Welcome back to Ask the Doc, an educational series from United Vein & Vascular Centers designed to provide clear, physician-led answers to common questions about vein and vascular health. Each week, a UVVC physician breaks down symptoms patients experience in everyday life and explains what they may mean medically.
In this installment, Dr. David Stone addresses one of the most common and confusing questions patients ask:
“Are my leg symptoms coming from poor circulation, nerve issues, or vein disease, and how do specialists tell the difference?”
Dr. Stone:
Leg symptoms can be challenging because multiple systems overlap in the legs. Veins, arteries, nerves, and lymphatic vessels all run alongside one another, so problems in one system can mimic symptoms of another.
Patients often experience similar sensations, such as aching, burning, tingling, heaviness, or fatigue, even though the underlying cause may be very different. That’s why guessing based on symptoms alone can be misleading and why proper evaluation is important.
Dr. Stone:
Vein-related symptoms are usually tied to chronic venous insufficiency (CVI), where blood struggles to flow back toward the heart.
Common signs include:
– leg heaviness or aching
– swelling in the ankles or lower legs
– symptoms that worsen after standing or sitting
– nighttime discomfort or restlessness
– burning or itching sensations
– visible or bulging veins
– skin discoloration or texture changes
These symptoms often improve with leg elevation and worsen as the day goes on.
Dr. Stone:
Nerve-related symptoms, often grouped under neuropathy, tend to involve abnormal sensations rather than pressure or heaviness. Patients may describe:
– tingling or pins-and-needles
– numbness
– sharp or shooting pain
– burning sensations
– reduced sensation in the feet or legs
Nerve symptoms are often unrelated to standing or gravity and may not improve with elevation. They can be caused by conditions like diabetes, spinal issues, or nerve compression.
Dr. Stone:
Poor arterial circulation affects how blood reaches the legs rather than how it returns to the heart.
Arterial symptoms may include:
– cramping or pain with walking that improves with rest
– legs that feel cold or weak
– slow-healing wounds
– skin that appears pale or shiny
– reduced hair growth on the legs
These symptoms are often activity-related and should always be evaluated, as arterial disease requires a different treatment approach than vein disease.
Dr. Stone:
We start by listening carefully to how symptoms behave, when they appear, what makes them better or worse, and how they’ve changed over time. That clinical history is just as important as imaging.
From there, we may use:
– venous ultrasound to assess vein function and blood flow
– arterial screening when circulation to the legs is a concern
– additional evaluation if nerve or musculoskeletal issues are suspected
This comprehensive approach allows us to determine whether symptoms are venous, arterial, neurological, or a combination and to tailor treatment accordingly.
Dr. Stone:
You should consider seeing a specialist if leg symptoms:
– persist or worsen over time
– interfere with sleep or daily activities
– are accompanied by swelling, skin changes, or visible veins
– occur in one leg more than the other
– don’t respond to basic measures like rest or elevation
Early evaluation helps prevent progression and ensures the right condition is treated the right way.
What’s Next in the Ask the Doc Series
Ask the Doc was created to help patients understand the full spectrum of vein and vascular health, from subtle symptoms and discomfort to accurate diagnosis and modern treatment options. Each week, a UVVC physician answers real patient questions to support informed, confident care decisions.
Up next, Dr. Sarah Donnelly Hans will address an important follow-up question many patients ask: when you should worry about varicose veins and when treatment is recommended. If you’re noticing changes in your veins or experiencing ongoing symptoms, you can find a United Vein & Vascular Centers clinic near you and schedule an evaluation with one of our specialists.
Medically reviewed by UVVC National Medical Director, Dr. Domenic Zambuto
