Varicose veins are enlarged, twisted veins that sit close to the surface of the skin, usually on the legs. They form when the one-way valves inside a vein weaken and allow blood to flow backward and collect, stretching the vein wall until it bulges visibly. Most people first notice them as raised, rope-like blue or purple cords along the calf or thigh.
They are extremely common, and they are frequently dismissed as purely cosmetic. Sometimes that is true. Often it is not. Varicose veins are the most visible sign of underlying venous reflux, and the same faulty valves that produce the bulge can also produce aching, swelling, and over time the skin changes associated with chronic venous insufficiency.
Varicose veins and spider veins are not the same thing
Spider veins, or telangiectasias, are the fine red and blue lines that appear just under the skin surface, often in a web or branching pattern. They are much smaller than varicose veins, sit shallower, and rarely cause symptoms. Varicose veins are larger, raised enough to feel through the skin, and much more likely to be associated with reflux in a larger vein feeding them.
Both respond to compression for symptom relief, but the clinical significance differs. A cluster of spider veins on the thigh is usually a cosmetic matter. A bulging varicose vein along the calf, especially with aching or swelling, warrants an evaluation of what is happening upstream.
Symptoms beyond appearance
- Aching or heaviness - in the affected leg, typically worse after standing.
- Throbbing or burning - localized over the vein itself.
- Swelling - around the ankle and lower calf, often worse in the evening.
- Itching - over or near the vein.
- Night cramps or restless legs - particularly in the calves.
- Tenderness - the vein may be sore to touch or feel firm.
Symptoms do not track size. Small veins can be uncomfortable and large ones can be painless, which is why how the leg feels matters more than how it looks when deciding whether to seek treatment.
Why they develop
Genetics is the strongest predictor. If both parents had varicose veins, the likelihood is high. Age contributes, because valves lose competence over decades. Pregnancy is a common trigger: blood volume increases, the growing uterus raises pressure on the pelvic veins, and hormonal changes relax vein walls. Prolonged standing or sitting reduces the calf muscle pump's contribution to venous return. Excess weight increases abdominal pressure. Women are affected more often than men, largely for hormonal reasons.
Where compression fits
Compression is the first-line conservative treatment, and it does two things. It relieves the aching, heaviness, and swelling by opposing the venous pressure that causes them. And by supporting the calf pump and improving venous return, it helps limit progression toward the skin changes and complications that come with untreated reflux.
What compression does not do is make an existing varicose vein disappear. The stretched vein wall does not return to its original shape, and no garment reverses that. Anyone promising otherwise is overselling. What compression does is manage the condition and the symptoms it produces, which for many people is enough to avoid intervention entirely.
For mild to moderate varicose veins with symptoms, 15-20 mmHg is a common starting point, being light, entry-level compression that is easy to wear daily. Moderate varicose veins with more pronounced aching or swelling are usually better served by 20-30 mmHg, the most commonly prescribed level. Compression is also standard after vein procedures, where a clinician will specify the level and how long to wear it.
Treatment options beyond compression
When symptoms persist despite conservative management, or when there is significant reflux, several minimally invasive options exist. Sclerotherapy involves injecting a solution that closes the vein. Endovenous ablation uses laser or radiofrequency energy delivered through a catheter to seal the vein from the inside. In both cases the body reroutes blood through healthy veins and the treated vein fades.
These are outpatient procedures with short recovery, and compression is worn afterward as part of the protocol. A duplex ultrasound is normally done first to map which veins are involved and confirm that a procedure would help.
Everyday measures
- Walk regularly - the calf muscle pump does the work that failing valves cannot.
- Elevate your legs - above heart level for short periods, especially at the end of the day.
- Move often - break up long stretches of sitting or standing with ankle pumps and heel raises.
- Avoid prolonged heat - very hot baths and extended sun exposure dilate veins and can worsen symptoms.
- Wear compression consistently - daily wear does considerably more than occasional wear.
When to get it looked at
See a clinician if a varicose vein becomes painful, hard, or warm, if the skin over it breaks down or discolors, if swelling becomes persistent rather than resolving overnight, or if a vein bleeds. Sudden swelling in one leg with warmth or pain needs urgent assessment.
This article is general education, not medical advice. Compression is not suitable for everyone, and firmer levels should be recommended and fitted by a healthcare professional who has assessed your circulation.