Leg Pain: Is It Your Arteries or Your Veins?
Two different problems, two different treatments. Two quick ways to tell them apart.
Legs that ache, feel heavy or swell up by the evening are one of the most common things people mention to us, usually at the end of an appointment about something else.
Almost always it turns out to be one of two things, and they are near opposites. One is a problem with the arteries bringing blood down into the leg. The other is a problem with the veins carrying it back up.
They can look similar from the outside. They are treated completely differently.
Call 911 if a leg suddenly becomes painful, cold, pale or numb. That can mean blood flow has stopped, and hours matter. Call your doctor the same day if one leg suddenly swells and is painful, warm or red, which can mean a clot in a deep vein.
The difference in one line
Arteries deliver. Veins return.
When arteries narrow, the muscle does not get enough blood when it asks for more. When veins fail, blood struggles to get back out of the leg and pools there under pressure.
Signs it may be your arteries
Pain brought on by walking, in the calf, thigh or buttock. Cramping, aching or tightness.
It stops when you stand still, usually within a few minutes, and comes back at about the same distance next time.
Hills and stairs bring it on sooner.
The leg or foot feels cool, may look pale, and hair on the leg may thin.
Sores on the toes or foot that will not heal.
In more advanced disease, pain at rest, often worst at night, eased by hanging the foot out of bed.
This is peripheral artery disease. We cover it properly on our page about
leg pain when you walk.
Signs it may be your veins
Heaviness, aching or throbbing rather than cramping.
Worse as the day goes on, and worse after standing still for a long time.
Better when you put your feet up, and often better for walking rather than worse.
Swelling around the ankle, mild in the morning and obvious by evening. Socks leave a mark.
Visible varicose veins, though plenty of people have vein trouble without them.
Skin changes near the ankle over time: brown staining, dryness, itching, thickening.
A sore around the inner ankle, shallow and often damp.
This is chronic venous insufficiency: the small valves inside the leg veins stop closing properly, so blood falls back down instead of being pushed up.
The two quickest tells
What you were doing when it hurt. Artery pain starts when you move and settles when you stop. Vein discomfort builds while you stand still and often eases once you get going.
What putting your feet up does. Raising the legs usually helps vein problems a great deal. With a bad artery problem it can make things worse, because you are now asking blood to travel uphill.
Neither test settles it on its own. But if someone tells us their legs feel best first thing and worst by evening, and that the recliner helps, we are already thinking veins.
It can be both, and it can be neither
Plenty of people have some of each, particularly over 65, and then the question becomes which one is causing the trouble today.
Legs also ache for reasons that have nothing to do with circulation: arthritis in the hip or knee, a trapped nerve in the back, muscle strain, thyroid problems, and some medicines that cause ankle swelling. Part of the job is ruling those in or out rather than assuming.
How it gets sorted out
Quickly, and without anything uncomfortable.
For arteries, the first test is an ankle-brachial index: blood pressure measured at both arms and both ankles and compared. It takes about fifteen minutes and involves nothing more than a cuff.
For veins, it is a duplex ultrasound, a scan that watches blood moving in the leg veins and shows whether it is flowing the wrong way.
Most people need one or the other. Some need both, and having both done on the same visit saves a second trip.
What treatment looks like
For arteries, the priorities are the things that stop the disease progressing: stopping smoking, blood pressure, cholesterol and blood sugar, and a structured walking program, which works far better than people expect. Where blood flow is badly limited, it can often be improved through a catheter rather than open surgery.
For veins, the foundation is compression stockings, elevation and keeping moving. For selected people, the failing vein can be closed off with a thin catheter, which redirects blood into healthier veins. It is done under local anesthetic and most people walk out afterwards.
FAQs
Quick answers
My ankles swell by evening. Is that my heart?
It can be, which is why it is worth checking rather than assuming. Swelling in both legs that comes and goes with the day is more often veins. Swelling that is new, getting worse, or comes with breathlessness needs looking at promptly.
I have varicose veins but no pain. Does anything need doing?
Often not. Many people live with them perfectly happily. It is worth a look if they ache, if the skin near the ankle is changing color, or if the swelling is getting worse, because those are the signs it is more than cosmetic.
Should I walk if my legs hurt?
For most people, yes, and for artery disease walking is part of the treatment rather than something to avoid. Get it checked first if the pain is new or severe, and never ignore a sore that will not heal.
Book Your Next Appointment
Get your legs looked at, in Fort Myers
If your legs ache, swell or tire more easily than they used to, we can work out which system is involved and what is worth doing about it.
We see patients at 13411 Parker Commons Blvd, Fort Myers, on the north side of Daniels Parkway, and care for people across Lee and Charlotte counties, including Cape Coral, North Fort Myers, Lehigh Acres, and Punta Gorda.
Call (239) 415-4900 or use the contact page to book. Physicians referring a patient can find what we need on the referral page.
This page is for general education. It is not a substitute for advice from your own doctor about your own case. If a leg suddenly becomes painful, cold, pale or numb, call 911.
Source: American Heart Association, peripheral artery disease symptoms and vascular health resources.
