Varicose veins are swollen, twisted veins visible just beneath the skin, most commonly on the legs, feet, and ankles. They appear dark purple, blue, or sometimes the same color as your surrounding skin, and they often look like raised, rope-like cords running along the surface. If you’re noticing veins that bulge outward and feel firm or lumpy to the touch, there’s a good chance you’re looking at varicose veins.
What Varicose Veins Look Like
The most obvious sign is a vein that visibly bulges above the skin’s surface. Healthy veins sit flat or are barely noticeable. Varicose veins, by contrast, look twisted and swollen, sometimes winding across the calf or inner thigh like a thick cord. Their color ranges from dark purple to blue, though on darker skin tones these color differences can be harder to spot. You may notice them more easily by running your fingers along your legs and feeling for raised, ropey sections.
Varicose veins are different from spider veins, which are smaller, thinner, and closer to the skin’s surface. Spider veins look like fine red or blue webs and are typically flat. Varicose veins are larger (usually 3 millimeters or more in diameter), raised, and often isolated to one or two main veins rather than spread in a web pattern.
Skin changes around the vein are another visual clue. You might notice discoloration, a brownish or reddish tint to the skin near the affected area, or patches where the skin looks shinier or feels harder than usual. These changes happen because blood is pooling in the vein and leaking small amounts of fluid into surrounding tissue.
How Varicose Veins Feel
Not everyone with varicose veins has symptoms beyond the visible bulging. But most people notice at least some discomfort, especially as the day goes on. The hallmark feeling is a heavy, aching sensation in the legs, particularly after long periods of standing or sitting. Your legs may feel tired or restless in ways that don’t match how much physical activity you’ve done.
Other common sensations include:
- Burning or throbbing along the path of the vein
- Cramping, especially at night
- Itching around the vein or on the skin nearby
- Swelling in the lower leg, ankle, or foot
- Tingling or a pins-and-needles feeling in the affected area
A useful pattern to watch for: symptoms that get worse throughout the day and improve when you elevate your legs. If your legs feel noticeably better after lying down with your feet propped up for 15 to 20 minutes, that’s a strong signal that blood is pooling in your veins when you’re upright. Heat also tends to make symptoms worse, so you may notice more discomfort in summer or after a hot bath.
A Simple Self-Check
Stand in front of a full-length mirror in good lighting with your legs bare. Look at the front, back, and inner sides of both legs from the thigh to the ankle. Varicose veins are most common along the inner calf and thigh, behind the knee, and around the ankle. Run your hands slowly over your legs and feel for raised, bumpy veins that weren’t there before or that seem to be getting larger.
Pay attention to areas where you feel aching or heaviness even if you can’t see a bulging vein yet. Early varicose veins sometimes cause symptoms before they become visually obvious, particularly if they’re deeper beneath the skin. Persistent swelling in one leg, especially around the ankle, is worth noting even without visible veins.
Who Gets Varicose Veins
Varicose veins are extremely common. A long-term study of over 6,000 adults tracked from their late 60s found that about 6% developed clinically recognized varicose veins over a 13-year follow-up period, and that figure only captures cases significant enough to be formally diagnosed. Many milder cases go unrecorded.
Three factors consistently raise your risk: being female, being taller, and having a higher body weight. Pregnancy is a major trigger because of increased blood volume and hormonal changes that relax vein walls. Jobs that require prolonged standing (nursing, teaching, retail work, hairdressing) also increase your likelihood. Family history plays a significant role too. If one or both of your parents had varicose veins, your chances of developing them go up substantially.
How Doctors Confirm the Diagnosis
A doctor can often identify varicose veins through a physical exam alone, checking your legs while you’re standing to see how the veins fill with blood. But to understand what’s happening beneath the surface, the standard diagnostic tool is a duplex ultrasound. This painless, noninvasive scan combines two technologies: traditional ultrasound to create images of the vein structure, and Doppler ultrasound to measure the speed and direction of blood flow in real time.
The scan reveals whether blood is flowing backward through faulty valves, a condition called venous reflux. Healthy vein valves open to let blood flow toward the heart and snap shut to prevent it from falling back down. In varicose veins, those valves don’t close properly. Doctors define reflux as backward flow lasting more than half a second in the superficial veins near the skin’s surface, or more than one second in the deeper veins of the leg. The 2023 clinical practice guidelines from the Society for Vascular Surgery recommend duplex ultrasound as the first-choice test for evaluating venous reflux.
The ultrasound also measures the width of affected veins and checks for any blockages, which helps determine severity and guide treatment decisions.
Mild vs. Serious: Stages of Venous Disease
Varicose veins exist on a spectrum. Doctors classify chronic venous disease into stages based on visible and physical signs. At the mildest end, you might have only tiny spider veins or slightly enlarged veins with no symptoms. Classic varicose veins with visible bulging represent a moderate stage. From there, the condition can progress to persistent swelling, then to skin changes like darkening, hardening, or eczema-like irritation.
The most advanced stages involve skin breakdown and ulcers, which are open wounds that form near the ankle when prolonged blood pooling damages the surrounding tissue. These ulcers heal slowly and tend to recur. Before an ulcer forms, you’ll typically see warning signs: a discolored patch of skin (often dark red, purple, or brown), itchy or flaky skin, and a feeling that the skin in that area is unusually thin or fragile.
Skin Changes That Signal Progression
If your varicose veins are getting worse, your skin will often tell you before anything else does. Stasis dermatitis is an early warning sign. It shows up as faint, reddish discoloration on the lower leg, sometimes with itching. This happens because pooling blood causes fluid and cells to leak out of the vein and into the surrounding skin.
More advanced skin changes include brown or purplish patches that feel hard or leathery to the touch, a condition where the skin and fat layer beneath it become thick and fibrous. The skin around the ankle may look shiny and feel tight. If you notice any of these changes near a varicose vein, the condition has moved beyond a cosmetic issue. These signs indicate that the tissue in that area is under sustained stress from poor circulation, and the risk of developing an ulcer increases significantly.
Sudden warmth, redness, and tenderness along a varicose vein can indicate a blood clot forming in the superficial vein, a condition called superficial thrombophlebitis. While less dangerous than a deep vein clot, it’s painful and worth getting evaluated promptly.