It is well known that the presence and severity of symptoms do not correlate with the size or severity of the varicose veins present. Symptoms usually attributable to varicose veins include feelings of heaviness, tiredness, aching,
TABLE 12.2 Symptoms of Varicose Veins and Telangiectasias
Aching Heaviness (on standing, prolonged sitting) Aching Pain (on standing, prolonged sitting) Burning (venous neuropathy) Itching (cutaneous inflammation) Nocturnal Cramps (recumbent edema reduction)
Trendelenburg Test Cough Test Schwartz Test Perthes' Test burning, throbbing, itching, and cramping in the legs (see Table 12.2). These symptoms are generally worse with prolonged sitting or standing and are improved with leg elevation or walking. A premenstrual exacerbation of symptoms is also common. Generally, patients find relief with the use of compression in the form of either support hose or an elastic bandage. Weight loss or the commencement of a regular program of lower extremity exercise may also lead to a diminution in the severity of varicose vein symptoms. Clearly, these symptoms are not specific, as they may also be indicative of a variety of rheumatologic or orthopedic problems. However, their relationship to lower extremity movement and compression is usually helpful in establishing a venous origin for the symptoms. Significant symptoms suggestive of venous disease should prompt further evaluation for valvular insufficiency and calf muscle pump dysfunction. If a venous etiology is suspected but all examinations are negative, repeat examination during a symptomatic period is warranted and often fruitful.
The recent development of an extremely painful area on the lower leg at the ankle associated with an overlying area of erythema and warmth may be indicative of lipodermato-sclerosis, which may be associated with insufficiency of an underlying perforator vein, and examination for this lesion should be performed. Lipodermatosclerosis may precede ulceration and has been shown to be improved by stiff compression and certain pharmacologic interventions.
Patients with a history of iliofemoral thrombophlebitis who describe "bursting" pain with walking may be suffering from venous claudication. In these patients an evaluation for persistent hemodynamically significant obstruction, possibly treatable with angioplasty and stenting, may be in order.
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