Visible leg veins are common at every age. The most frequent types are spider veins and varicose veins. Spider veins are small red, purple or blue lines on the surface of the skin. Varicose veins are larger and can look raised or twisted. They may cause aching, heaviness, itching or ankle swelling, especially after standing.
This article explains how to recognise each type and what symptoms deserve attention.
Quick overview of varicose veins and spider veins
Spider veins
- What they look like: small fine red, purple or blue lines on the skin
- Typical symptoms: usually none; may itch a little
- Where they appear: thighs, calves and around the ankles; sometimes the face
- Main concern: appearance rather than health for most people
Varicose veins
- What they look like: wider, lumpy veins that can be raised or bulging
- Typical symptoms: aching, heaviness, throbbing, itching, night cramps and ankle swelling; often worse after long periods of standing and eased by leg elevation
- Where they appear: mainly the legs
- Possible complications: skin irritation and colour change, varicose eczema, inflammation, bleeding and leg ulcers
Simple self-care for both
- Keep active with regular walking and calf raises
- Elevate your legs when resting
- Use compression stockings on long journeys
When to seek advice
For spider veins
- The appearance bothers you, and you would like to discuss treatment
- New clusters are spreading or becoming more noticeable
- There is persistent itching or a light burning sensation in the area
- Small veins on the face are difficult to cover, and you want options
- A small vein bleeds or the skin breaks easily over a cluster
- You are not sure whether what you see are spider veins or early varicose veins
For varicose veins
- Ongoing aching, heaviness, throbbing or ankle swelling
- Skin changes around the lower leg, such as brown staining, dry itchy patches or thickening
- A sore near the ankle that does not heal within two weeks
- A vein bleeds. Lie down, raise the leg and press firmly. Seek urgent care if it does not stop or if you feel unwell
- A vein becomes hard, tender and red
- Sudden swelling or pain in one leg, especially with breathlessness or chest pain. Call 999 or go to A&E
If any of these apply, a clinical assessment and an ultrasound scan can confirm the diagnosis and guide the right treatment.
Recommended treatment
For spider veins
At Southwest Veins, microsclerotherapy is our main treatment for leg thread veins. A very fine needle is used to place a small amount of sclerosant into the tiny surface veins. This makes the vein wall stick together, so the vein closes and then fades over the following weeks. Most people need a short series of sessions for the best cosmetic result, and you can walk straight after treatment.
For varicose veins
Our preferred method is ultrasound-guided foam sclerotherapy. A specialist foam is injected into the target vein under ultrasound guidance. The foam irritates the lining, so the vein collapses and seals. Blood is then directed through healthy veins, and the treated vein is absorbed by the body over time. Foam sclerotherapy is suitable for a wide range of varicose vein patterns, including many recurrent veins, and is performed under local anaesthetic as a walk-in in walk-out procedure.
Discuss your veins with a specialist
Spider veins and varicose veins are common and treatable, whether your concern is appearance or symptoms such as aching or swelling. If you are unsure what you are seeing or would like clear advice on the best next step, please get in touch to arrange a free assessment and discuss a tailored plan.
Jamie Barwell is a Consultant Vascular Surgeon who has treated over 1000 patients with varicose vein problems, using open surgical techniques and, since 2007, foam sclerotherapy. He is a graduate of Guy’s Hospital Medical School and a fellow of Royal College of Surgeons of England.