Clinical Sciences/Health Conditions
.jpg "Beom Suk Kim, MD, PhD (he/him/his) photo")
Beom Suk Kim, MD, PhD (he/him/his)
Professor
Chung-Ang University College of Medicine
Seoul, Seoul-t'ukpyolsi, Republic of Korea
Yong Jae Na, MD
Clinical assistant professor
Chung-Ang University Gwangmyeong Hospital
Gwangmyeong, Kyonggi-do, Republic of Korea
Sang Lim Choi, MD
Professor
Chung-Ang University College of Medicine
Seoul, Seoul-t'ukpyolsi, Republic of Korea
Seung Ho Lee, MD
Professor
Chung-Ang University College of Medicine
Seoul, Seoul-t'ukpyolsi, Republic of Korea
Don Kyu Kim, MD
Professor
Chung-Ang University College of Medicine
Seoul, Seoul-t'ukpyolsi, Republic of Korea
Lower limb discomfort is frequently encountered in rehabilitation medicine, yet many patients present with vague symptoms or limited response to conventional treatment. Chronic venous disease (CVD) has recently emerged as an underrecognized contributor. This study aimed to highlight the clinical “faces” and ultrasonographic “footprints” of CVD in patients with unexplained discomfort.
Design:
From January 2024 to May 2025, patients with persistent lower limb symptoms not attributable to spinal, musculoskeletal, or peripheral nerve disorders and unresponsive to ≥1 month of treatment were enrolled. A total of 215 patients (158 women, 57 men; 430 limbs) underwent bilateral duplex ultrasonography to assess reflux in the great saphenous vein (GSV), small saphenous vein (SSV), common femoral vein, and popliteal vein. In 133 patients with unilateral symptoms and concordant ultrasound findings, isokinetic testing of ankle plantarflexors compared affected versus unaffected limbs.
Results:
Common symptoms included cramping (72.1%), heaviness (67.9%), swelling (59.1%), tingling (45.1%), and pain (7.0%). Patients reported an average of 2.7 ± 1.2 symptoms. CEAP classification was C0–C6, with 33% at C0 and 29.8% at C1. Abnormal venous reflux was identified in 77.2%, predominantly bilateral (62.7%) and involving superficial veins (89.8%). The GSV alone was affected in 64.0%, accounting for 76.4% of abnormal vessels, most often in the distal segment. The SSV showed whole-length reflux in 41.7%. Isokinetic testing revealed significantly lower torque on affected sides, though endurance was preserved.
Conclusion:
CVD may be a substantial but overlooked cause of lower limb discomfort, manifesting with varied symptoms and detectable venous reflux on duplex ultrasound. While muscle weakness may be associated, further research is needed to clarify causality. Rehabilitation physicians should broaden diagnostic perspectives to include venous pathology as a potential hidden contributor.
