Varicose Veins

EPIDEMIOLOGY AND CAUSES

Annual incidence of varicose vein is 2%

Life time prevalence approaches 40%

Varicose vein are more common in females than men with ration of 2-3:1

10-20% patients are highly symptomatic that complaint about lower leg varicose vein

CAUSES

Obesity

Pregnancy

Genetic Predisposition

Hormonal Imbalance

Large Exercise

Uncomfortable footwear

Prolonged Standing / Sitting

Improper dietary habits

CLINICAL FEATURES AND PATHOPHYSIOLOGY

Varicose veins may not cause any pain. Signs you may have with varicose veins include:

Veins that are dark purple or blue in color

Veins that appear twisted and bulging; often like cords on your legs

When painful signs and symptoms occur, they may include:

An achy or heavy feeling in your legs

Burning, throbbing, muscle cramping and swelling in your lower legs

Worsened pain after sitting or standing for a long time

Itching around one or more of your veins

Bleeding from varicose veins

A painful cord in the vein with red discoloration of the skin

Color change, hardening of the vein, inflammation of the skin or skin ulcers near your ankle, which can mean you have a serious form of vascular disease that requires medical attention

saphena varix is a dilatation of the saphenous vein at the saphenofemoral junction in the groin, it is commonly mistaken for a femoral hernia, suspicion should be raised in any suspected femoral hernia if the patient has concurrent varicosities present in the rest of the limb. These can be best identified via duplex ultrasound and management is via high saphenous ligation.

PATHOPHYSIOLOGY

PHYSICAL EXAMINATION AND DIAGNOSIS

Trendelenburg Test or Brodie-Trendelenburg test

It is a test which can be carried out as part of a physical examination to determine the competency of the valves in the superficial and deep veins of the legs in patients with varicose veins

Perthe’s test

With the patient positioned supine, to assess the functioning of the deep veins

Place the tourniquet around the thigh

Ask the patient to raise their heels off the ground ten times

Look for collapse of the superficial veins

If the superficial veins collapse, indicates deep veins are functioning (as blood is returning through the deep system); if the superficial veins remain dilated, suggests there may be a problem with the deep system

Tap test

To assess the competency of the valves

Place one hand at the saphenofemoral junction and the other hand on any varicosity visible

Tap at the saphenofemoral junction and feel for the percussion with the other hand

Move distally down the varicosity until unable to feel the percussions

CEAP CLASSIFICATION

PHYSIOTHERAPY MANAGEMENT

Compression Therapy

Wearing compression stockings is vital for preventing and treating varicose veins. They steadily squeeze your legs to help improve your circulation. They may also help to relieve pain, discomfort or swelling in your legs.

Walking

It encourages blood circulation in your legs.

Pedaling

Lie flat on your back. Place your hands out to your sides. If you prefer you can place them beneath your buttocks to prevent strain to the lower back. Lift your legs off the floor, and pedal them as if you were pedaling a bicycle. The more you elevate your legs, the more you will increase blood circulation.

Leg Lifts

Lie on your back with your hands beneath your buttocks. Keep your buttocks pressed down, and your lower back against the floor. Lift one leg at a time and hold in an elevated pose perpendicular to the floor until you feel the blood begin to flow back up from your feet, calves, and thighs. Repeat with your other leg. Alternately, you can raise both legs and rotate your ankles to further improve leg circulation.

Knee bends with ankle flexion

Lie again on the floor on your back. Slowly pull one knee into your chest, holding onto your leg behind your knee. Now, point and flex your foot several times.

Don’t let your foot flap around loosely, but rather tighten the muscles of the calves and the tendons around your ankle.

PREVENTION

Exercise Regularly

Avoid Wearing tight clothing

Encourage Weight loss

Avoid Prolonged Standing and Sitting

Quit Smoking

Avoid High Heels