More than 30 million people suffer from varicose veins or their more serious form, chronic venous insufficiency.1 Women are more commonly affected than men. Venous insufficiency is a condition that occurs when the venous wall and/or valves in the leg veins are not working effectively, making it difficult for blood to return to the heart. Chronic venous insufficiency causes blood to pool, causing stasis.
The risk factors for both men and women include age, deep vein thrombosis, obesity, smoking, cancer, occupation, muscle weakness, leg injury, inactivity, family history, phlebitis and shoegear.2 Pregnancy and poor biomechanics due to footwear make women more prone to chronic venous insufficiency than men.
Why Does Pregnancy Increase A Woman’s Risk For Chronic Venous Insufficiency?
The venous system is altered during pregnancy. These changes are both functional and structural. Up to 30 percent of women will develop venous insufficiency during their first pregnancy and the risk is higher with each pregnancy.3 If the patient already has other risk factors (such as heredity component, weight gain, etc.), the incidence increases.
• Pregnancy stresses the heart and circulatory system. During this time, a pregnant woman’s blood volume increases by 30 to 50 percent to nourish the growing fetus. This increase in blood volume allows the veins to stretch more than the normal state.
• The combination of an expanding stomach and the extra pressure the fetus puts on a pregnant woman’s body causes the veins to dilate and work much less efficiently. With the weight gain from pregnancy and with obesity, the weight puts extra stress on the veins’ one-way valves. Excess fat compresses and tries to collapse the vein. The vein valves start to malfunction, blood starts to pool, veins dilate and blood flows backward toward the feet.
• The pressure exerted on the inferior vena cava by the enlarging uterus causes obstruction of the flow of venous blood out of the legs.
Why Do High Heel Shoes Increase The Risk?
With normal heel height shoes, when the foot is off the floor, the foot veins fill with blood. As the heel and arch contact the floor, the blood flows into the relaxed calf veins. The calf muscles then contract, which propels blood up the deeper veins back to the heart.
High heels change the natural walking motion, shifting the weight to the forefoot and causing the muscles to remain contracted. This results in a decrease in the filling of the foot and calf veins, and a less forceful calf muscle pump. This lost efficiency causes pooling of venous blood in the leg.
Patients with heel heels and chronic venous insufficiency often present with the following chief complaints.
• Tightness around the calf area
• Pain subsides when raising legs
• Veins, when swollen, will push against the skin where they look bluish in color and bulge out
• Tingling or itching sensation
• Ankles, feet or lower legs will eventually develop ulcers (venous stasis ulcers)
• Skin looks scaly in the leg region
• Varicose veins (superficial)
• Cramping in the legs
• Sores and rashes start to form
• Pain increases when you stand upright
• A feeling of heaviness in the legs
• Skin starts to thicken around the ankles and legs
• Discoloration around the skin area of the ankles (brown/red)
The physical exam will reveal the following: pitting edema, venous stasis, ulcerations (medially), hyperpigmentation, chronic cellulitis, venous dermatitis, atrophie blanche and hemosiderin staining.
It is important to listen to our patients’ complaints and diagnose accordingly. We must identify the underlying etiology in order to help with the treatment protocol. Stay tuned for my next blog post on treatment options for patient with venous insufficiency.
1. Callam MJ. Epidemiology of varicose veins. Br J Surg. 1994; 81(2):167–73.
2. Fowkes FG, Evans CJ, Lee AJ. Prevalence and risk factors of chronic venous insufficiency. Angiology. 2001; 52(Suppl1):S5–15.
3. Krajcar J, Radakovic B, Stefanic L. Pathophysiology of venous insufficiency during pregnancy. Acta Med Croatica. 1998; 52(1):65–69.