Varicose veins are one of those conditions everyone has an opinion about, but most people don’t understand what’s actually happening underneath the skin — or why treating the visible vein doesn’t always fix the underlying problem. Here’s what causes them, what genuinely helps, and how to think about surgery. (Based on insights of Dr. Tom Biernacki, a double board-certified podiatrist)
Key Takeaways
- A hard, red, tender vein in only one leg needs immediate medical attention — it can indicate a blood clot, which carries real pulmonary embolism risk.
- Biomechanics — tight muscles, flat footwear, and asymmetric foot flexibility — are an often overlooked root cause of varicose veins and uneven leg swelling.
- Start with low-compression, inexpensive compression socks rather than jumping to prescription-strength options, which many people end up not wearing consistently.
- Surgery treats the visible vein but doesn’t address the underlying biomechanical cause — new varicose veins can develop elsewhere afterward.
- Supportive foo