Varicose veins on the feet
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Varicose veins on the feet are pathologically dilated, elongated, and tortuous superficial veins located on the dorsum or lateral aspects of the foot. They are one of the manifestations of chronic venous insufficiency (CVI), a disorder of venous blood outflow from the lower limbs to the heart. Their development is related to failure of the venous valves and persistent venous hypertension. Although varicose veins of the lower leg are more commonly observed, changes on the feet are not uncommon and may be the first sign of hemodynamic disturbances in the venous system. In addition to an aesthetic defect, varicose veins on the feet can cause pain, swelling, and a feeling of heaviness in the limbs, and in advanced stages lead to cutaneous and thrombotic complications.
Varicose veins on the feet – what do they look like
Varicose veins on the feet appear as veins visible through the skin, dilated and tortuous, with a color ranging from blue to bluish‑purple. They are most often located on the dorsal surface of the foot, along the course of the dorsal veins and in the area of the medial and lateral ankle.
In the clinical presentation the following can be distinguished:
- Telangiectasias (so‑called "spider veins") – small, dilated intradermal vessels with a diameter <1 mm.
- Reticular veins – vessels with a diameter of 1–3 mm, usually bluish‑purple.
- Classic varicose veins – dilated veins with a diameter >3 mm, clearly raised above the skin level.
The changes may worsen in the standing position, with high ambient temperature and toward the end of the day. Associated symptoms include:
- a feeling of heaviness in the feet,
- swelling that increases in the evening,
- tenderness on pressure,
- skin itching,
- calf muscle cramps.
In more advanced stages of chronic venous insufficiency (CVI) (CEAP classification C3–C6) hemosiderin discoloration, skin induration (lipodermatosclerosis) and venous ulcers may occur. It should be emphasized that the presence of varicose veins on the feet often coexists with great or small saphenous vein insufficiency, and therefore requires Doppler ultrasound diagnostics.
Varicose veins on the feet – how to treat
Treatment of varicose veins in the legs should depend on the stage of the disease, the presence of reflux in the main veins, and clinical symptoms. Management includes both conservative and interventional methods.
Conservative treatment aims to reduce symptoms and slow disease progression:
- compression therapy (compression stockings of an appropriate pressure class),
- venotropic pharmacotherapy (e.g., diosmin, hesperidin),
- weight reduction,
- regular physical activity (walking, swimming),
- avoiding prolonged standing or sitting.
In cases of symptomatic varicose veins with confirmed reflux, interventional treatment is indicated. Modern phlebology favors minimally invasive techniques that allow closure of incompetent vessels without traditional surgical operation.
Doppler ultrasound is crucial, as it allows assessment of the direction of blood flow, valve competency, and planning of an appropriate therapeutic strategy.
Varicose veins on the feet – removal
Varicose vein removal on the feet involves several methods, selected individually depending on the vessel's diameter, its course, and the presence of reflux in larger venous trunks.
The most commonly used methods include:
- Sclerotherapy – injection into the vessel lumen of an obliterating agent that causes its closure and fibrosis. Particularly effective for reticular veins and smaller varicose veins.
- Transcutaneous laser therapy – uses light energy to selectively close small vessels.
- Endovascular treatment (EVLT, RFA) – intravascular closure of incompetent venous trunks using laser energy or radiofrequency waves.
- Miniphlebectomy – surgical removal of individual varicose veins through microincisions in the skin.
In clinical practice, combined therapy is often used – closure of the main source of reflux (e.g., the great saphenous vein), followed by sclerotherapy of residual varicose veins in the foot.
As part of modern treatment for venous insufficiency, procedures such as sclerotherapy, laser vessel closure, and endovascular procedures are used in specialized centers that treat varicose veins of the lower limbs.
It should be emphasized that untreated varicose veins can lead to complications such as superficial thrombophlebitis or venous ulcers, therefore their presence – even if limited to the feet – requires a phlebological consultation.
