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Varicose veins are enlarged and twisted veins. Any superficial veins can get varicosed; however, the most common ones are the ones present in the legs. The veins of the legs are more prone because standing and walking increase the venous pressure in the lower body.

For most people, varicose veins are a cosmetic concern, while for some, it is a painful condition causing discomfort. However, one should not take the condition lightly as it can lead to more serious problems.

Physiology

The blood in our body is circulated from the heart to the rest of the body through arteries, and the blood returns to the heart through veins. The blood is propelled back to the heart by its pumping, and it is pushed by our leg and foot muscles when we move our ankle or walk.

Veins in our body are one-way valves that stop the blood from falling in the backward direction. These valves can get damaged, and when this happens, the veins become swollen. The pressure in the veins increases than in the arteries, and the blood starts to flow backwards. The blood starts to collect in the veins making it enlarged and swollen, and as a result, you may see swollen veins on your legs.

Symptoms of Varicose Veins:

Varicose veins are usually painless. The signs that you should look for are:

a.  Dark-purple or blue-coloured veins.

b. Twisted or bulging veins that look like cords in the legs.

c.  Heavy or achy feeling in your legs

d. Swelling or burning in your legs

e.  Itching

f.  Skin discolouration

g. Pain getting worse after prolonged sitting or standing

Spider veins are similar to varicose veins, but they are smaller and are found closer to the surface of the skin. They are mostly red or blue in colour.

Causes of Varicose veins:

Incompetent valves lead to varicose veins. Arteries carry blood from the heart to other parts of the body, and veins return the blood from other parts of the body to the heart. The veins present on the legs have to work against gravity to allow the blood to reach the heart. There are tiny valves in eth veins that open when blood flows towards the heart, and they close to stop the blood from going backwards. When these valves are damaged, blood goes in the backward direction resulting in pooling leading to stretching and twisting of the veins. In addition, muscle contraction of the calf also acts as a pump that helps the blood is returning to the heart.

Risk factors:

There are a few factors that increase the risk of developing varicose veins like:

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a. Age – The chances of developing varicose veins increases with age. With age, the valves that help in regulating the blood flow get damaged slowly. Eventually, the blood flows back to the veins resulting in varicose veins.

b. Gender – Women are more susceptible to developing varicose veins. Hormonal changes during periods, pregnancy or menopause relax the walls of the veins. In addition, hormonal treatments like birth control pills etc., also increase your chance of developing varicose veins.

c. Pregnancy – Pregnancy causes the blood volume in your body to increase to support the growing fetus. However, this also causes the veins in the legs to enlarge. Hormonal changes during pregnancy also play a key role in developing the condition.

d. Obesity – If you are overweight, your chances of developing varicose veins is high as extra weight puts additional pressure on your veins (van Rij et al., 2008).

e.  Prolonged sitting or standing – If you are sitting or standing in one position for very long, the contraction of the calf muscle doesn’t happen, resulting in blood pooling in the veins (Bahk et al., 2011).

f. Family history – If someone in your family has varicose veins, there are high chances that you will also have it.

Prevention:

To decrease the risk of developing varicose veins, there are a few things that you should keep in mind:

• Engage in plenty of exercise like walking

• Keep your body weight in the normal range

• Don’t stand for too long

• Avoid sitting with crossed legs

• Keep your feet raised by putting them on a pillow while sitting or standing

Treatment:

There are a lot of options available to treat varicose veins. Some of them are:

1. Surgery – The surgery for varicose veins is minimally invasive. During the procedure, the damaged vein is either removed or is sealed shut so that blood can be redirected to the healthy veins. The procedure can either be done using a traditional approach or by new endovenous techniques.

2. Radiofrequency ablation therapy – Ablation is the process of damaging the tissue using heat. In RFA, radiofrequency energy is used to heat the wall inside a vein which makes the varicose veins of the leg shrink and collapse. Study shows that patients undergoing RFA have a faster recovery and earlier return to work (Lin et al., 2015)

3. Physiotherapy treatment

Patients’ education is one of the most important steps to get a better outcome. Changing lifestyle, controlling weight, and regularly exercising are a few things that you can do to keep your ankle joint and calf muscles supple.

a.  Compression stockings – Compression therapy by using elastic stockings, pneumatic compression devices and bandages is recommended for patients with varicose veins. One study found that compression stockings can be used in the early stages of varicose veins to prevent the condition from getting worse (Shingler et al., 2010). Chronic venous insufficiency is a condition that demands lifelong care, so the patient is advised to maintain normal body weight and wear compression stockings for the complete day.

Compression garments combined with leg elevation and oral pain medications provide relief to most patients. Compression therapy is best for patients who do not want to have surgery. The recommended compression rate is 20-30 mmHg; however, it can be increased to 30-40 mmHg in some cases. A compression stocking is a good option for patients with varicose veins, but hot weather can be the biggest issue with such patients.

b. Exercise program – One of the causes of Varicose veins may be immobility of the ankle due to storage of fibrotic tissue. Due to this, the calf pump cannot work, leading to the pooling of venous blood. So, a good exercise program is used to improve muscle pump function.

A walking motion is needed to activate the calf muscle pump. One study found that exercise two times a week increase the angle of dorsi and plantar flexion in people with varicose veins (ÖZdemir & Surmeli, 2017).

If you have varicose veins, then exercises are a must to prevent them from getting worse and reduce the discomfort caused by the condition. Usually, low impact exercises are the best in varicose veins:

i.                 Walking – Walking for 30 minutes daily for five days a week can produce good results. You can also try running wearing good shoes and on the grassy surface to minimize the stress on your joints.

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ii.          Bicycling – Riding a bicycle is also highly effective in varicose veins. If you don’t own a bike, you can do bicycle legs exercises at home. Lie down on your back, put your legs in the air and bend them from your knees. Pedal slowly as if you are bicycling. Try doing the exercise with alternate legs.

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iii.           Leg lifts – Lie on your back and straighten the feet. Lift one leg at a time and hold it for a few seconds. Slowly lower it down and continue with the other leg.

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iv.          Lunges – Stand with your legs apart and take a step forward. Bend from your knee and ensure that your knee is directly above your ankle. Hold the position and slowly straighten the leg while keeping the back in neutral. Continue with the other leg.

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v.     Rocking the feet – Rock your feet back and forth by transferring the weight from toes to heel and vice versa. You can do this exercise anytime when you are sitting or standing. 

c.  Kinesio taping – Skin taping is also effective in boosting the circulation of the region by making the dermis rise up. Kinesio taping works as an alternative compression therapy in patients with venous insufficiency (Naci et al., 2020).

Many people ignore the condition of varicose veins by considering it a harmless cosmetic condition. But if varicose veins are not treated in time, it can lead to discolouration and pooling of blood in the calf and ankle. If the condition worsens, it can cause superficial phlebitis, which is a painful condition. Physiotherapy can help you in improving your condition before it becomes dangerous. Experts from Progressive care can help you in managing the discomfort caused by Varicose veins. 

References:

a.  Van Rij, A., de Alwis, C., Jiang, P., Christie, R., Hill, G., Dutton, S., & Thomson, I. (2008). Obesity and Impaired Venous Function. European Journal of Vascular and Endovascular Surgery, 35(6), 739–744. 

b. Bahk, J. W., Kim, H., Jung-Choi, K., Jung, M. C., & Lee, I. (2011). Relationship between prolonged standing and symptoms of varicose veins and nocturnal leg cramps among women and men. Ergonomics, 55(2), 133–139.

c.  Lin, F., Zhang, S., Sun, Y., Ren, S., & Liu, P. (2015). The management of varicose veins. International Surgery, 100(1), 185–189. 

d. Shingler, S., Robertson, L., Boghossian, S., & Stewart, M. (2010). Compression stockings for varicose veins. Cochrane Database of Systematic Reviews. Published. 

e.  ÖZdemir, Z. I., & Surmeli, M. (2017). Conservative Management of Chronic Venous Insufficiency. Clinical Physical Therapy. Published. 

f.  Naci, B., Ozyilmaz, S., Aygutalp, N., Demir, R., Baltaci, G., & Yigit, Z. (2020). Effects of Kinesio Taping and compression stockings on pain, edema, functional capacity and quality of life in patients with chronic venous disease: a randomized controlled trial. Clinical Rehabilitation, 34(6), 783–793.