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What are the best treatment options for varicose veins around the ankle?

I have unsightly varicose veins on my lower legs including my ankles. I would like to explore treatment options and was wondering what challenges veins around the ankles present? With little fat around the ankles and the veins being in close relation to the ankle bones, will this make treatment more painful?

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Doctors Answers (9)

Treating veins around the ankle is more sensitive and depending on the size and location of the varicose vein, your treatment options include a micro-phlebectomy to physically remove the vein, and possibly either sclerotherapy or even an endovenous ablation can be done for a significant length and diameter of varicose vein to be treated. I would recommend starting with an ultrasound evaluation to determine the extent of the problem and discuss your options with a physician specializing in the treatment of veins.

Large, tortuous varicose veins around the ankles often are best treated with microphlebectomy. The small veins are best treated with foam sclerotherapy and the tiny ones can be treated with liquid sclerotherapy. Large veins at the ankles treated with sclerotherapy often leave tender areas which are troublesome with straps on women's shoes, in particular, causing discomfort for weeks to months. Your physician's experience with each of these techniques may be the determining factor, but this area can be unforgiving in the hands of a novice.

Usually the best treatment for veins around the ankles is sclerotherapy .The treatment of veins around the ankle is a bit more painful.

Any discussion of options regarding your condition is best addressed after seeing the problem, with either photos or a visit. However, the two most common options are surgical vein removal (phlebectomy) or injections (sclerotherapy). Fat deposition will not make a difference in most cases.

I would discuss this with a physician. If you have varices in your ankle, this could be a sign of a deeper problem. I would talk to a physician to see if you have venous insufficiency in the leg. Injections around the ankle are more painful.

Although the ankles are usually the most sensitive areas, expert sclerotherapy provides a good outcome in most cases. However, if you have either large bulging varicose veins or a dense patch of spider veins at the ankle, a simple Doppler or duplex ultrasound test should first be done to rule out underlying saphenous vein reflux. If the saphenous vein is involved, it must be treated first for a good result. If the saphenous vein is not involved, conventional sclerotherapy should work well.

First, it should be determined if these are truly varicose (larger typically tortuous bulging veins) or more superficial spider veins. Additionally, an ultrasound exam by an experienced surgeon who specializes in vein treatment should be performed to determine if there is underlying saphenous reflux (caused by failure of small valves in the veins). Whether your problem causes you pain or discomfort or is totally cosmetic will determine the course of treatment. Spider veins can be treated with injection sclerotherapy and laser treatments. While ankles are more sensitive, most people tolerate treatment well in our clinic. Varicose veins caused by reflux can be treated by endovenous ablation. Often once the pressure is reduced the ankle veins may be less prominent and may not require any intervention. If persistent they can be removed by microphlebectomy (tiny incisions through which the veins are removed under local anesthetic). This should only be done by an experienced surgeon due to the presence of many nerves in the ankles. These procedures are covered by insurance only if symptomatic and affect your normal activities.

This is very common and treatable.

Bulging varicose veins around the ankle are often because of an underlying vein problem. Often this is caused by backwards blood flow in veins that are deeper down. It is important to have an ultrasound to identify the cause of the ankle varicose veins before determining the best treatment options. Bulging veins around the ankle can be treated with sclerotherapy (varicose vein injections) or surgical removal with microphlebectomy. Both are minimally invasive. However, if the underlying vein problem that is causing the varicose veins is fixed than the veins at the ankle may not require treatment and go away on their own.

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