Varicose veins are surface veins that have become enlarged and twisted because the valves inside them stopped closing properly. Whether they need treating has little to do with how they look and a lot to do with what else the leg is doing.
When a varicose vein needs urgent attention
- Bleeding from a varicose vein. Lie down, raise the leg high, press firmly over the point with a clean pad, and get medical help. Raising the leg is what stops it — standing up makes it worse.
- A hard, hot, red, tender cord along a vein — this can be superficial thrombophlebitis, which needs assessment because it can extend into the deep system.
- A break in the skin near the ankle that is not healing.
- A whole leg suddenly swollen and painful — that is a different problem and needs same-day assessment. More →
Why they happen
Leg veins carry blood upward against gravity, helped by the calf muscles and a series of one-way valves. When valves leak, blood refluxes downward and pressure rises in the veins below. Surface veins have less support from surrounding tissue than deep veins, so they stretch, lengthen and become visibly tortuous.
Contributing factors: a strong family history, pregnancy, age, prolonged standing, previous deep vein clot, and higher body weight. Most people with varicose veins have more than one of these.
Cosmetic or clinical — the distinction that matters
| Mostly cosmetic | Clinically significant |
|---|---|
| Visible veins, no symptoms | Aching, heaviness or throbbing that builds through the day |
| Thread veins and spider veins | Ankle swelling that clears overnight |
| No skin change | Itching, dryness or eczema over the lower leg |
| No swelling | Brown or rust staining above the ankle |
| Stable over years | Skin becoming firm and tight; a previous or current ulcer |
The right-hand column is the same disease process moving forward. Those features are the argument for treating the underlying reflux rather than the appearance, and they are what most insurers look for too.
Assessment
A venous duplex ultrasound maps which veins are refluxing and how badly, and checks for clot. It needs to include a standing or tilted portion, because valve leakage only shows properly when gravity is loading the veins — a scan done entirely lying flat can miss reflux. Alongside it, an arterial check establishes whether compression is safe.
More on what the two ultrasounds do →
Treatment options
- Compression, elevation and movement. Often tried first, genuinely effective for symptoms, and continued after any procedure. Requires an arterial assessment first. Fit matters →
- Endovenous thermal ablation. A catheter delivers heat — radiofrequency or laser — inside the vein to close it. Done under local anaesthetic, usually with a rapid return to normal activity. The most common first-line procedure.
- Non-thermal ablation. Medical adhesive or a chemical agent closes the vein without heat, avoiding the need for anaesthetic along the vein’s length.
- Sclerotherapy. An agent injected into smaller veins, often foamed, used for residual or smaller vessels and for thread veins.
- Phlebectomy. Bulging surface veins removed through tiny incisions, often alongside ablation.
- Surgical stripping. The older operation, now used less often since endovenous options became available.
Closing a vein does not remove the underlying tendency, so new veins can appear over the years and compression usually continues.
What creams and supplements do
Nothing applied to the skin closes a leaking valve. Some products reduce the sensation of heaviness, which is a real benefit and a different claim from treating the disease. Be wary of anything promising to “remove” varicose veins topically — the vein is a structure several millimetres under the skin, and no cream reaches it.
Common questions
Will varicose veins get worse if I leave them?
They tend to progress slowly, and the progression is in the underlying venous pressure rather than just the appearance. Whether that matters depends on whether you have symptoms or skin changes. Visible veins with nothing else are often stable for years; veins with aching, swelling and staining are further along a path that ends in skin breakdown.
Does crossing my legs cause them?
No. That one is folklore. Genetics, pregnancy, age and prolonged standing are the real contributors.
Can I exercise with varicose veins?
Yes, and you should. Walking uses the calf pump, which is one of the main things helping your venous return. Prolonged standing still is the difficult one, not movement.
Do they come back after treatment?
The treated vein stays closed, but the underlying tendency remains, so new varicosities can develop over the years. That is not treatment failure — it is the reason compression and daily habits usually continue afterwards.
Will insurance cover it?
Varies considerably by plan. Most look for documented symptoms, skin changes, and a trial of compression before approving a procedure, and treat purely cosmetic work as not covered. Worth asking the plan directly what they require, because the documentation often has to be gathered in advance.
Where to go next
Sources
- NHS. Varicose veins.
- Society for Vascular Surgery. Chronic Venous Insufficiency.
- NHS. Leg ulcer — treatment.
Written by Tom Biernacki, DPM, FACFAS. Published 21 September 2026. General education, not medical advice.