Don't Forget Varicose Veins as a Cause of Leg Pain
Varicose veins are common cause of obscure leg pain, and it’s quite interesting to learn how often we see symptoms improve once venous hypertension is resolved. Even in the absence of superficial visible varicosities, internal venous reflux can lead to neuropathic symptoms of foot and toe tingling, numbness and even coldness in the presence of strong pedal pulses.
As seen here the veins within the muscle compartments can dilate in response to valve insufficiency, causing pressure on neighboring sensory nerves.
Often patients being treated with neuropathy medications can reduce or even eliminate their medication needs once the venous insufficiency is treated. Of course, there are other causes of neuropathy, such as diabetes or degenerative back disease, and treating venous issues may not impact these symptoms much at all.
When we first evaluate a patient in who we suspect venous disease is an issue, we first do a venous duplex ultrasound to provide us a roadmap of the circulation. This, then, help determine where the backflow in the veins is occurring and what treatment might be beneficial. Ablation of a refluxing saphenous vein can often be the only procedure that is required to normalize venous flow and eliminate symptoms. This office based procedure is done under local anesthesia and allows immediate return to normal activity.
Once patients develop venous reflux, due to weak vein valves, the constant pressure of gravity tends to exacerbate the condition, leading to larger veins, more discomfort, and the potential for permanent skin damage and even blood clots. Earlier intervention can limit the longer term harmful effects of varicose veins.