Do You Have Your Mother’s Legs?
One of the strongest risk factors for varicose veins is a family history. We often see mothers and their daughters, fathers and sons, siblings, and some times the entire family for similar varicose vein issues. This picture demonstrates a mother and her daughter with ironically the same varicose vein pattern of distribution. Don’t want your mother’s legs? Stay on top of your vein condition and have them treated or maintenance treatment to avoid bulging varicosities.
70% of chronic leg wounds are a result of long standing varicose veins and underlying venous insufficiency. Ulcers, or leg wounds are usually preceded by changes of the skin such as a brownish skin discoloration around the ankles and stasis dermatitis. A venous leg ulcer is often referred to as a ‘stasis ulcer’ since blood is stagnant in varicose veins.
Recognize the signs and symptoms of venous disease:
heavy, tired and aching legs
swollen legs and or ankles
cramping in the legs
dull or sharp pain in the calf
varicose veins and spider veins
red or warm veins
itching around the veins
skin changes around the ankles such as pigmentation, brownish discoloration, eczema, new red and blue veins, breakdown of the skin
In the circulatory system, the veins carry de-oxygenated blood back to the heart. The leg veins carry blood toward the heart, against gravity. Therefore, the leg veins have one-way valves the prevent back flow of blood. When the valves do not function properly, they allow blood to flow backward, causing pooling of blood. This is referred to as venous reflux or venous insufficiency. Eventually, the backflow of the blood will cause varicose veins to develop and symptoms related to the increased pressure in the leg veins such as leg heaviness, aching, swelling, restless legs, night cramps, throbbing and pain.
Muscle herniations of the legs frequently are confused with varicose veins. Patients may present with bulging along the outer part of the shin, that looks like a varicose vein. It may or may not be painful. It goes away with flexing the foot (pointing your toes to your head). But, to experienced vein care specialists, it is clearly a muscle herniation.
A Muscle herniation is a focal protrusion of muscle tissue through a defect in the deep fascial layer. Anterior tibial muscle is the most commonly affected muscle of the lower extremities because its fascia is the most vulnerable to trauma. Clinically it is characterized by asymptomatic or painful, skin-coloured, soft, subcutaneous nodules of various size depending on the position. The diagnosis is usually made clinically based on its typical manifestations, but ultrasonographic examination is useful for detecting the fascial defect and excluding other conditions caused by soft tissue tumours such as lipomas, angiolipomas, fibromas, schwannomas or varicosities.
Usually, surgical treatment is not needed, but may be necessary for increasingly painful hernias.
At La Jolla Vein Care, we frequently see muscle herniations that are confused with varicose veins. Using ultrasound technology and a clinical examination, we can make the accurate diagnosis.
A point mutation (G20210A) in the Factor II (prothrombin) gene is the second most common cause of inherited blood clots and accounts for 20% of the inherited blood clotting disorders. The incidence of this mutation in the Caucasian population is 1-2% and in African Americans it is 0.1%. Carriers of this mutation have an increased risk (3x) of developing a blood clot in the deep veins (deep venous thrombosis or DVT). A test for this mutation is usually only recommended if there is a family history of blood clots (DVT) or in cases where the cause of the blood clot is not clear or in pregnant women with recurrent miscarriages. A more common cause of a blood clotting disorder that is inherited from the parents is the Factor V Leiden mutation.
It is impossible to prevent an inherited tendency toward having varicose veins, but it is certainly possible to take measures that will help. Remember that varicose veins are veins that have been stretched so often that they have become chronically dilated. The trick is to limit the opportunity to distend the veins.
1. Wear compression stockings
2. stay fit and maintain a healthy weight
3. exercise: exercising helps your veins pump blood.
4. avoid prolonged sitting or standing
5. avoid prolonged exposure to direct sunlight
6. elevate your legs as much as possible
Varicose veins and venous insufficiency are neglected causes for restless leg syndrome. Restless legs syndrome (RLS) is a neurological disorder characterized by throbbing, pulling, creeping, or other unpleasant sensations in the legs and an uncontrollable, and sometimes overwhelming, urge to move them. Symptoms occur primarily at night when a person is relaxing or at rest and can increase in severity during the night. Moving the legs relieves the discomfort. Often called paresthesias (abnormal sensations) or dysesthesias (unpleasant abnormal sensations), the sensations range in severity from uncomfortable to irritating to painful.
RLS is often felt to be a neurological problem that is treated with medication, but there are other causes such as thyroid disease, anemia, pregnancy, and varicose veins. RLS is actually common amongst patients with varicose veins. La Jolla Vein Care’s Dr. Bunke completed a clinical study at UCSD along with Dr. Maria Alfaro, MD evaluating the correlation between restless leg syndrome and varicose veins. Eight patients who had restless legs syndrome, and underlying venous insufficiency were study. These patients underwent treatment of their varicose veins either with foam sclerotherapy or endovenous ablation. All patients had either resolution or improvement of their restless legs symptoms, eliminating the need for neurological medications. The impact of this study is that all patients with RLS should be screened for venous disease clinically by their doctors. If they have signs of venous disease such as varicose veins, Dr. Bunke recommend an ultrasound evaluation. ‘If RLS symptoms are related to varicose veins, it is correctable by treating the varicose veins, eliminating the need for pharmacologic therapy in many patients and a better nights sleep,’ says Dr. Bunke.
Complications of Varicose Veins #6: Darkening of the Skin Around the Ankles
Untreated varicose veins and underlying venous insufficiency can cause changes of the skin, including darkening of the skin. We call this skin hyperpigmentation. This usually occurs in the inner ankle and can worsen to involve the lower portion of the leg as shown in the picture. Over time, the skin becomes firm, dry, eczema like and can even break open, causing a venous leg ulcer. When the skin becomes darker as a result of a vein problem, this is referred to as chronic venous insufficiency (CVI). This can be prevented by addressing the underlying venous insufficiency and varicose veins early on.