In chronic venous insufficiency faulty valves in the leg veins let blood flow backward and pool, raising pressure in the lower leg. Over years this causes swelling, skin changes and slow-healing ulcers near the ankle, especially in people with obesity, a past DVT or long hours standing.
Key symptoms
- Aching, heavy or tired legs, worse at the end of the day
- Leg swelling that improves with elevation
- Itching or cramps
- Visible varicose veins
- Sores near the inner ankle
What you find on exam
- Varicose veins and spider veins
- Pitting edema of the lower legs
- Brown skin staining, eczema or hard, tight skin (lipodermatosclerosis)
- Shallow ulcer above the inner ankle
- Pulses and ankle-brachial index before compression
Tests
- Duplex ultrasound for reflux and past clots
- Ankle-brachial index to rule out arterial disease
- Wound culture only if the ulcer looks infected
- Kidney, liver, thyroid and heart workup if both legs swell
Treatment basics
- Compression stockings or bandages if arterial flow is adequate
- Leg elevation, walking, calf exercises and weight loss
- Skin care with moisturizers; topical steroid for eczema
- Ulcer care: compression plus wound dressings
- Vein ablation or sclerotherapy for reflux in selected patients
Red flags
- Sudden painful swelling of one leg (possible DVT)
- Spreading redness, warmth and fever (cellulitis)
- Ulcer that does not heal or looks unusual
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.