From the Guidelines
Varicose veins and ankle swelling are primarily caused by weakened valves in the leg veins, allowing blood to pool and increasing pressure that forces fluid into surrounding tissues, and can be managed through elevation, compression therapy, regular exercise, and avoidance of prolonged standing or sitting. The clinical presentation of varicose veins varies, and some patients may be asymptomatic, but localized symptoms may include pain, burning, itching, and tingling at the site of the varicose veins, while generalized symptoms consist of aching, heaviness, cramping, throbbing, restlessness, and swelling in the legs 1. Established risk factors for varicose veins include family history of venous disease, female sex, older age, chronically increased intra-abdominal pressure, prolonged standing, deep venous thrombosis, and arteriovenous shunting 1. To manage ankle swelling, it is recommended to elevate your legs above heart level for 15-30 minutes, 3-4 times daily, and wear compression stockings with a minimum pressure of 20 to 30 mm Hg during the day, putting them on before getting out of bed 2. Regular exercise like walking or swimming improves circulation, while avoiding prolonged standing or sitting helps prevent fluid buildup. For immediate relief, over-the-counter anti-inflammatory medications like ibuprofen (400mg every 6-8 hours with food) can reduce discomfort, and applying cold compresses for 15-20 minutes several times daily can decrease swelling. If swelling persists, worsens, is accompanied by pain, skin changes, or ulcers, seek medical attention as more advanced treatments like sclerotherapy or surgical options might be necessary. Compression therapy has been widely described as the best initial treatment for varicose veins, reducing venous stasis, containing edema, and improving lymphatic drainage 2. It is essential to note that adherence to compression therapy should be encouraged with proper fitting, education, and detailed instructions, and caution is advised when the ankle-brachial index is <0.6, as it indicates an arterial anomaly needing revascularization 2. Key factors to consider when managing varicose veins and ankle swelling include:
- Elevation of the legs above heart level
- Compression therapy with a minimum pressure of 20 to 30 mm Hg
- Regular exercise
- Avoidance of prolonged standing or sitting
- Use of over-the-counter anti-inflammatory medications
- Application of cold compresses
- Monitoring for signs of more serious underlying vascular insufficiency, such as changes in skin pigmentation, eczema, infection, superficial thrombophlebitis, venous ulceration, loss of subcutaneous tissue, and lipodermatosclerosis 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 3
- Prolonged standing and obesity are major reasons for varicose vein disease 4
- Varicose veins can be caused by existing (inherited) valve dysfunction or decreased vein elasticity (primary venous reflux) or valve damage from prior thrombotic events (secondary venous reflux) 5
- The end result of varicose veins 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 5
Risk Factors for Varicose Veins
- Obesity is a major risk factor for varicose vein disease 4, 3
- Women who have had more than two pregnancies are at a higher risk of developing varicose veins 3
- Age is also a risk factor, with varicose veins affecting up to 40% of adults 3
- Family history also plays a role, with a strong familial predisposition to varicose veins 5
Complications of Varicose Veins
- Varicose veins can lead to chronic venous insufficiency (CVI), which can result in chronic skin changes, including edema, hyperpigmentation, eczema, lipodermatosclerosis, and stasis ulceration 5
- CVI can also lead to a reduced quality of life, particularly in relation to pain, physical function, and mobility 5
- Varicose veins can also lead to superficial thrombophlebitis, variceal rupture, and hemorrhage 5