate medical qualifications including Memberships to the Royal Colleges of Physicians in UK and to the Royal College of General Practitioners, Diploma of the Royal College of Obstetricians and Gynaecologists, Child Health as well as Clinical Dermatology.

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This article was independently written by Healthy Matters and is not sponsored. It is informative only and not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be relied upon for specific medical advice.

Dr. Cheung Chak Man Gordon
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