Location of Pain in Chronic Venous Insufficiency
Patients with chronic venous insufficiency typically experience pain in the lower leg, particularly affecting the calf and medial (inner) aspect of the lower leg, with symptoms characteristically worsening with prolonged standing or walking and improving with rest and leg elevation. 1, 2
Anatomical Distribution of Pain
The lower leg and calf region are the primary sites of discomfort, described by patients as aching, heaviness, tension, or a feeling of "dead weight" 1, 3, 2
The medial lower leg and "gaiter area" (the region from mid-calf to ankle) are particularly affected, often showing associated skin changes including hyperpigmentation and induration 4, 2
Pain is typically bilateral but can be asymmetric depending on the severity of venous disease in each leg 2, 5
The foot and ankle area may also be involved, particularly when edema is present 1
Characteristic Pain Pattern
Symptoms worsen at the end of the day, especially after prolonged standing, and usually resolve when patients sit and elevate their legs 1, 2
The pain improves with leg elevation and rest, which is a key distinguishing feature from arterial insufficiency where pain worsens with elevation 1, 2
Venous claudication (bursting leg pain during exercise) can occur in more severe cases, particularly with iliofemoral or popliteal vein involvement 3
Associated Clinical Features in Painful Areas
Pretibial edema (swelling in front of the shin) is commonly present in areas of pain 1, 2
Skin induration and hyperpigmentation often develop in the lower third of the calf where pain is experienced 1, 4
Lipodermatosclerosis (chronic inflammation and fibrosis of subcutaneous tissue) causes tightening and discomfort in the lower legs 4, 2
Critical Distinction from Arterial Disease
Unlike critical limb ischemia, CVI pain is NOT worse when supine and does not require the limb to be kept dependent for relief 1, 2
Always check lower extremity pulses and consider ankle-brachial index (ABI) before initiating compression therapy, as arterial insufficiency presents with forefoot rest pain that worsens with elevation 1, 2
Compression therapy is contraindicated if ABI <0.6, as this indicates significant arterial disease that could lead to tissue necrosis with compression 2
Severity Correlation
Women are significantly more likely than men to report lower limb symptoms 1
Patients are more likely to have symptoms and increasing severity with advancing CEAP clinical class (the classification system for chronic venous disorders) 1, 2
Narcotic medications are typically NOT required for CVI pain, unlike critical limb ischemia where narcotics are often necessary 1, 6