Also called: Vein disease; heavy legs
Relief and prevention
Strength
Stretch
Bulging veins, heavy aching legs and ankle swelling by evening. The valves in the leg veins have failed, and the calf muscle pump is the only remaining mechanism pushing blood back up - which is why standing still is the worst thing and walking is the best.
How common: 20-25% of adults have varicose veins; chronic venous insufficiency in up to 40% of women over 50
What it is
Leg veins return blood upward against gravity using one-way valves and the squeezing action of the calf muscles. When the valves fail, blood falls back down and pressure in the veins stays high, which stretches them further and damages more valves.
The calf muscle pump is what is left. Each contraction squeezes the deep veins and moves blood upward, and it is remarkably effective - which is why symptoms are worst after prolonged standing or sitting and better after walking, and why calf strengthening is a genuine treatment rather than a general recommendation.
What it feels like
- Aching, heavy or tired legs, worse at the end of the day
- Visible bulging or rope-like veins
- Ankle swelling that is worse in the evening and gone by morning
- Itching or a burning sensation over the veins
- Sometimes night cramps and restless legs
What causes it
Most people have more than one of these at once, and they feed each other. Read the
list looking for the two or three that sound like your week rather than for the one
true answer — the ones that describe you are the ones worth acting on.
- Failed venous valves
- The one-way valves that stop blood falling back down become incompetent. The resulting high pressure stretches the vein further and damages the next valve down, which is why it progresses.
- A weak or unused calf muscle pump
- Calf contraction is the main mechanism returning blood from the legs. A weak or idle pump means blood sits in the veins at high pressure for hours.
- Prolonged standing still
- Standing without moving is the worst possible position: full gravitational load with no pump action at all. Occupations involving it show consistently higher rates.
- Prolonged sitting
- Sitting also idles the pump and adds compression at the back of the thigh. Long flights and long drives are common aggravators.
- Genetics
- Family history is one of the strongest predictors, reflecting inherited differences in vein wall and valve structure.
- Pregnancy
- Increased blood volume, hormonal relaxation of vein walls and pressure from the uterus all contribute. Varicose veins commonly first appear during pregnancy and partly regress afterwards.
- Body weight
- Extra abdominal weight raises the pressure the leg veins have to work against, and it is associated with more severe disease.
- A previous deep vein thrombosis
- A clot damages the deep vein valves directly, producing post-thrombotic syndrome - the same picture but usually more severe.
- Age
- Vein walls and valves lose elasticity over time, so prevalence rises steadily through life.
- Sex and hormones
- More common in women, and oestrogen relaxes vein walls, which is part of why pregnancy and hormonal treatments contribute.
Who tends to get it
- Anyone with a family history, which is the strongest single factor
- People whose work involves prolonged standing - retail, hairdressing, teaching, nursing
- Women who have been pregnant
- Anyone who has had a deep vein thrombosis
- Older adults and people carrying extra weight
What makes it worse, and what settles it
Makes it worse
- Standing still for long periods
- Long unbroken sitting, particularly on flights and long drives
- Hot baths and hot weather, which dilate the veins further
- Crossing the legs for long periods
- Ignoring skin changes around the ankle, which are the warning sign of ulceration
Settles it
- Walking, which is the calf pump in action and the single best thing available
- Calf raises and calf strengthening, which builds the pump itself
- Elevating the legs above heart level for periods during the day
- Compression stockings, which reduce symptoms and swelling substantially
- Ankle range work, since a stiff ankle limits how well the pump works
What actually helps
The short version: Failed venous valves; the calf muscle pump is the main return mechanism and it needs contraction to work
Strength work: Legs: Calves: Gastrocnemius; Legs: Calves: Soleus; calf raises; ankle pumps; walking
Stretching: Legs: Calves; Legs: Hamstrings
Massage: Legs: Calves - light, upward strokes; avoid deep work directly over varicosities
Also worth doing: Compression socks (Physical Therapy item 855); leg elevation (item 913)
What the evidence says: Calf-pump exercise and compression improve symptoms and edema. Exercise does not reverse the varicosities themselves - be honest about that.
The names above are the Targets qFIT tracks —
the Muscle Guide explains what each one does, and
Quick Add switches on the Exercises you
already have.
The qFIT routine for this
Ready-made routineCirculation & Swollen Legs
qFIT already has this one built. It runs massage first, then stretching, then
strength — the order that works on a body that is already sore — and every
activity in it carries the reason it is there.
The button below opens your Checklist with this routine already selected, so instead
of your whole list you land on just its Categories, Targets
and Exercises, each with its checkbox, ready to tick as you work through
them.
Have more than one problem? Tick yours under My Problems on
My Profile and your Checklist's Routine list gains
Recommended for my problems — every routine for the problems you picked, merged
into one. Your picks stay private; that filter is the only thing they feed.
Get it checked if…
Hot swollen painful calf, especially one-sided after travel or surgery - possible DVT, do NOT massage, urgent assessment; skin ulceration needs vascular review
And whatever the body part: chest pain or unusual breathlessness on
exertion; a fever alongside the pain; unexplained weight loss; pain that is constant and
unrelated to how you move; new numbness, weakness or loss of bladder or bowel control; or
one calf that is swollen, warm and painful. Any of those, stop and get assessed.
How it usually goes
Symptoms improve considerably with calf strengthening, walking, elevation and compression, usually within four to eight weeks - but the damaged valves do not repair, so this is management rather than cure. Progression is slowed, not stopped. Skin discolouration, hardening or eczema around the ankle indicates advanced venous disease and needs assessment before it ulcerates. A suddenly swollen, painful, warm calf is a possible deep vein thrombosis and is an urgent, same-day problem.
Prevalence basis: Vein population studies
Others the same routine covers
These share the Circulation & Swollen Legs routine, so the work is the same. If one of them also
sounds like you, that is a reason to expect more from it, not less.
This is general information, not a diagnosis, and it cannot examine you.
If it matches you, use it to ask better questions of a clinician rather than to replace one.