Condition Guide
Venous Insufficiency
Diagnosis and management of chronic venous disease causing leg swelling, skin changes, and ulceration.
01Overview
Chronic venous insufficiency (CVI) occurs when the veins of the lower extremities fail to return blood efficiently to the heart. Normally, one-way valves within the leg veins prevent blood from flowing backward (reflux) as it works against gravity on its way up. When these valves become damaged or incompetent, blood pools in the lower legs and feet - a condition called venous hypertension. Over time, this chronic elevation in venous pressure causes a cascade of changes: swelling (edema), skin discoloration, fibrosis of the subcutaneous tissue (lipodermatosclerosis), and ultimately open venous ulcers around the ankle, which are among the most difficult chronic wounds to heal. Venous insufficiency is far more common than many patients realize, affecting an estimated 30% of adults to some degree, and it is the underlying cause of the majority of lower-extremity ulcers treated in podiatric practice.
02Causes & Etiology
The root cause of CVI is valvular incompetence in the superficial, deep, or perforating venous systems of the leg. Deep vein thrombosis (DVT) is a major precipitating event - the clot damages or destroys valve leaflets, resulting in post-thrombotic syndrome with chronic reflux. Primary valvular insufficiency, occurring without prior DVT, is also common and has a hereditary component. Prolonged standing or sitting (occupational or lifestyle factors) increases hydrostatic pressure over time and accelerates valve damage. Obesity significantly increases venous pressure in the lower limbs. Pregnancy repeatedly stresses the venous system through hormonal effects on vessel walls and mechanical compression of pelvic veins.
Risk Factors
- History of deep vein thrombosis (DVT) or pulmonary embolism
- Varicose veins (superficial venous reflux)
- Obesity and sedentary lifestyle
- Occupations requiring prolonged standing (nurses, teachers, retail workers)
- Multiple pregnancies
- Family history of varicose veins or venous disease
- Female sex (higher prevalence, particularly postmenopausal)
- Age over 50
03Signs & Symptoms
- Heaviness, aching, or fatigue in the legs - worse at end of day and relieved by elevation
- Swelling of the ankles and lower legs (edema) that pits when pressed
- Visible varicose veins or spider veins on the legs
- Skin discoloration - brownish staining (hemosiderin) around the ankles
- Dry, itchy, or inflamed skin on the lower leg (venous eczema or stasis dermatitis)
- Hardening or thickening of the skin and fatty tissue above the ankle (lipodermatosclerosis)
- Open wound or ulcer near the medial ankle that is slow to heal
- Cramping or restless legs, particularly at night
When to See Dr. Golan
If you have persistent leg swelling, skin discoloration around the ankles, or an open wound near the ankle that is not healing, seek evaluation. Venous ulcers rarely resolve without specialized wound care and treatment of the underlying venous disease. Early diagnosis and compression therapy can prevent ulceration entirely. Dr. Golan evaluates venous insufficiency as part of comprehensive wound care and lower-extremity vascular assessment.
04Frequently Asked Questions
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