Symptoms of Impaired Blood Circulation in the Leg

Leg circulation disorders cause symptoms such as coldness, numbness, pain, and swelling due to insufficient blood flow. Early recognition of these symptoms is crucial for preventing serious complications such as ulcers or gangrene.

Peripheral artery disease in the leg is a common underlying cause and leads to narrowing of blood vessels, reducing oxygen supply to tissues. Risk factors include smoking, diabetes, and high cholesterol.

Venous insufficiency also contributes to leg circulation disorders, resulting in swelling, heaviness, and varicose veins due to impaired venous return. These symptoms often worsen after prolonged standing or sitting.

Diagnostic methods such as Doppler ultrasound and angiography are essential for identifying the degree of obstruction. Early treatment with lifestyle changes, medications, or surgical interventions improves quality of life and prevents severe outcomes.

Is the circulatory problem in my legs arterial or venous?

The simplest way to determine whether your symptoms are arterial or venous is to pay attention to when and how they occur. The character of these two situations is quite different.

When you think of vein problems (venous insufficiency), you should think of “pooling and swelling”. The problem is that blood cannot return to the heart efficiently and pools in the legs. This condition usually gives symptoms such as

• The pain is a dull aching and a feeling of heaviness.
• It increases at the end of the day, especially if you stand or sit for a long time.
• Elevating the legs provides significant relief as it helps the blood to return.
• Swelling (edema) of the ankle and lower leg is the most typical symptom.
• The skin is usually at a normal temperature, sometimes it may even feel warm.

Arterial problems (Peripheral Arterial Disease) can be thought of as “insufficiency and lack of nutrition”. The problem is that the muscles do not receive enough blood and oxygen due to narrowed arteries. The symptoms of this condition are different:

• The pain is like a sharp cramp or fatigue that occurs with movement.
• It typically starts with exertion, such as walking, and goes away in a few minutes at rest.
• Lifting the leg up can worsen the pain as it further reduces blood flow.
• The feet and legs are usually cold to the touch.
• The skin may look pale or bruised.

Vein Insufficiency: The Obstacle in Blood’s Return Journey

Circulatory disorders of the veins are usually caused by a “mechanical malfunction”. Rather than a narrowing or blockage, as in arteries, the main problem is a malfunction of the valves that prevent blood from escaping back downwards. The veins in our legs have the challenging task of carrying blood against gravity, i.e. uphill to the heart. Inside these veins, there are one-way valves that allow blood to flow only upwards, but not downwards. When these valves become weakened for some reason and cannot close properly, the blood escapes backwards due to gravity. This backflow (reflux) causes the blood to pool, especially in the ankle and lower leg area. Just as water builds up in front of a dam and builds up pressure, this accumulation of blood in the veins of the legs increases the pressure on the vein walls. This condition, which we call “venous hypertension” in medicine, is the starting point of a chain of problems leading to swelling, pain, varicose veins, skin changes and even wounds.

Is Ankle Swelling and Leg Pain a Symptom of Venous Insufficiency?

Yes, swelling and aching pain, especially at the end of the day, are among the most common early signs of venous insufficiency. It is important to read these signals your body is sending you correctly. The most common symptoms of chronic venous insufficiency are:

• Swelling in the ankle and lower leg (edema)
• Stinging, throbbing or dull pain
• Feeling of heaviness and fullness in the legs
• Increased itching, especially at night
• Painful muscle cramps (usually at night)
• Restless leg syndrome-like sensations
• Visible veins on the skin (spider veins or varicose veins)

Why Do Varicose Veins Occur and Are They Only an Image Problem?

Varicose veins are veins that appear prominent, tortuous and bulging above the surface of the skin, where blood accumulates and dilates due to defective valves. These veins are only a reflection of underlying venous insufficiency and should never be seen as a purely cosmetic problem. The presence of varicose veins is the clearest visual evidence of a “leak” in your venous system. It is a warning sign that the disease can progress to more advanced stages and, left untreated, can lead to more serious problems such as clots (thrombophlebitis), bleeding or non-healing wounds. Smaller, red or blue, web-shaped veins are called spider veins (telangiectasias) and are a more superficial result of the same mechanism.

Why has my leg skin turned brown and itchy?

This is a serious symptom that occurs in advanced stages of venous insufficiency and is called “stasis dermatitis” and “hemosiderin deposition”. Rather than a skin disease, this is a reflection of the high pressure inside the vein on the skin. The process works like this: The intense pressure inside the blood vessel forces the walls of the smallest blood vessels, the capillaries, to become permeable. The red blood cells that leak out of the blood vessels break down under the skin. Hemosiderin, the iron pigment in these cells, accumulates under the skin and permanently stains the area rust-colored, brown or bruised. At the same time, the leaking fluid and blood components trigger a chronic inflammatory reaction in the skin, causing itching, dryness, scaling and eczema (stasis dermatitis). These skin changes are a precursor to venous ulcers (non-healing wounds), the most difficult complication to treat, and should be evaluated by a specialist.

Who is at Risk for Chronic Venous Insufficiency?

Although anyone can develop venous insufficiency, certain factors significantly increase the risk. Most of these risk factors are conditions that increase the pressure on the leg veins or weaken their structure. The main risk factors are:

• Family history of varicose veins or venous insufficiency (genetic predisposition)
• Advanced age (over 50 years)
• Female gender (hormonal influences)
• Previous pregnancies
• Obesity (overweight)
• Professions requiring prolonged standing or sitting (teacher, surgeon, barber, office worker)
• Sedentary lifestyle
• Previous history of Deep Vein Thrombosis (DVT)

How is Vein Insufficiency Diagnosed?

Diagnosis of venous insufficiency is usually a simple and painless process for an experienced Cardiovascular Surgeon. The process begins by listening to your complaints and taking a detailed medical history. A physical examination will then be performed to evaluate visible findings such as swelling, varicose veins and skin changes in your legs.

The gold standard method to confirm the diagnosis and plan treatment is Color Doppler Ultrasound. During this test, a cold gel is applied to your leg and the ultrasound probe is moved over the skin. Sound waves are used to create a map of your veins. This map shows the direction and speed of the blood flow and clearly identifies which valve in which vein is “leaking” (reflux) and how much. This procedure is completely painless, does not involve radiation and does not require any preliminary preparation.

What are the Treatment Methods for Varicose Veins and Venous Insufficiency?

Today, the treatment of venous insufficiency and varicose veins offers a wide range of options, tailored to the stage of the disease and the patient’s condition. The aim of treatment is to relieve symptoms, stop the progression of the disease and improve quality of life.

There are conservative methods that form the basis of treatment and should be practiced by everyone:

• Regularly lifting the legs above the level of the heart
• Regular exercise such as walking and swimming
• Maintaining ideal weight or losing excess weight
• Using medical compression stockings with appropriate pressure

In more advanced cases, modern and minimally invasive (non-surgical) methods are used to eliminate the “leaking” vein that is the source of the problem.

• Sclerotherapy (Foam Therapy): A special drug is injected into the problematic vein, causing the vein to close and be destroyed by the body over time.
• Endovenous Laser Ablation (EVLA): Using laser energy, the diseased main superficial vein is closed by heating it from the inside.
• Radiofrequency Ablation (RFA): The same closure is performed with radiofrequency energy instead of laser.
• Ambulatory Phlebectomy: Large varicose vein packets on the skin surface are removed through very small incisions with special instruments.
• Thanks to these modern methods, the need for classical surgery (stripping) has decreased considerably. All treatments are usually performed comfortably under local anesthesia and patients can return to their normal lives on the same day.
• Peripheral Arterial Disease: The Problem in the “Supply Line” to the Legs

Arterial circulatory disorders are a “supply” problem. It is a narrowing or blockage of the arteries, the “clean blood pipes” that carry enough oxygen and nutrients to the muscles and tissues of the legs. The most common cause of this blockage is atherosclerosis, or “arteriosclerosis”, which can affect arteries throughout the body. Over the years, deposits of cholesterol, fat and calcium, called plaques, build up on the artery walls. These plaques, like a layer of lime in an old water pipe, grow over time, narrowing the inside of the artery and blocking blood flow. This is a harbinger of a systemic disease that affects not only the legs but also the heart (coronary artery disease) and brain (risk of stroke).

Why does the cramp in my calf go away when I rest?

This is the classic and most typical symptom of Peripheral Arterial Disease (PAD) and is called “intermittent claudication”. The best way to understand this pain is to think of it as “angina of the legs”. Just as a person with a narrow heart artery feels chest pain (angina) when climbing stairs, a person with a narrow leg artery feels leg pain when walking.

The mechanism is simple: At rest, the small amount of blood passing through the narrowed vessel can meet the minimal oxygen demand of the muscles. But when you start walking, the energy demand of your muscles, and therefore the oxygen demand, increases many times over. The narrowed “pipe” cannot carry enough blood to meet this increased demand. Deprived of oxygen, the muscle cries out for help, causing a cramping pain. When you stop and rest for a few minutes, the oxygen demand of the muscles decreases again and the pain goes away completely as the available blood supply becomes sufficient. This is a repetitive and predictable pain that occurs almost every time after walking the same distance.

Which Other Symptoms of Peripheral Arterial Disease Should I Watch Out For?

Walking pain is the most common symptom, but reduced blood flow also signals other signs in the body. These symptoms usually indicate that the disease is progressing and should be carefully monitored:

• Marked coldness in the feet and legs, especially compared to other body parts
• Pallor of the skin or red-purple discoloration when the leg is lowered (rubor)
• Taut, glowing and paper-thin skin
• Hair loss on the legs and toes
• Slow growth and thickening of toenails
• Wasting (atrophy) of the leg muscles
• Wounds on pressure points such as toes and heels that heal very difficult or never heal (arterial ulcers)

Resting Pain: It is the most advanced stage of the disease. It is a severe, burning foot pain that occurs when lying down at night, especially when the feet are elevated and wakes the person from sleep. This is a sign that blood flow cannot nourish even resting tissue and requires urgent intervention.

What Are the Most Important Risk Factors for Vascular Occlusion?

The risk factors that predispose to peripheral arterial disease are almost identical to those that cause heart attack and stroke. Knowing and controlling these factors is the most important part of treatment:

• Smoking: It is the most important, single most powerful and preventable risk factor for peripheral arterial disease.

• Diabetes (Diabetes)
• High Blood Pressure (Hypertension)
• High Cholesterol and Triglyceride Levels (Hyperlipidemia)
• Advanced age (over 65 years)
• Family history of cardiovascular disease
• Obesity and sedentary lifestyle
• Chronic kidney disease

What Tests Are Performed to Diagnose Leg Vascular Occlusion?

The diagnosis of PAH begins with a careful examination by a Cardiovascular Surgeon. Palpation of the pulses in the feet (on the back of the foot and the inner ankle) provides valuable information. Weak or absent pulses are a strong sign of a blockage.

• Ankle-Arm Index (ABI): This is a simple, quick and reliable test that is most commonly used in PAH screening. With a sphygmomanometer and Doppler device, blood pressure is measured in both the arm and ankle. A ratio is obtained by dividing the pressure in the ankle by the pressure in the arm. A ratio below 0.9 indicates a significant vascular occlusion.
• Color Doppler Ultrasound: As with venous insufficiency, this test is used to visualize the arteries and determine the exact location, length and severity of the blockage.
• CT or MR Angiography: Used to create a detailed three-dimensional map of the vessels in patients with severe blockages and in patients who are scheduled for interventional treatment (stenting, surgery).
• Catheter Angiography: It is the “gold standard” imaging method of the vessels for both diagnostic and therapeutic purposes (during a balloon/stent procedure).

Which Methods Are Used in the Treatment of Peripheral Arterial Disease?

Treatment of PAH has two main goals: The first is to improve quality of life by increasing walking distance; the second, and more important, is to reduce the risk of heart attack and stroke by controlling underlying atherosclerosis.

Treatment is always based on lifestyle changes and control of risk factors:

• Absolute cessation of smoking
• Blood thinners (aspirin, clopidogrel, etc.)
• Cholesterol-lowering drugs (statins)
• Regulation of blood pressure and blood sugar
• Supervised exercise programs (special programs on a treadmill)

In patients who do not respond to these basic treatments or who have advanced disease, interventional treatments are used to open the blocked vessel.

• Balloon Angioplasty: It is the process of expanding the blocked area with a balloon.
• Stent Placement: Placement of a metal cage (stent) to prevent the dilated vessel from narrowing again.
• Atherectomy: It is the removal of plaque in the vein by shaving with special devices.

Bypass surgery is the last resort for very long or completely blocked veins for which these methods are not suitable. In this surgery, a new “bridge” pathway is created using an artificial vein or the patient’s own vein to carry blood beyond the blockage.

Which Leg Symptoms Require “Urgent” Consultation with a Cardiovascular Surgeon?

Some symptoms indicate that the circulatory disturbance has reached a critical level and that there is a risk of irreversible damage or loss of limbs. If you experience any of the following “red flag” symptoms, you should consult a Cardiovascular Surgeon immediately:

• Leg pain that occurs when walking and stops you in your tracks (claudication)
• Increasing swelling in your legs or feet that does not go away
• Brown-red spots or itchy eczema that appear on your skin, especially around the ankle
• A constant coldness or a pale, purple color in your feet
• The slightest sore, blister or cut on your toes or heel that just won’t heal
• Severe foot pain that wakes you from sleep at night, relieved by hanging your legs off the bed

Remember that your legs are your most valuable assets that carry you throughout your life. Do not ignore the signals they send you by saying “fatigue will pass”. These symptoms can be harbingers of serious diseases that can be treated very effectively when diagnosed early. Modern medicine offers comfortable and successful treatment options for both arterial and venous diseases. Take that first step for your health and do not hesitate to consult a specialist.