Normal veins in our legs

Blood flow is a two-way traffic. Blood is pumped from the heart and is carried to various parts of the body by arteries. This blood is then returned to the heart by veins.


Blood from the legs is returned to the heart by a two-lane system of veins; the deep system and the superficial system.

The deep system of veins are located between the muscles of the legs and return the majority of blood from the legs to the heart. The superficial system of veins are present just under the skin. It is the visible bulging of these veins that are called varicose veins.

Venous Insufficiency Treatment

How do varicose veins develop?

Normally, the muscles in the leg act like a pump, squeezing the blood within the veins. The blood can move up towards the heart, or down towards the feet. One-way valves within these veins only allow the flow of blood up towards the heart.


In superficial veins, when one or more valves are not working properly, blood then tends to flow in the wrong direction, down towards the legs. This leads to bulging of the segment of vein that is controlled by the deformed valves. These bulges are called varicose veins and can be seen below the skin.

Normal Vein and Varicose Vein

Source: National Heart, Lung, and Blood Institute; National Institutes of Health; U.S. Department of Health and Human Services

Figure A shows a normal vein with a working valve and normal blood flow. Figure B shows a varicose vein with a deformed valve, abnormal blood flow, and thin, stretched walls. The middle image shows where varicose veins might appear in a leg.

Problems due to varicose veins

Cosmesis - Most varicose veins are cosmetically unacceptable but may not cause symptoms. By 80 years of age, 80% of people have prominent veins in the leg.

Ache / pain - Over a period of time varicose veins tend to get worse and can cause aching especially after standing for long periods of time. The ache can continue even when resting. Varicose vein can be the cause of heaviness and tiredness of legs and swelling around the ankle. Support tights help some people, but this is not a practical long-term solution.

Thrombophlebitis – Clots tend to form within the bulging veins causing a very painful, red and tender lump around the varicose vein. If this occurs once, then there is high chance that this may occur again and again.

Skin changes – In some patients who have had varicose veins for years, a rash (varicose eczema) can appear on the lower leg.

Ulcers – Untreated varicose veins can cause venous ulcers. Varicose ulcers are managed initially by compression hosiery or bandaging. This is a long and uncomfortable process. Unless the underlying causes, i.e. the varicose veins, are treated the ulcers will return.

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Other types of veins

As well as varicose veins other problems with veins can occur. These include reticular veins and thread veins

Reticular veins are flat blue veins commonly seen behind the knees. They are located in the deeper layers of the skin

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Thread veins, also called as spider veins, are the very thin-walled veins that resemble a spider web or tree branch in shape. These lie very close to the surface of the skin. Spider veins are commonly found on the legs and face, and can be red or blue in colour.

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