Veins carry blood back to the heart from the rest of the body. In the legs, the blood has to run uphill in order to reach the heart. The muscles of the leg actually work like a pump to push the blood up against gravity. There are valves (thin tissue flaps) inside the veins which prevent the blood from running back downhill.

There are two systems of veins in the leg: the deep system is made up of large veins within the muscles of the leg; the superficial system is a network of smaller veins located just under the skin. The two systems are connected in a few places by short perforating veins. The function of veins is to carry blood from the leg back to the heart. In the leg, the deep veins do most of this work, forcing the blood uphill when the leg muscles contract. The blood is kept from running back down to the leg by valves inside the veins. Both the deep and superficial systems have valves. Both systems empty into one main vein in the groin. The superficial system has two large veins (called saphenous veins); one is behind the calf, like a stocking seam, and the other runs along the inner side of the leg from the ankle to the groin. These saphenous veins can be removed without any side effects; they are the veins used for coronary and arterial bypass operations.

In some people, the valves in the veins do not work. This causes the blood to pool in the veins when standing, and the weight of the blood causes very high pressures in the veins in the lower leg. The stretching of the vein wall causes discomfort and dilates the vein. In the lowest parts of the leg, the pressure in the vein can become so high that blood actually leaks out of the vein into the surrounding tissue. This leakage causes swelling and inflammation of the skin and underlying tissue (dermatitis) which appears as areas of inflammation which are red and tender. If the inflammation is severe enough, the skin can break down and open sores or ulcers can form. This severe condition usually occurs in the area just above the ankles on the inner side of the leg, because there is a concentration of veins in that area. Dermatitis usually occurs if the valves in the deep veins are scarred, but sometimes it happens in people with severe superficial vein problems alone.

Once this process of inflammation and skin breakdown has begun, it can be very difficult to reverse. For that reason, it is very important to prevent the development of stasis changes if possible. Elevating the legs empties the veins and relieves the pain. Likewise, wearing medical compression stockings keeps the veins empty, relieving the discomfort, and preventing further dilation of the veins.

Treatment of venous stasis disease depends on its cause. If only the superficial veins are malfunctioning, a vein stripping operation may solve the problem. If the deep veins are diseased, other nonsurgical measures are necessary. These are quite simple. If they are started early enough, they can prevent worsening of the condition.

These measures include:

1. Leg elevation. Whenever possible, the legs should be raised above the level of the heart: blood will flow downhill and out of the leg. If possible, place six-inch blocks under the foot of your bed. This will help reduce swelling at night, and make it easier to apply the stockings in the morning.

2. Compression stockings. Special knee-high elastic stockings which exert more pressure on the foot and ankle, and less on up, should be worn and will prevent the veins from becoming distended with blood, and will promote the return of fluid from the swollen tissues of the leg. They should be applied first thing in the morning and worn all day by anyone with stasis disease. Stockings should be replaced every three to four months to remain effective.

3. Skin Care: it is very important to avoid dry, cracked skin, and to pay attention to any new areas of inflammation which develop. Follow these steps:
i. check your legs every day. Call if any areas of redness, drainage, or skin breakdown occur.
ii. Do not use soap on your legs. Plain water is best to avoid dryness.
iii. Apply moisturizing cream such as Eucerin to your skin from the knees to the feet every night before bed. Rub it in and wipe off the excess.

4. Surgical treatment may be necessary if the above measures don't work. This may just involve vein stripping if the problem is mainly in the superficial system. Occasionally, an operation to cut the perforating veins of the lower leg is helpful to prevent blood from flowing from the deep system into the superficial veins. Sometimes it is possible to repair the valves in the deep veins if none of the other forms of treatment work. However, it should be noted that, except for vein stripping, it is rarely necessary to have surgery for venous stasis disease, as long as the other measures are followed.