When Your Leg Veins Aren’t Working as They Should

Heavy, aching or swollen legs can sometimes be a sign that blood is not returning efficiently from the legs toward the heart. These symptoms are commonly associated with chronic venous disease (CVD), a broad term covering conditions that affect the veins in the legs.

Chronic venous disease ranges from relatively mild symptoms and visible varicose veins to persistent swelling, skin changes and, in more advanced cases, venous ulcers. Chronic venous insufficiency (CVI) generally refers to more significant venous dysfunction in which the veins have difficulty returning blood efficiently from the legs.

Compression therapy is commonly used as part of the management of chronic venous disease. Understanding what is happening inside the veins can help explain where compression socks and stockings fit into treatment.

What is Chronic Venous Disease?

The veins in your legs have an important job: returning blood toward your heart, often against gravity. One-way valves inside the veins help prevent blood from flowing backward, while contractions of the calf muscles help push blood upward through the legs.

When these mechanisms do not work efficiently, blood can pool in the leg veins and pressure within the venous system can increase. This is known as venous hypertension and is an important part of chronic venous disease.

Chronic venous disease can include:

• Aching, tired or heavy legs
• Spider veins or reticular veins
• Varicose veins
• Swelling around the ankles or lower legs
• Skin discoloration or other skin changes
• Chronic venous insufficiency
• Venous leg ulcers in advanced disease

Chronic Venous Disease vs. Chronic Venous Insufficiency: What’s the Difference?

The terms chronic venous disease and chronic venous insufficiency are sometimes used interchangeably, but they do not mean exactly the same thing.

Chronic venous disease is the broader term. It includes the full range of problems associated with abnormal venous function, from symptoms such as aching or heaviness to visible veins and more advanced complications.

Chronic venous insufficiency generally describes more significant venous dysfunction and is often associated with persistent edema, skin changes or ulceration.

Put simply: chronic venous disease is the broader category; chronic venous insufficiency describes more advanced manifestations of that disease.

What Causes Chronic Venous Disease?

Chronic venous disease can develop for several reasons. One of the most common mechanisms is venous reflux, which occurs when valves inside the veins do not close effectively and blood flows backward.

Venous obstruction can also interfere with blood flow, and some people have a combination of reflux and obstruction. Reduced effectiveness of the calf muscle pump can further affect venous return.

Factors associated with chronic venous disease can include:

• Increasing age
• Family history of venous disease
• Pregnancy
• Obesity
• Long periods of standing or sitting
• Reduced mobility
• Previous injury or damage to the veins
• A history of deep vein thrombosis (DVT)

A previous DVT can damage veins or their valves and may lead to a condition known as post-thrombotic syndrome.

What Are the Symptoms of Chronic Venous Disease?

Symptoms vary considerably between people and may change depending on the severity of the underlying venous problem.

Common symptoms can include:

• Tired or heavy-feeling legs
• Aching or discomfort
• Throbbing or burning sensations
• Swelling around the ankles or lower legs
• Visible varicose veins
• Itching or irritation
• Leg cramps
• Symptoms that become worse after prolonged standing

More advanced venous disease can cause persistent swelling, changes in skin colour or texture and, in some cases, venous leg ulcers.

How Can Chronic Venous Disease Progress?

Chronic venous disease exists on a spectrum. Some people experience symptoms without obvious visible changes, while others develop varicose veins, persistent edema or skin changes.

A simplified way of looking at the spectrum is:

Early symptoms → visible spider or varicose veins → persistent swelling → skin changes → advanced chronic venous insufficiency → venous ulceration

This does not mean that everyone with chronic venous disease will progress through each of these stages. The condition can present differently from one person to another.

Healthcare professionals may use the CEAP classification system to describe the clinical severity of chronic venous disease, ranging from no visible signs through varicose veins, edema, skin changes and healed or active venous ulcers.

Where Does Compression Therapy Fit?

Compression therapy is an established conservative approach used in the management of many forms of chronic venous disease.

Graduated compression applies the greatest pressure around the ankle, with the pressure gradually decreasing higher up the leg. This external pressure helps support venous return and can help manage fluid accumulation in the lower legs.

Compression may help manage:

• Leg swelling
• Aching and discomfort
• Heaviness or fatigue
• Symptoms associated with varicose veins
• Edema associated with chronic venous disease

Compression can help control symptoms, but it does not necessarily correct the underlying venous abnormality. Depending on the cause and severity of the disease, additional medical treatment may be appropriate.

If you are new to compression therapy, our complete guide to compression socks and stockings explains compression levels, styles, fit and common uses in more detail.

Do Compression Socks Help Varicose Veins?

Compression stockings are commonly used to help manage symptoms associated with varicose veins, including aching, heaviness and swelling.

Compression does not eliminate existing varicose veins. If varicose veins are painful, worsening or associated with significant swelling or skin changes, a healthcare professional may recommend further assessment or treatment.

What Compression Level Is Used for Chronic Venous Disease?

Medical compression is commonly described in mmHg (millimetres of mercury). Higher numbers indicate stronger compression.

The appropriate compression level depends on the condition being treated, the severity of symptoms, the person's circulation and the recommendations of their healthcare professional.

Stronger is not automatically better. The appropriate compression level depends on the underlying condition, arterial circulation, medical history and other individual factors.

For more detail, see our guide to choosing a compression level and our explanation of compression ratings and mmHg.

Knee-High, Thigh-High or Waist-High Compression?

Medical compression garments are available in knee-high, thigh-high and waist-high styles. The most appropriate length depends on where symptoms occur, the underlying venous condition and the recommendations of your healthcare professional.

Knee-high compression is commonly used when symptoms are concentrated in the lower leg, while thigh-high or waist-high garments may be appropriate when compression is needed higher on the leg.

Getting the Right Fit Matters

Compression stockings need to fit correctly to provide the intended level of graduated pressure. A garment that is too large may not provide adequate compression, while one that is too small may be uncomfortable or inappropriate.

Measurements are generally best taken when swelling is at its lowest, often earlier in the day. Depending on the garment, measurements may include the ankle, calf, leg length and, for longer stockings, the thigh.

Our compression sock measuring guide explains how to take the measurements used by most major compression brands.

When Are Compression Socks Worn?

Compression stockings are commonly worn during the daytime, when gravity and daily activity place greater demands on the veins in the legs.

Many people put their stockings on in the morning, before significant swelling develops, and remove them later in the day. However, individual instructions can vary depending on the condition being treated.

If you find medical compression difficult to put on, see our guide to putting on compression socks correctly.

Are Compression Socks Safe for Everyone?

No. Compression is not appropriate for every person or every circulatory condition.

In particular, arterial circulation needs to be considered before stronger compression is used. People with known or suspected peripheral arterial disease, significant circulatory problems or other relevant medical conditions should seek professional advice before beginning compression therapy.

If you are uncertain whether compression is appropriate for you, speak with a qualified healthcare professional.

When Should You Speak With a Healthcare Professional?

Medical assessment is particularly important if you experience:

• New or unexplained leg swelling
• Swelling affecting only one leg
• Significant or worsening leg pain
• Sudden changes in your symptoms
• Persistent skin discoloration or other skin changes
• Open wounds or ulcers around the lower leg or ankle
• Painful or increasingly symptomatic varicose veins
• Symptoms that continue to progress despite conservative management

Choosing Compression for Chronic Venous Disease

Once the appropriate compression level and garment length have been determined, comfort and wearability become important. A compression stocking only works when it is worn consistently as recommended.

Medical compression is available in a wide range of fabrics and styles, including opaque, sheer, cotton and microfiber options. Different materials can provide different levels of softness, breathability, durability and ease of application.

Our compression sock style and fabric guide can help explain the differences.