# Chronic venous insufficiency

> Chronic venous insufficiency (CVI) is when leg vein valves stop working, so blood pools in the legs. Checked compression stockings are often the first step, alongside regular walking and calf movement.

Guide in [Diabetes, arthritis and other conditions](https://footanklelowerlimb.com.au/learn/topics/diabetes-arthritis-and-other-conditions), from Foot Ankle Lower Limb: https://footanklelowerlimb.com.au/learn/chronic-venous-insufficiency
Reviewed by Andrew Schox, BSc(Hons) PGradDipPod MPod (Podiatrist) on 1 November 2026.
Next review by 1 November 2027.

- **It's a long-term vein problem:** the valves in your leg veins stop working well, so blood pools in your legs.
- **Compression stockings are often a first step,** once they have been properly checked, and regular walking and calf movement are also encouraged.
- **Your leg's arteries are checked before compression,** to make sure stockings are safe for you.

## What is chronic venous insufficiency?

Chronic venous insufficiency (CVI) is a long-term condition in which the vein walls and the valves in your legs have been weakened or harmed and cannot function properly [1]. The valves no longer stop blood flowing backwards, so blood collects in the veins of your legs [1]. It is sometimes called chronic venous disease [1].

CVI is common [2]. Over time it can bring heavy, uncomfortable legs, swelling, changes in skin colour and, in some people, leg ulcers (open sores) [2][1].

## What causes it, and who gets it?

When the valves in your leg veins fail, blood flows back down and pools instead of travelling up towards your heart [1][3][4]. This raises the pressure in the veins, and that raised pressure is a major factor in skin breakdown and ulcers [3][5]. Valves can also become less effective as you get older [4].

A weak calf muscle pump also contributes to CVI [3][6]. Being inactive, standing for long periods and being overweight are linked with it [6].

These are linked with chronic venous disease, not proven causes: older age, being female, a family history, previous pregnancies, obesity and standing for long periods [7]. Past leg clots (DVT), leg injury, arthritis and a sedentary lifestyle can also damage the valves [8].

## What does it feel like, and how is it diagnosed?

Symptoms of venous insufficiency include dull leg pain that worsens on standing, cramping, aching or heavy legs, itchy skin and swelling in the lower legs [1]. Discomfort generally gets worse with prolonged standing and eases when you raise your leg [5]. Over time your skin may turn brown and thicker, sometimes called venous (varicose) eczema [1].

A podiatrist or doctor will ask about your symptoms and examine both legs, looking at swelling, varicose veins, skin changes and any sores. They will also check the pulses in your feet and ankles [9]. If you have a leg ulcer due to venous insufficiency, or if the pulses in your foot or ankle are weak or can't be felt before compression starts, they should measure your ankle-brachial pressure index (ABPI) [8][9]. An ABPI above 0.8 is generally used to rule out significant arterial disease [8], as severe arterial disease means compression stockings should not be used [9].

## What helps first?

Walking, moving your calf muscles and taking breaks from long spells of standing or sitting are encouraged, though it isn't clear yet whether this stops CVI developing.

Compression stockings are often the first treatment, and they help most people without much discomfort [6]. They should only be used once your leg's arteries have been checked, because they may worsen poor arterial supply [6], and once the fit has been checked [9]. Extra care is needed with diabetes, reduced feeling in your feet, fragile skin or severe heart failure [9][10].

Take your stockings off at the end of the day. Wash and dry them, check your skin, and make sure they fit with no bunching [11][4]. Stop wearing them and report significant increased pain, numbness or colour change in your toes [12][4].

> [!tip] Try this
> Take a short walk today. Move your calf muscles regularly and take breaks from long periods of sitting or standing.

## What helps if that isn't enough?

If a venous leg ulcer (an open sore caused by poor vein function) isn't healing despite proper compression, a podiatrist or doctor can re-check the diagnosis and your leg's arteries. They may add a device that helps your calf muscle pump work better [13]. This can also be an option if compression can't be used or isn't comfortable enough to keep wearing [13].

If an ulcer still hasn't healed after about 12 weeks of appropriate treatment, they may refer you on for further assessment [14]. It isn't clear yet how well procedures for CVI work or how they compare with each other.

## How long does it take, and how can I stop it coming back?

CVI is a long-term condition, so the aim is to manage it over time [1]. A weak calf muscle pump goes with slower ulcer healing and larger ulcers in people with advanced CVI [6]. Compression stockings help most people without much discomfort [6]. Regular walking and calf movement are worth keeping up.

It isn't clear yet what best stops ulcers coming back.

## What can make it serious?

- A wound or sore on your foot or leg hasn't started to heal after two weeks, or keeps coming back.
- A spot, mole or sore on the skin of your foot or leg is new, changing, bleeding or not healing.
- Your calf or leg on one side becomes swollen and painful, especially if it is also warm or red.
- Redness from a wound, sore or infection is spreading into your foot or leg, or red streaks run up from it.
- You have a foot wound, ulcer or infection, or a red, hot, swollen foot, and also have a fever, chills, a fast heartbeat or feel unwell.
- Your foot, or a patch of skin on your foot or leg, becomes red, hot, swollen and painful.
- You have diabetes, poor circulation or reduced feeling in your feet and notice a new wound, sore, blister or colour change on your foot, or a sore that isn't healing.
- You have constant pain in your foot or toes that is worse at night or when your legs are raised, and eases when you hang your leg down (this can be a sign of poor circulation).
- The skin on your toes or foot turns dark or black, or a wound turns black and smells bad.
- Numbness or tingling in your foot or leg spreads quickly, or comes with new weakness.
- A varicose vein on your leg has bled.
- You have a foot wound, ulcer or infection and also feel very unwell, with confusion or slurred speech, severe shivering or muscle pain, severe breathlessness, mottled or discoloured skin, or little or no urine (possible sepsis).
- The skin over your infection turns dusky, purple or blistered, or the redness spreads very fast and the pain is much worse than the skin looks.
- You suddenly become short of breath, have chest pain or cough up blood.
- Your leg or foot suddenly turns cold and pale, with pain or numbness, or you suddenly can't move it.
- You have bleeding that won't stop when you press firmly on it.

## Common questions

### What's the difference between varicose veins and chronic venous insufficiency?

Varicose veins are an earlier stage of chronic venous disease (class C2). Chronic venous insufficiency (CVI) is a later stage, when the vein problem has led to swelling, skin changes or ulcers. So you can have varicose veins without CVI, but CVI is the more advanced end of the same vein problem.

### Why do my legs swell and ache more after standing?

Standing for a long time makes it harder for blood to travel back up your legs, so more of it pools in the veins and your legs can feel heavier and achier. Raising your legs usually eases this. Many people with vein problems notice the same pattern, with discomfort worse when standing and better when legs are raised.

## Further reading

- [Chronic venous insufficiency on Clindice](https://clindice.com/chronic-venous-insufficiency)
- [Chronic Venous Insufficiency: Causes, Symptoms & Treatment](https://my.clevelandclinic.org/health/diseases/16872-chronic-venous-insufficiency-cvi), Cleveland Clinic
- [Venous insufficiency: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/000203.htm), MedlinePlus
- [Venous leg ulcer](https://www.nhs.uk/conditions/leg-ulcer/), NHS

## Sources

1. Venous insufficiency · Health New Zealand | Te Whatu Ora. https://www.healthnz.govt.nz/health-topics/conditions-treatments/blood/venous-insufficiency
2. Chronic Venous Insufficiency and Management · Attaran RR, Babapour G, Mena-Hurtado C et al. · Interventional Cardiology Clinics · 2025. https://doi.org/10.1016/j.iccl.2024.11.013
3. Chronic Venous Insufficiency: a Frequently Underdiagnosed and Undertreated Pathology · Spiridon M, Corduneanu D · Maedica · 2017. https://pmc.ncbi.nlm.nih.gov/articles/PMC5574075/
4. Leg ulcers · leicspart.nhs.uk. https://www.leicspart.nhs.uk/wp-content/uploads/2024/08/649-Leg-ulcers-3.pdf
5. Chronic Venous Insufficiency With Emphasis on the Geriatric Population · Mayrovitz HN, Aoki KC, Colon J · Cureus · 2023. https://doi.org/10.7759/cureus.40687
6. Understanding Chronic Venous Disease: A Critical Overview of Its Pathophysiology and Medical Management · Ortega MA, Fraile-Martínez O, García-Montero C et al. · Journal of Clinical Medicine · 2021. https://doi.org/10.3390/jcm10153239
7. Global Epidemiology of Chronic Venous Disease: A Systematic Review With Pooled Prevalence Analysis · Salim S, Machin M, Patterson BO et al. · Annals of Surgery · 2021. https://doi.org/10.1097/sla.0000000000004631
8. Foam dressings for venous leg ulcers · O'Meara S, Martyn-St James M · The Cochrane Database of Systematic Reviews · 2013. https://doi.org/10.1002/14651858.cd009907.pub2
9. Risks and contraindications of medical compression treatment - A critical reappraisal. An international consensus statement · Rabe E, Partsch H, Morrison N et al. · Phlebology · 2020. https://doi.org/10.1177/0268355520909066
10. Guidance on compression hosiery and garments - South & West · South & West. https://southwest.devonformularyguidance.nhs.uk/formulary/chapters/17-wound-management/guidance-on-compression-hosiery-and-garments
11. 7047-1 Chronic venous insufficiency (CVS) · wsh.nhs.uk. https://www.wsh.nhs.uk/CMS-Documents/Patient-leaflets/Deep-vein-thrombosis/7047-1-Chronic-venous-insufficiency-CVS.pdf
12. Leg ulcers — foot ulcers · Healthdirect Australia. https://www.healthdirect.gov.au/conditions/skin-conditions/leg-ulcers
13. Canadian Consensus Statement for the Management of Venous Leg Ulcers · Stacey MC, Sibbald RG, Evans R et al. · International Wound Journal · 2025. https://doi.org/10.1111/iwj.70415
14. Venous leg ulcer clinic standard operating procedure for assessment of venous leg ulcers · Right Decisions. https://www.rightdecisions.scot.nhs.uk/vascular-surgery-pathways/venous-leg-ulcer/venous-leg-ulcer-clinic-standard-operating-procedure-for-assessment-of-venous-leg-ulcers/

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This is general information, not advice about your own situation. To discuss your issues, book with one of our podiatrists. In an emergency, call 000.