By: Dr. Dev Batra | 01.30.23
Your veins may actually be the reason that you experience frequent night cramps, restless leg activity, and soreness in your legs. Our patients are often surprised by the symptoms that their veins are causing. Unfortunately, the cosmetic manifestations of vein problems tend to bias our thinking away from the medically significant (and sometimes quite severe) symptoms of venous reflux.
I’ve dealt with my fair share of medical peers and even patients that stigmatize vein treatment as a cosmetic solution only, not knowing that their other symptoms are potentially a consequence of venous reflux, or that treatment today could help them avoid more advanced symptoms down the road. To help correct some of this thinking, we’ve provided a detailed review of the non-visual symptoms of venous reflux.
Vein Problems Do Not Always Have a Visual Cue
The underlying cause of most vein problems is a phenomenon known as “venous reflux.” Venous reflux refers to the condition in which blood in a vein or a group of veins flows backwards (away from the heart), causing blood to accumulate in the veins. Medical professionals will often refer to the symptoms of venous reflux as “chronic venous insufficiency” (CVI) or “chronic venous disease” to describe the medically significant problems that result from long-term insufficient flow of blood through the veins.¹
Venous reflux can cause a variety of symptoms, leading to very diverse presentation across individuals with vein problems. Some only have visual signs and no further symptoms, while others unknowingly feel the consequences of their vein problems but have no visible vein anomalies.² In many instances, patients will present with both visual signs and non-visual symptoms.
Painful cramping in the calf, especially at night, can be a telling symptom of underlying venous reflux. Our current understanding of the disease process suggests that venous reflux limits the supply of oxygen and other important nutrition to muscles, leading to an energy shortage that can cause the calf muscle to periodically ‘lock up’.³
Restless Leg Symptoms
Individuals with venous reflux frequently describe an uncontrollable urge to move the affected leg caused by throbbing, tingling, or another uncomfortable sensation. These symptoms are similar to what are commonly referred to as “Restless Leg Symptoms.” Restless leg symptoms are typically most troublesome at night and, in severe cases, can interrupt sleep. Even when legs appear normal, an ultrasound exam may reveal that restless leg symptoms are linked to underlying venous reflux; in which case, vein treatment may alleviate restless leg symptoms.⁴
Leg Pain or Soreness
It is common for venous reflux to be accompanied by general pain or soreness in the lower half of the leg even in the absence of visual vein problems. Leg pain caused by venous reflux may only manifest after walking or running a short distance, limiting physical activity. This pain pattern is sometimes referred to as ‘claudication’ and often resembles a cramping sensation.
Leg Fatigue or Heaviness
As reflux worsens, the affected area may begin to swell as fluid ‘leaks’ from the refluxing veins. Extra fluid on the legs can cause them to feel heavy while walking and tire quickly during physical activity.
Tingling or Numbness
Depending on the severity of reflux, individuals may experience sensations of tingling or numbness similar to the feeling of ‘pins and needles’ or their leg ‘falling sleep.’ These sensations may be clinically described as ‘paresthesia,’ and are typically attributed to nerve changes caused by reflux.
Throbbing or Aching
Some of our patients have described a persistent, unexplained throbbing or aching in their legs that accompanies an inconspicuous vein issue. While these sensations are not always related to venous reflux, a quick ultrasound exam may lead to the discovery of an underlying vein problem.
Itching or Burning
Venous reflux can cause changes to the skin in the affected area. During the early stages of venous insufficiency, subtle skin, and nerve changes can cause unexplained dryness, itchiness, or burning. These symptoms can persist as reflux worsens and skin changes become more overt.
The spectrum of symptoms caused by venous reflux can baffle general practitioners and other medical providers that aren’t familiar with vein pathology. Too often, vein problems aren’t considered as a cause of cramping, restless legs, or leg pain without the obvious visual signs of bulging veins or skin color changes. If you’re experiencing any of these symptoms and aren’t sure why, you may want to consider seeing a vein specialist. Vein disease is very treatable, but if left unchecked, vein symptoms can worsen over time.
About The Author
Dr. Dev Batra, M.D. is a vein specialist and founding partner of Texas Vascular Institute. Holding board certifications in Radiology and Vascular & Interventional Radiology, he is well-versed in vein issues and has been voted one of D-Magazine’s best doctors in Dallas for three years running.
This blog post was written with research and editorial assistance from OnChart™.
 Jacobs, B. N., Andraska, E. A., Obi, A. T., & Wakefield, T. W. (2017). Pathophysiology of varicose veins. Journal of Vascular Surgery: Venous and Lymphatic Disorders, 5(3), 460–467.
 Michael H. Criqui, Maritess Jamosmos, Arnost Fronek, Julie O. Denenberg, R., & D. Langer, John Bergan, and B. A. G. (2003). Chronic Venous Disease in an Ethnically Diverse Population The San Diego Population Study. American Journal of Epidemiology, 158(5), 448-456. PMC 2015 Jan 6.
 Allen, R. E., & Kirby, K. A. (2012). Nocturnal leg cramps. American Family Physician, 86(4), 350–355.
 Hayes, C. A., Kingsley, J. R., Hamby, K. R., & Carlow, J. (2008). The effect of endovenous laser ablation on restless legs syndrome. Phlebology, 23(3), 112–117.
The Materials available in the Texas Vascular Institute blog (“The Vein Blog”) are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients.
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Cramping, Itchiness, & Restless Legs: The Hidden Symptoms of Vein Problems
I’ve dealt with my fair share of medical peers and even patients that stigmatize vein treatment as a cosmetic solution only, not knowing that their other symptoms are potentially a consequence of venous reflux, or that treatment today could help them avoid more advanced symptoms down the road.
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