Lower Leg Pain Differential

Diagnosis
A Selection of Venous Causes
Chronic Venous Insufficiency
Description
● Chronic venous insufficiency is the common definition given to a disorder defined by
the lack of the venous system to properly return blood and nutrients to the heart. The
underlying cause is typically involved with the valves within the venous system and
the failure of these valves to assist with the return of blood to the heart, and also
prevent blood from flowing backwards within the veins, also known as backflow. The
results of this disorder are not immediately medically serious but can cause chronic
pain and disability.
Chronic Venous Insufficiency
Causes
● Chronic venous insufficiency in the leg typically stems from an improper functioning
of the vein’s valves causing backflow within the vein itself.
● The purpose of the vein is to prevent backflow in the direction of the heart and if this
does occur it can be harmful in the form of localized inflammation, skin color
change, and can even result in leg ulcers.
Chronic Venous Insufficiency
Treatment
● Treatment for venous insufficiency typically includes a varying degree of
compression mainly to activate and stimulate blood flow.
● Improving blood flow is the main priority to treat this disorder and compression is
not the only modality to stimulate blood flow in the lower leg.
● Certain medications have to ability to stimulate blood flow in the lower leg and are
typically used in combination with compression.
● If the order has progressed to a serious condition then the use of RFA (endovenous
laser ablation or radiofrequency ablation) or surgery may be used.
Deep Vein Thrombosis
Description
● A deep vein thrombosis, also known as a DVT, occurs when a thrombus (blood clot)
forms in the veins that are farther away from the heart, typically in the legs. The
lower portion of the legs is the most common site for this disorder with a high risk of
this thrombus becoming a pulmonary embolism. The mortality rate of individuals
with a DVT ranges from 6-12%. There are a wide range of verified and valued
clinical tools and tests that are used to both screen for the risk factors of a DVT and
determine if the individual currently has a DVT.
Deep Vein Thrombosis
Causes
● A DVT is caused by an occlusion mass known as a thrombus or a blood clot in one of
the deep veins. This typically occurs in the legs and more specifically the lower
portion of the legs because of the distance between this anatomical region and the
heart pumping blood to this region.
● The cause of this thrombus varies greatly between individuals but most often is
connected to the rate of perfusion in a specific anatomic region. Post surgical patients
are at a very high risk because of the lack of movement after such a traumatic event,
especially patients that have just gone through surgery of the hip or knee.
● Trauma is the most common cause of this disorder.
Deep Vein Thrombosis
Treatment
● Typically after being diagnosed with a DVT the main priority is to thin the blood within the patient
using medication. These medications are typically anticoagulants that prevent the binding of fibrin
to platelets forming blood clots within the blood.
● Thrombolytics are also a very common modality after diagnosis of a DVT and essentially break up
a blood clot that has already formed within the blood. This is a much more serious treatment for an
individual experiencing a DVT.
● Compression is usually used in combination with these treatments and the main reason for this is to
stimulate blood flow to the anatomical region where the DVT was experienced to prevent any
further DVT’s.
● This is mainly because the risk factors of a DVT cannot be reversed in any short amount of time
and the formation of one DVT means an exacerbated chance of formation of a DVT in the future.
Varicose Veins
Description
● Varicose veins are described as enlarged veins that are twisted causing a decrease in
the functional components of the vein, most commonly the valves. The condition is
not very serious but can cause uncomfortable sensations and eventually lead to issues
that are much more serious. The most common site for varicose veins are in the lower
portion of the legs. In more serious cases of varicose veins there may be need for
surgical removal but the use of newer technology such as RFA and EVLT has
decreased the rate of cases that need surgical treatment.
Varicose Veins
Causes
● Varicose veins are caused mainly by an increase in the overall blood pressure within
and individuals veins. The most common site of varicose veins are the veins that are
more superficial in the lower component of the legs.
● The curvature of the vein caused by the twisting and swelling of the vein causes
damage to the valve within the vein.
● The role of this valve is to help blood continue its course along the veins and to
prevent backflow.
● Without the structure of the valve intact, the vein experiences backflow in the
opposite direction as normal which causes the underlying effects of varicose veins.
Varicose Veins
Treatment
● Typically after being diagnosed with a varicose veins an individual will want to use
compression usually in the form of stockings.
● The purpose of this compression is to both facilitate and stimulate blood flow in the
affected region where the varicose veins are present.
● Implementing physical care as regular exercise and stretching along with the use of
compression is typically a benefit to the reduction of symptoms experienced with varicose
veins.
● If the disorder has progressed into a harmful and more serious condition there may be
cause for surgery or laser treatment to resolve the varicose veins themselves.
● The removal of these veins can typically ease the symptoms experienced with this disorder.
References
Youn, Y. J., & Lee, J. (2019). Chronic venous insufficiency and varicose veins of the lower extremities. The

Korean Journal of Internal Medicine, 34(2), 269–283. https://doi.org/10.3904/kjim.2018.230

Leren, L., Johansen, E., Eide, H., Falk, R. S., Juvet, L. K., & Ljoså, T. M. (2020). Pain in persons with

chronic venous leg ulcers: A systematic review and meta ‐analysis. International Wound Journal, 17(2),

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Dean, S. M., Valenti, E., Hock, K., Leffler, J., Compston, A., & Abraham, W. T. (2020). The clinical

characteristics of lower extremity lymphedema in 440 patients. Journal of Vascular Surgery. Venous and

Lymphatic Disorders, 8(5), 851–859. https://doi.org/10.1016/j.jvsv.2019.11.014

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References
Youn, Y. J., & Lee, J. (2019). Chronic venous insufficiency and varicose veins of the lower extremities. The

Korean Journal of Internal Medicine, 34(2), 269–283. https://doi.org/10.3904/kjim.2018.230

Rezaie, E. S., Maas, M., & van der Horst, C. M. A. M. (2018). Episodes of extreme lower leg pain caused by

intraosseous varicose veins. BMJ Case Reports, 2018, bcr-2017-223986. https://doi.org/10.1136

/bcr-2017-223986

Smyth, R. M., Aflaifel, N., & Bamigboye, A. A. (2015). Interventions for varicose veins and leg oedema in

pregnancy. The Cochrane Database of Systematic Reviews, 2015(10), CD001066. https://doi.org

/10.1002/14651858.CD001066.pub3
References
Chwała, M., Szczeklik, W., Szczeklik, M., Aleksiejew-Kleszczyński, T., & Jagielska-Chwała, M. (2015). Varicose veins of lo
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