Venous insufficiency can occur due to the incompetence of one or more of the perforator veins as well as the Great Saphenous or Lesser Saphenous vein or a combination thereof. Physical exam alone is not diagnostic and only a venous duplex exam will determine accurately where the problem is originating from. The most common treatment for these vein currently are the heat based endovenous (from inside the vein) treatments like EVLT or the VNUS procedures.
As to whether vigorous exercise can help or worsen chronic venous insufficiency due to venous reflux, it is important to remember what the calf muscle activity generates high venous pressure in the muscle compartment propelling the deep venous blood toward the heart and against gravity. With venous reflux, this blood is misdirected into the superficial vein network where high venous pressure and gravity lead to uncontrolled dilation of superficial veins. If untreated, the resulting venous congestion may lead to leg swelling and irreversible skin changes including pigmentation, venous eczema and even ulceration. Since the surface veins do not have the muscle envelope that deep veins do, generating high pressures in the calf muscles with vigorous exercise may actually worsen your condition since blood is forced into the superficial veins where there is no external force pushing it upwards toward the heart. The result is more congestion and worsening symptoms. Short of treating the sources of reflux, only wearing of high pressure compression stockings (20-30 mmHg) continuously would counter the deep venous pressure and temporarily prevent venous congestion in these superficial veins. Growing collateral superficial veins only makes the problem worse because these veins invariably communicate with the dilated superficial veins and therefore eventually fail and dilate themselves due to the high venous pressure in the exiting varicosities. This results in more blood being trapped in the venous tree of the leg and more swelling of the leg. The bottom line, the sooner the origin of venous reflux is identified and treated the better, in order to prevent progression of the disease and appearance of irreversible skin changes.
I have had the orangish discoloring of my feet and ankles that is typical of chronic venous insufficiency or incompetent perforator veins for years, but never had any progression of the condition to the red splotches on my ankles until recently. I took up bicycling this last Spring and I have ridden over 1000 miles so far this Summer. It seems to me that this condition has progressively worsened the more I ride my bike. I bike at my limits all the time, and it seems to me that I probably am putting some heavy demands on the vascular system in my legs. Even though every thing I read says that exercise is important, I am beginning to think that maybe too much exercise increases the venous pressure and make the condition worse. These red splotches are getting worse all the time. I had no trace of them last April and it makes me think that it coincides with my bike riding. If that is true, I will know when the weather turns cold here and I put the bike away for the winter, because I would think the red splotches should diminish. Another question I have is: I know that arteries grow collaterals to satisfy the demands for blood... has anyone ever heard of growing collateral veins? With all the biking I have done, I am sure that I am revascularizing my legs to some extent. My endurance as improved remarkably over the Summer and no doubt I have much better blood circulation TO my legs... the blood just can't get back to my heart as efficiently as it gets to my feet. I am wondering if continued biking will grow new veins to cope with the physical demands.