From the Guidelines
Varicose veins are primarily caused by a combination of genetic predisposition, incompetent valves, weakened vascular walls, and increased intravenous pressure, leading to symptoms such as ankle swelling, pain, and discomfort. The exact pathophysiology is debated, but established risk factors include family history of venous disease, female sex, older age, chronically increased intra-abdominal pressure, and prolonged standing 1. Ankle swelling with varicose veins can be managed through several approaches, including:
- Elevating the legs above heart level for 15-30 minutes several times daily to reduce swelling
- Wearing compression stockings (20-30 mmHg pressure) during waking hours to improve blood flow and reduce fluid accumulation, although evidence for their effectiveness is lacking 1
- Regular exercise like walking or swimming to help pump blood from the legs back to the heart
- Maintaining a healthy weight and avoiding prolonged standing or sitting
- For immediate relief, over-the-counter anti-inflammatory medications like ibuprofen (400mg three times daily with food) can help reduce swelling and discomfort
- Staying hydrated but limiting salt intake to prevent fluid retention
If swelling is severe, persistent, or accompanied by pain, skin changes, or ulcers, consulting a healthcare provider is necessary as medical treatments such as sclerotherapy, laser therapy, or surgical procedures may be required 1. These symptoms occur because varicose veins have damaged valves that allow blood to pool in the legs, causing increased pressure in the veins and forcing fluid into surrounding tissues, which manifests as swelling. Endovenous thermal ablation has become a preferred treatment option over surgery due to its potential for better outcomes and fewer complications 1.
From the Research
Causes of Varicose Veins and Ankle Swelling
- Varicose veins are caused by poorly functioning valves in the veins and decreased elasticity of the vein wall, allowing pooling of blood within the veins and their subsequent enlargement 2
- Prolonged standing and obesity are major reasons for varicose vein disease 3
- Varicose veins can be a result of existing (inherited) valve dysfunction or decreased vein elasticity (primary venous reflux) or valve damage from prior thrombotic events (secondary venous reflux) 4
- The end result is pooling of blood in the veins, increased venous pressure, and subsequent vein enlargement, leading to symptoms such as aching, swelling, throbbing, night cramps, restless legs, leg fatigue, itching, and burning 4
Risk Factors for Varicose Veins
- Obesity is a significant risk factor for varicose veins 3, 2
- Women who have had more than two pregnancies are at a higher risk of developing varicose veins 2
- Age is also a risk factor, with the prevalence of varicose veins increasing with age 4
- Family history plays a role, with a strong familial predisposition to varicose veins 4
Complications of Varicose Veins
- Varicose veins can lead to chronic venous insufficiency (CVI), which can cause complications such as phlebitis, formation of ulcers, and stasis dermatitis 5, 4
- CVI can result in chronic skin changes, including edema, hyperpigmentation, eczema, lipodermatosclerosis, and stasis ulceration 4
- Untreated varicose veins can lead to variceal rupture and hemorrhage, as well as superficial thrombophlebitis 4