Have you ever looked down at your legs and noticed blue or purple lines beneath your skin? Maybe you’ve felt a heavy feeling in your lower legs after standing for long periods or even dealt with leg pain that seems to get worse by the end of the day. These could be signs that your veins are working harder than they should be.

Veins play a crucial role in your body by helping return blood back to your heart. But when things go wrong, you might develop problems like varicose veins or spider veins. In this guide, you’ll learn about the types of veins in legs, how they function, and what happens when they don’t work as they should.

What are Veins and How Do They Work?

Your veins are an important part of your venous system. They work nonstop to return blood to your heart after it delivers oxygen to the body’s tissues. Leg veins form an intricate network from the top of your thigh down to the feet and toes.

While arteries carry oxygen-rich blood away from the heart, veins carry blood back using a network of one-way valves that prevent it from flowing backward. These valves work with the movement of your leg muscles to help push venous blood against gravity and back toward the heart.

Types of Veins in the Legs

Your leg veins act as a complex network designed to keep your body’s tissues nourished and your circulation strong. But not all veins in the legs function in the same way. Some lie closer to the skin’s surface, while others run deep in the muscles. Both deep and superficial veins play different roles in moving blood efficiently.

Superficial Veins

Your superficial veins are located just beneath the skin’s surface. They play a vital role in moving blood from the outer layers of the body to the deep veins. 

Unlike deep veins, which are surrounded by leg muscles, superficial veins don’t have the same muscular support to push venous blood back to the heart. Instead, they rely on the one-way valves inside them to prevent blood from pooling and causing issues like blood clots.

Deep Veins

Unlike superficial veins, your deep veins are buried within the leg muscles, where they handle the heavy lifting of circulation. These veins carry the majority of your blood volume back to the heart. 

Your leg muscles squeeze them each time you move, helping push venous blood upward while the one-way valves prevent it from flowing backward. One of the most important veins in your legs is the great saphenous vein, which runs from your ankle up to your groin.

Problematic Veins: Varicose and Spider Veins

Not all leg veins function properly. Blood pools when vein walls weaken or one-way valves fail, causing enlarged veins that can lead to discomfort, swelling, and visible skin changes. These issues may not just be cosmetic concerns—they can indicate underlying venous disease that affects circulation and overall leg health.

Two of the most common vein problems are varicose veins and spider veins. While they may seem similar, they have distinct causes, symptoms, and treatments. Let’s break down the differences and what you need to know about each.

What They Are

Varicose Veins

Varicose veins are enlarged veins that appear twisted, bulging, and blue or purple in color. They typically develop in the lower legs due to weakened vein walls and malfunctioning one-way valves, which allow blood to pool instead of flowing efficiently back to the heart. 

Over time, the added pressure causes veins to open wider than normal and leads to visible bulges on the skin’s surface. They can also indicate underlying venous disease and increase your risk of developing deep vein thrombosis (DVT), a serious condition that occurs when blood clots form in the deep veins and block circulation.

Spider Veins

Spider veins are smaller, thread-like veins that appear blue, red, or purple and spread in a spider web pattern just beneath the skin’s surface.  They commonly develop on the legs and face. They don’t bulge or cause significant discomfort like varicose veins, but they can be a sign of underlying venous disease.

A vein specialist examining varicose veins in the legs

Causes and Risk Factors

Varicose Veins

Varicose veins form when blood pools in the leg veins due to weakened vein walls and one-way valves that function improperly. Several factors can contribute to this condition:

  • Genetics
  • Age
  • Prolonged standing or sitting
  • Multiple pregnancies
  • Obesity
  • Lack of physical activity
  • Hormonal changes like birth control, hormone replacement therapy, or pregnancy hormones

Spider Veins

Spider veins may be smaller than varicose veins, but they develop for many of the same reasons. In some cases, they’re purely a cosmetic concern. In other cases, they may indicate chronic venous disease. Some causes include:

  • Sun exposure
  • Hormonal shifts
  • Genetics
  • Prolonged sitting or standing
  • Obesity
  • Injury or Trauma
  • High heels
  • Tight clothing

Symptoms

Varicose Veins

Varicose veins can cause a range of uncomfortable symptoms that may interfere with daily activities. Many experience these symptoms even before their enlarged veins become visibly bulging:

Spider Veins

Unlike varicose veins, spider veins are typically painless. But they can still cause discomfort for some people. Their appearance can be frustrating, and in certain cases, they may signal deeper vein problems. Common symptoms include:

  • Thin, web-like veins on the skin surface
  • Mild itching or burning
  • Visible veins on the legs and face
  • Skin sensitivity
  • Worsening over time

Diagnosis

Varicose Veins

Diagnosing varicose veins starts with a thorough physical examination. A doctor will examine your legs to look for enlarged veins that bulge from the skin’s surface. They may ask about symptoms like leg pain, swelling, or a heavy feeling in your lower legs. 

In many cases, they’ll use an ultrasound to assess blood flow and check for underlying vein problems. A review of your medical history and family history also helps identify potential risk factors.

Spider Veins

Diagnosing spider veins is usually straightforward. A doctor can often identify them with a simple physical exam, checking for the characteristic spider web pattern of small, visible veins beneath the skin’s surface. Unlike varicose veins, spider veins rarely require further testing since they typically don’t indicate serious circulation issues. 

However, if you have symptoms like leg pain, itching, or burning, your doctor may evaluate whether they are connected to reticular veins or underlying venous disease. In some cases, a vein specialist may recommend an ultrasound to rule out deeper vein problems, especially if the spider veins are widespread or worsening.

Treating Varicose and Spider Veins

Varicose Veins

Because varicose veins occur when vein walls weaken and blood pools, treatment focuses on sealing off or removing the affected veins to restore proper circulation. Treatment options include:

  • Laser ablation: A thin laser fiber is inserted into the affected vein under ultrasound guidance. The laser heats the vein walls and closes the vein so blood flow is rerouted to healthy veins.
  • Ultrasound-guided chemical ablation: A specialist injects a special solution into deeper veins to cause them to collapse and redirect blood to healthy veins. This is especially effective for veins that are not easily treated with a laser.
  • Ambulatory microphlebectomy: This in-office procedure removes larger, bulging varicose veins through tiny incisions to provide immediate relief and cosmetic improvement.
  • Sclerotherapy: This common treatment involves injecting a solution into the vein, making it collapse and gradually fade.

You may also make lifestyle changes for preventative care to keep them from developing.

Spider Veins

While spider veins are typically a cosmetic concern, many patients choose treatment to improve their appearance and prevent them from worsening. Treatment options include:

  • Laser therapy: This non-invasive treatment uses targeted laser energy to collapse fine spider veins on any area of the skin.
  • Sclerotherapy: This common treatment involves injecting a solution into the spider veins, causing them to close and fade over time. 
  • Combined Sclerotherapy and Surface Laser: This treatment is sometimes used for spider veins that do not respond to initial sclerotherapy treatment.

If you’re considering treatment for varicose veins or spider veins, a consultation with a vein surgeon can help determine which is the best option for you.

Trust Your Vein Health to the Experts at the Kimmel Institute 

If you’ve been dealing with leg pain, swelling, or the frustration of visible veins, you don’t have to accept it as just a part of life. Understanding how your veins work is the first step—taking action is the next. With the right care, you can restore comfort, improve circulation, and feel confident in your legs again.

At the Kimmel Institute, we specialize in treating varicose veins and spider veins with advanced, minimally invasive techniques. Led by a board-certified cardiovascular surgeon with over 30 years of experience, our team provides expert care with a personal touch. This is our specialty—we don’t just treat vein problems, we help you get back to feeling your best.

Your legs deserve expert care. Schedule your consultation at the Kimmel Institute today to experience the difference specialized, experienced treatment can make.