What Your Legs Are Trying to Tell You About Your Health
According to Dr Syaiful Azzam bin Sopandi, Consultant General & Vascular Surgeon at Ara Damansara Medical Centre, when leg veins stop functioning properly, blood begins to pool in the lower limbs, placing pressure on the vessel walls and surrounding tissue. These symptoms can eventually lead to skin changes, ulcers, and infections if untreated.
Understanding how CVI develops and learning to recognise its early warning signs is essential, especially as more older Malaysians face symptoms that are too often mistaken for ordinary ageing.
More Than Just Tired Legs
CVI develops when the valves in the leg veins are weakened or damaged. These valves ensure blood moves upward to the heart. When they fail, blood pools in the lower limbs, increasing pressure and damaging surrounding tissue. Over time, this leads to swelling, skin changes, and even ulcers.
Venous hypertension, or increased pressure in the veins, can cause fluid and blood cells to leak into surrounding tissues, often resulting in a brownish skin discolouration—a visible sign of ongoing inflammation.
CVI often goes undiagnosed. Globally, chronic venous disease affects 20 to 40% of adults, and the numbers rise with age. In Malaysia, a 2021 Vein Consult Programme found that over 30% of people aged 50 and above show signs of the disease.
Among those over 60, the figure may be as high as 50%. Risk factors include obesity, sedentary lifestyles, prolonged standing, or a history of blood clots.
Know the Signs, Take Early Action
Chronic venous insufficiency (CVI) often develops gradually with overlooked symptoms. Early warning signs include leg pain that worsens with standing or walking, swelling around the ankles, and the appearance of varicose veins. As the condition progresses, the skin on the lower legs may darken, tighten, or become itchy.
In more advanced stages, slow-healing ulcers—typically near the inner ankle—may form. 'These signs shouldn't be ignored, especially if you're over 50,' says Dr Syaiful Azzam bin Sopandi, Consultant General & Vascular Surgeon at Ara Damansara Medical Centre. 'Early diagnosis makes a big difference.'
One reason these symptoms are so common in older adults is the natural decline in venous function that comes with age. Over time, vein walls lose elasticity, valves begin to leak, and calf muscles—key to pumping blood back to the heart—grow weaker due to reduced physical activity. This combination slows circulation and increases the likelihood of venous disease.
'Movement keeps blood flowing,' Dr Syaiful explains. 'When older adults become less active, it puts them at greater risk of developing vein-related complications.' Recognising the signs early and understanding why circulation slows with age are crucial steps toward preventing more serious outcomes.
Modern Treatments and Common Myths
Thankfully, diagnosis and treatment today are far less invasive than people assume. A quick and painless ultrasound can confirm if the veins are malfunctioning. If CVI is diagnosed, there are several treatment options.
The most common is endovenous ablation therapy. This therapy involves using heat, glue, or medication to close faulty veins. 'Patients are often surprised how quick and straightforward it is,' says Dr Syaiful. 'Most walk in and out on the same day.'
Misconceptions about vein health persist. Many believe varicose veins are purely cosmetic or that older adults are too frail for treatment. Dr Syaiful clarifies that age is not a barrier, and treatments are tailored to individual needs.
Removing or sealing a diseased vein does not harm circulation, as other veins compensate. While compression stockings can help manage symptoms, they do not address the root cause, and without proper treatment, CVI tends to worsen.
Home Care and Early Treatments
While medical intervention is key for advanced cases, lifestyle changes can help manage or delay symptoms. Regular walking, leg elevation, maintaining a healthy weight, and wearing compression stockings in the morning are all helpful.
Avoiding long periods of sitting or standing, quitting smoking, and moisturising the skin—especially around the ankles—also supports vein health.
If left untreated, CVI can cause lasting damage, including ulcers, infections, and even amputation in severe cases. It may also lead to cellulitis—a painful skin infection that may require hospital care. 'It's like ignoring a leaking roof,' says Dr Syaiful. 'It may seem minor, but it can turn serious.'
With Malaysia's elderly population growing rapidly, awareness around vein health must improve. Leg pain is not always a sign of ageing; it can be something more. Early intervention can lead to better mobility, less pain, and a higher quality of life. 'Healthy ageing is not just about living longer,' Dr Syaiful concludes. 'It's about staying active, independent, and pain-free.' Related
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As Malaysia moves closer to becoming an aged nation by 2030, many adults over 60 are noticing leg discomfort, swelling and skin discolouration. These changes are often brushed off as part of growing old, but they may actually signal a medical condition that deserves attention: chronic venous insufficiency (CVI). 'Many people think leg pain and swelling are just part of ageing, so they try to live with it,' says consultant general and vascular surgeon Dr Syaiful Azzam Sopandi. 'But when veins in the legs stop working properly, it can lead to more than just discomfort. "If left untreated, the complications can be serious.' Damage to the veins CVI happens when the valves in the leg veins weaken or become damaged. These valves are meant to ensure that blood flows upward to the heart. As we grow older, the structure of our veins changes. The valve flaps that once closed firmly may now leak. The vein walls, once elastic, become stiff. 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When red cells break down, they release iron, which gets trapped in the tissue and causes a dark staining effect on the skin. 'This is why some patients notice a brownish discolouration on their lower legs,' Dr Syaiful shares. 'It is not just a skin issue, but a sign of ongoing inflammation inside the tissue.' Over time, this inflammation weakens the skin, making it more fragile and prone to ulcers, which are slow to heal, especially in older adults. Common, yet overlooked Despite its seriousness, CVI is often underdiagnosed in older adults. Varicose veins are one of the common early warning signs of CVI. — Dr TAN KIA LEAN Globally, chronic venous disease affects an estimated 20% to 40% of the adult population, with its occurence increasing significantly with age. In Malaysia, a 2021 study under the Vein Consult Programme Malaysia found that more than 30% of Malaysians over the age of 50 show signs of chronic venous disease. 'Among those aged 60 and above, the numbers are likely even higher, possibly up to 40% or 50%,' Dr Syaiful says. 'This is especially true for people with risk factors like obesity, a history of prolonged standing, previous deep vein thrombosis or a sedentary lifestyle.' He adds that as Malaysia's elderly population continues to grow, vein-related problems will become more common and should not be overlooked as just a part of ageing. Some patients delay care due to fear of hospitals or believing nothing can be done. Others face language barriers, limited mobility or financial concerns. In some cases, reduced sensitivity in the legs can cause patients to overlook pain altogether. He recalls the case of a 60-year-old woman who had been living with a chronic leg ulcer for six months. She had been dressing the wound at home with the help of her family, unaware that the root cause was a treatable vein condition. An ultrasound assessment showed that she had bilateral CVI with significant venous reflux and damaged skin. Following a minimally-invasive laser treatment, the ulcer healed completely within a month. Types of treatment The warning signs of CVI can appear gradually. Leg pain that worsens with standing or walking, swelling around the ankles and visible varicose veins are among the most common early indicators. Skin around the lower leg may become darker or feel tight and itchy. In more advanced cases, ulcers may form, usually near the inner ankle. 'These are more than skin deep,' says Dr Syaiful. 'If you notice them, especially after 50, you should speak to a doctor. "Early treatment can make a huge difference.' When a patient presents with leg swelling, pain or skin changes, the first step is a quick and painless ultrasound scan. 'It is a safe, non-invasive way for us to assess blood flow and valve function in real time,' he explains. 'It gives us a clear picture of what is going on.' Once diagnosed, there are a range of minimally-invasive treatments that are suitable even for older patients. The most common approach is endovenous ablation therapy, which has two main forms. Thermal ablation uses heat, through either laser or radiofrequency energy, to seal off the diseased vein. Non-thermal methods include medical-grade glue, mechanical ablation and sclerotherapy, which involves injecting a chemical solution into the vein. These procedures are typically performed under local anaesthesia. Recovery is fast and minimally disruptive to daily routines. 'Most patients can walk in and walk out the same day and return to their normal routine shortly after,' Dr Syaiful says. Debunking common myths Despite advancements in treatment, myths and misinformation continue to delay care. One of the most persistent beliefs is that varicose veins are purely cosmetic. In reality, they may signal an underlying disease. Another common myth is that older adults are too frail for surgery or that vein removal will disrupt blood flow. 'Age is not a barrier,' says Dr Syaiful. 'We tailor our treatments to suit the patient's condition and needs. "And no, removing or sealing a diseased vein won't harm your circulation, other veins will take over.' He also warns against relying solely on compression stockings. While helpful in managing symptoms, they do not address the root cause. And without proper treatment, CVI tends to worsen over time. 'Vein disease is progressive,' he says. 'The earlier we catch it, the easier it is to manage.' Left untreated, CVI can result in open ulcers that take months to heal, frequent infections, and in severe cases, deep vein thrombosis, or even limb amputation. This condition may also lead to cellulitis, a painful bacterial skin infection that can require hospitalisation. 'Delaying treatment is like ignoring a leak in your roof,' says Dr Syaiful. 'It might seem small initially, but eventually the damage becomes extensive and costly to fix.' Additional self-care tips While medical treatment is necessary for more advanced cases, adopting good daily habits can help maintain healthy veins and manage early symptoms. Dr Syaiful recommends regular walking to strengthen the calf muscles, elevating the legs a few times a day to reduce swelling, and avoiding long periods of sitting or standing. Wearing compression stockings in the morning, maintaining a healthy weight, eating a fibre-rich diet, and avoiding tight clothing that restricts circulation can also make a difference. Daily leg care is also important. Moisturising the skin, especially around the ankles, helps prevent cracks, while regular self-checks can catch early signs of swelling, wounds or discolouration. 'Smoking damages blood vessels and worsens circulation,' he notes, 'so quitting is one of the best things you can do for your vascular health.'
