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There are many different symptoms of varicose veins. The disease affecting varicose veins is technically known as venous incompetence or venous insufficiency. Varicose veins are larger veins affected by venous insufficiency and smaller veins such as reticular veins and spider veins can also be affected by venous insufficiency. 

Patients with venous insufficiency may notice they have heavy or restless legs. They may suffer from night cramps or night aches. Their legs may become swollen or puffy. Some patients will notice darkening of the skin particularly around the ankles or over large patches of varicose veins. Patients may develop itchy dermatitis with dry inflamed skin overlying areas of the diseased veins. Sometimes these veins are not visible.  Over time people with venous insufficiency develop poor healing of skin wounds. They notice that scratches and cuts on their legs take much longer to heal than previously. If a person continues to develop worsening venous insufficiency they will eventually develop venous ulcers which are chronic wounds on the legs that last many months. 

The first sign a patient may notice is small spider veins on the legs. Over time a patient may develop more obvious varicose veins. Some patients cannot see any obvious varicose veins or spider veins yet they are suffering from skin conditions that are a result of hidden venous incompetence beneath the skin. These patients may have venous dermatitis, poor healing or lipodermatosclerosis – a form of inflammation of the skin with tight cuffing and sclerosis of the skin at the ankles.