How can I differentiate between varicose veins and other venous disorders during a clinical examination?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 14 August 2025Updated: 14 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

To differentiate varicose veins from other venous disorders during clinical examination:

  • Look for dilated, tortuous superficial veins, typically visible and palpable, which are characteristic of varicose veins ,.
  • Assess for symptoms associated with varicose veins such as aching, heaviness, swelling, itching, and discomfort in the lower limbs .
  • Check for skin changes indicative of chronic venous hypertension, including pigmentation, venous eczema, lipodermatosclerosis, and atrophie blanche, which suggest advanced venous disease ,.
  • Identify any venous ulcers, especially breaks in the skin below the knee that have not healed within 2 weeks, which are more typical of chronic venous insufficiency rather than isolated varicose veins ,.
  • Note the presence of hard, painful veins which may indicate superficial vein thrombosis, a different venous disorder that requires further evaluation ,.
  • Look for signs of deep vein thrombosis (DVT) such as unilateral leg swelling, tenderness along the deep venous system, and pitting oedema confined to the symptomatic leg; use clinical prediction tools like the Wells score to assess probability .
  • Observe for collateral superficial veins that are non-varicose, which may suggest deep venous obstruction rather than primary varicose veins .
  • Use duplex ultrasound to confirm the diagnosis, assess the extent of truncal reflux, and differentiate varicose veins from other venous pathologies such as DVT or venous incompetence ,.

Summary: Varicose veins present as dilated, tortuous superficial veins with associated symptoms and possible skin changes, whereas other venous disorders like superficial thrombophlebitis or DVT have distinct clinical signs such as painful hard veins or deep leg swelling. Duplex ultrasound is essential for definitive differentiation and assessment ,,.

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