Legs That Ache, Lives That Matter: Living with Chronic Venous Insufficiency

If you are listening to the news over the last week, you will undoubtedly have heard that President Trump has Chronic Venous Insufficiency (CVI). Many news sources will have shown you a picture of feet, in dress shoes and dress socks, the ankle appearing to balloon over the top of the shoes. Before now, have you ever heard of this disease? You hear the news reports saying it is common, could you have it, should you worry about it? Let’s break this down and help you know how you should respond if you see the signs of CVI.

CVI is a disease of the veins in the legs. Veins are blood vessels, or tubes, that carry blood back to the heart. The walls of the veins are thinner, and contain less muscle than the arteries, the vessels that carry blood from the heart. Also, when the heart pumps, it drives blood through the arteries, while the veins have valves in them that keep the blood from flowing backward. As the blood gets further from the heart, the pressure of each pump of the heart has less impact on the flow of the blood. So, the blood coming back to the heart, especially from the legs and feet, has the furthest way to travel with the least pushing pressure from the heart. That is why there are valves, the opening and closing of the valves helps to keep the blood flowing back to the heart, even from the farthest parts of your body. Over time, your veins may widen, which is one cause of CVI. You might ask why that would happen. There is no one cause, but a few things that CVI can be accredited to are:

·       Injury

·       Surgery

·       Long periods of standing or sitting

·       Excessive weight

·       Being over the age of 50

·       Family history

No matter how you end up with CVI, there are some signs that you may notice before your doctor tells you that you have it.

More than 25 million adults have CVI. Many of these individuals will notice their legs have edema, which is a swelling of the leg caused by extra fluid in the area. This is especially noticed in the lower leg by the ankle.  If you are a person who has CVI you may notice swelling and heaviness. This is due to the extra fluid that is collecting in your legs as the blood is not being moved through your legs as efficiently as previously. You may notice that your calf feels full and hard, this means that you have a greater chance of other complications, like ulcers. An ulcer is an open sore. When there is one on your leg it is frequently by the ankle. These are open sources which can become infected.

Some of the common symptoms you may have, that should be reported to your doctor, are:

·       A dull ache or annoying cramping

·       Burning or tingling which is more bothersome when standing but decreases if legs are put up when sitting

·       Itchiness

·       Changes to the appearance of the skin

·       Flakiness or a change in color, frequently to reddish brown

·       Weepy areas or an ulcer, at more advanced stages

If you tell your doctor about any of these symptoms, be sure to mention if you know someone else in your family who has had the same problems.  Remember, one of the causes of CVI can be connected to your family history. You should expect that your doctor will ask many questions, including how long you have noticed these symptoms. They may ask you if you have notice varicose veins. These are veins you can see close to your skin which seem twisted. You should tell your doctor about all the changes to your legs, even if you do not think they are related to CVI.

There are some tests that your doctor may decide to do, starting with a physical exam of your legs, looking them over and feeling or gently pushing on different areas. Frequently there will be an ultrasound done on your legs. This is a simple procedure, done with a handheld transducer, a small probe, with some gel on the end. This probe will be gently rubbed over your leg. A picture is transmitted to a screen that shows what is going on in your veins. This helps your doctor know how the blood is flowing or if there is any blockage.

If you are diagnosed with CVI some of the things that you should expect are quite simple and you will be able to do them at home. These may include wearing compression stockings, which will help support the veins and encourage the return of the blood to the heart.  You may also be asked to sit or lie with your legs elevated, when you are not standing. Also, your doctor will encourage you to continue or increase the exercise you do. Knowing that more weight adds to the work of the veins returning blood to the heart, your doctor will encourage you to be cautious about weight gain.

There are ways to treat your veins if your CVI has progressed that are simple treatments. Some of those treatments are non-invasive, which means that you will not have surgery for them. These include using heat or high-frequency radio waves to close the vein that is the problem. There is also an option for the doctor to inject a solution that will cause the blood to flow away from the less healthy vein that receives the injection and toward   a healthier vein. You may have heard of someone having a stent placed.  A stent is a small mesh tube that the doctor can insert into your vein in the upper leg close to your groin. When the stent is in place it will keep this vein open and promote blood flow from the leg.

If your disease is more progressed, there are surgeries that may be recommended. Less than one in ten people will require surgery. If you do need surgery, your doctor can remove a vein or sometimes tie it off, so the blood takes another path back to the heart.  As with any surgery, your doctor will discuss this prior to the procedure and tell you all the advantages and potential disadvantages. You will have time to talk about what the doctor will do. You will also be able get as much information as you need before any of these procedures are done.

Not everyone will have treatment for CVI, but everyone should look at what is the best way to live to avoid worsening of their symptoms. It is recommended that the person who has been diagnosed with CVI should move around, which includes:

·       If you stand for long periods take breaks to sit and put your feet up

·       If you sit for a long time, don’t cross your legs

·       Move your feet and ankles when sitting, this is important if you are traveling long distances as well

Moving the muscles of your legs, ankles and feet helps the muscle to support the veins and valves.

Be sure you are really looking at your skin. When you are bathing or showering it is a good time to do this. You should be looking for changes in color, any sores that appear or seem to be getting worse, and cracking of your skin. If cracks in your skin get deep enough, they may open the skin and allow an area to become infected. Moisturizing your feet and lower legs is important to keep your skin healthy. The moisturizing will decrease any itching you may have as well. Tight clothes or shoes can cause a blockage of blood flow, much like crossing your legs, be aware and choose loose clothing.

Like all diseases, the earlier you are aware of the signs of CVI and begin to practice healthy living habits, the better. CVI is not thought to be life-threatening, but it can affect the quality of the life that you are living. Remember, be aware of changes to your lower legs and your feet. Talk to your doctor about puffiness or swelling. Tell your healthcare provider if you notice a change in color of your lower legs or if there is any open sore that you notice. If you cannot adequately examine your legs, allow a partner or caregiver to look at your legs so that you are not missing an early indication of CVI. Keeping your veins, your legs, and your feet healthy will allow you to continue to live the active life you have been living.

  Cleveland Clinic. (2025). Chronic Venous Insufficiency: Causes, Symptoms and Treatment. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/16872-chronic-venous-insufficiency-cvi

  Mayo Clinic Press. (2025, July 18). What is chronic venous insufficiency? Mayo Clinic Health Letter Editors. https://mcpress.mayoclinic.org/living-well/what-is-chronic-venous-insufficiency/

  WebMD. (2024, January 12). Chronic Venous Insufficiency: Symptoms, Causes, Diagnosis, Treatment. Dumain, T., & Marks, J. https://www.webmd.com/dvt/dvt-venous-insufficiency

  Society for Cardiovascular Angiography and Interventions (SCAI). (2025). SCAI Clinical Practice Guidelines for the Management of Chronic Venous Disease. Attaran, R. R., Edwards, M. L., Bunte, M., et al. https://scai.org/publications/clinical-documents/scai-clinical-practice-guidelines-management-chronic-venous-disease

Cleveland Clinic. (2022). Leg Ulcers: What Is It, Treatments, Causes and Types. Cleveland Clinic. Leg Ulcers: What Is It, Treatments, Causes and Types

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