Dee, Sandra V. M.D.


Dee, Sandra V. M.D.

Leg Pains Are Not Created Equal

It’s the time of year to start becoming more active as everyone looks forward to the warm weather in the next few months. As you embark on your lofty fitness goals this year, have you noticed that your legs hurt when you walk a certain distance and wondered about those unsightly discolorations on your legs?

Painful legs can occur as a result of different conditions affecting the bones, joints, muscles, tendons, ligaments, blood vessels, nerves and skin. It is important to differentiate between the causes of leg pain: musculoskeletal from arthritis, trauma or injuries; neuropathy from diabetes or nerve entrapment; infections; vascular disorders due to peripheral arterial disease, venous insufficiency or blood clots.

In patients with atherosclerotic heart disease, leg pain could be secondary to peripheral arterial disease, manifested as claudication or cramp-like muscle pain during exertion or ambulation and relieved with rest or chronic venous insufficiency from varicose veins.


Varicose veins affect about 15% of men and 25% of women in the United States. This occurs when the valves that carry blood from the legs to the heart become incompetent and cause pooling of blood in the legs. They are enlarged veins that look like bulging cords that appear blue, red or flesh colored. Chronic venous insufficiency (CVI) is a progressive medical condition that worsens in time, affecting the veins of the leg and varicose veins.


There are several predisposing factors that contribute to the development of varicose veins. These include heredity, female gender, hormonal changes such as puberty, pregnancy or menopause, obesity, aging, prolonged standing, previous leg injury or blood clots.


Symptoms of varicose veins include leg heaviness, pain or fatigue, ankle or leg swelling, leg cramps, bulging rope-like cords on the legs, skin changes or discoloration, hyperpigmentation, dermatitis, itchiness and non-healing ulcers.


Treatments of varicose veins include conservative management and/or the use of different modalities or procedures. Conservative treatment to improve symptoms involves leg elevation, use of anti-inflammatory agents, exercise and wearing prescription strength compression stockings.  Exercise will not remove varicose veins, but it can empty the pooled blood from the legs and ease the painful symptoms. The use of compression stockings not only alleviates the swelling and pain but also helps heal inflammation and ulcerations due to venous reflux.

Specific treatment for varicose veins depends on the severity of the condition. Treatment includes sclerotherapy, micro-phlebectomy, endovenous laser ablation (EVLT), radio frequency ablation (VNUS), ligation and stripping. Treatment of varicose veins is an outpatient office procedure, which does not require general anesthesia or hospitalization. A non-invasive Doppler ultrasound and mapping of the veins are performed and your individualized treatment plan is formulated.  Local anesthesia is applied, and a procedure is conducted to seal the faulty vein.  Sclerotherapy is a non-surgical procedure where a solution is injected into the lining of the vessel, which causes inflammation, fibrosis and closure of the vein. Microphlebectomy involves making tiny punctures through which varicose veins are removed.


Spider veins are dilated capillary veins or telangiectasia that appears as tiny purple or red blood vessels under the skin surface of the leg. These “broken veins” are also visible around the nose or lips.  Treatment for spider veins is sclerotherapy. Patients are advised to wear compression stockings for two - three days after treatment.

It is important to be aware that leg pains could be due to a number of causes, and if you develop considerable pain, swelling or ulcers, you must seek urgent medical attention. Consult your provider if you are concerned about why you have leg pains, swelling or discoloration.