Venous insufficiency means the one-way valves inside your leg veins have stopped closing properly. Blood that should move up toward the heart falls back and pools in the lower leg. The pressure that builds is what you see and feel: swelling at the ankle, legs that ache by the afternoon, veins that bulge, and skin that slowly changes colour above the ankle bone.
It is progressive. Left alone it tends to move from a cosmetic complaint to a circulation problem, and the leg is where that gets expensive.
Why a podiatry practice treats veins
Because we usually see it first. People book an appointment for an ankle that swells every day, or a heaviness that arrives after a shift on their feet, or a sore on the shin that has not closed in a month. Those get attributed to age, or to standing too long, or to a foot problem. Often the cause is venous.
Dr. Orlando Cedeno is a board-certified podiatric surgeon with a focus in vein care, which means one evaluation covers the foot, the ankle and the circulation feeding both. For patients with diabetes or existing wound risk, catching venous insufficiency early is part of protecting the limb, not a separate cosmetic question.
The condition behind it has its own page: venous insufficiency and saphenous vein reflux, covering what the valves do, why the problem compounds, and how it is mapped.
Signs worth having looked at
- Ankles or lower legs that swell, particularly later in the day
- Legs that feel tired, heavy or achy after standing
- Visible varicose veins, or clusters of fine spider veins
- Burning, cramping or throbbing in the calf
- Skin above the ankle that has darkened or hardened
- Restless, uncomfortable legs at the end of the day
- A wound on the lower leg or foot that will not heal
- Discomfort that eases when you put your legs up
Symptoms that improve with elevation point strongly toward a venous cause. That one is worth paying attention to, because it is the pattern patients most often dismiss.
What raises your risk
Family history is the strongest single factor. Age, pregnancy, carrying extra weight, prior blood clots, smoking, and work that keeps you standing or seated for long stretches all add to it. Several of those describe a lot of people who work on their feet in Palm Beach County.
How it gets diagnosed
The visit starts with an examination of the legs, ankles and feet, and a conversation about what your symptoms do across a day. If reflux is suspected, an ultrasound maps blood flow and shows which vein segments are failing. That matters, because the treatment depends entirely on which veins are involved and how far the problem has gone. The diabetic foot exam covers circulation too, and the two are often booked together.
Treatments we offer
| Treatment | What it treats | How it works | Recovery |
|---|---|---|---|
| Sclerotherapy | Spider veins, small to medium varicose veins | A solution injected into the vein closes it; the body reroutes the blood and the vein fades | Back to normal activity in a few days, with compression |
| Endovenous laser therapy (EVLT) | Larger varicose veins, saphenous reflux | Laser energy delivered inside the vein seals it closed | Minimally invasive, a few days |
| Radiofrequency ablation (RFA) | Larger varicose veins, saphenous reflux | Radiofrequency energy heats the vein wall until it closes | Minimally invasive, a few days |
| Vein stripping & ligation | Severe varicose veins that have not responded to other treatment | Surgical removal, or tying off the vein | Longer; reserved for advanced cases |
| Compression therapy | Symptom management and post-procedure care | Graduated stockings support the calf pump and reduce pooling | Ongoing, not a cure |
Which one applies depends on the ultrasound. Small surface veins are treated very differently from a failing great saphenous vein, and the point of mapping first is to avoid treating the visible problem while leaving the cause running.
What treatment is meant to achieve
Three things, in order of how much they matter: reduce the symptoms you actually feel, improve circulation in the lower leg, and protect the skin and tissue that poor venous return has been damaging. The appearance of the leg usually improves as well. For most patients that is a welcome side effect rather than the reason they came in.
Common questions
Why does a podiatry practice treat veins?
Because the first signs usually appear in the foot and ankle. Patients come in for swelling that will not go down, heaviness after a shift on their feet, darkening skin above the ankle, or a sore that has not closed. All of those can be venous rather than structural. Dr. Cedeno is a board-certified podiatric surgeon with a focus in vein care, so one evaluation covers both.
What is the difference between varicose veins and spider veins?
Varicose veins are larger vessels that bulge above the skin, often rope-like, and they frequently ache. Spider veins are much finer, sit flat against the skin in red or blue clusters, and are usually painless. They can occur together, and spider veins sometimes signal a larger vein underneath that has stopped working.
Does sclerotherapy hurt?
Most patients describe a brief sting as the solution enters the vein, then a mild cramping that passes within a minute or two. No anesthesia is needed. You walk out afterward, and you will usually be asked to wear compression stockings for a period set by what was treated.
How long is recovery?
It depends which procedure you have. After sclerotherapy or endovenous laser therapy most patients are back to normal activity within a few days. Surgical treatment takes longer. In every case recovery goes better if you wear the compression stockings as directed, elevate the legs when you can, and leave strenuous exercise until you are cleared.
Is vein treatment covered by insurance?
It depends on whether the treatment is being done for symptoms or for appearance. Evaluation and medically necessary treatment of venous insufficiency are often covered; purely cosmetic spider vein work generally is not. Call (561) 915-1934 and the team will verify your benefits before anything is scheduled.
What if I also have diabetes?
Then this matters more, not less. Poor venous return and diabetes both slow healing in the lower leg, and together they raise the risk that a small wound becomes a serious one. Vein evaluation is worth combining with diabetic foot care and, if there is an open wound, our wound care program.
Get your legs looked at
If your ankles swell most days, or a wound on your lower leg is not closing, that is worth an appointment rather than another month of waiting.