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by
Anna Parkinson, APRN, MSN, FNP-C
Medically reviewed by Anna Parkinson, APRN, MSN, FNP-C
Most people who notice a rope-like vein on their calf file it under appearance. They decide it is something to cover with longer pants, not something to bring up at a doctor's appointment. That instinct is the single most common reason vein disease goes untreated for years.
Anna Parkinson, APRN, MSN, FNP-C, a nurse practitioner at Center for Vein Restoration (CVR) in Dothan, Alabama, appeared on WTVY News 4's Morning Mingle on September 15, 2026, to correct that assumption and explain what’s happening inside the leg when veins start to show.
Watch the full segment on WTVY News 4's Morning Mingle.
The interview opened with the question patients ask most: is this medical or cosmetic?
"A lot of people think that it is just cosmetic, but it is definitely not. It is a chronic disease," Parkinson said.
The mechanism is mechanical. Leg veins carry blood upward against gravity, and they rely on a series of one-way valves to keep it moving in the right direction.
"You've got a lot of valves in the veins, and the valves are supposed to close properly and not let blood come down. But when you have venous insufficiency, the valves don't work properly, so you get a pooling of blood, which can cause a lot of different things: swelling, skin changes, cramps, and restless legs."
— Anna Parkinson, APRN, MSN, FNP-C
Center for Vein Restoration, Dothan, Alabama
Chronic venous insufficiency (CVI) is a condition in which damaged valves fail to close, allowing blood to flow backward and pool in the leg. The resulting pressure can burst capillaries and cause tissue damage and inflammation. Symptoms include leg and ankle swelling, calf tightness, muscle cramps, skin discoloration, and restless legs syndrome.
According to Cleveland Clinic, roughly 1 in 20 adults has the condition.
Asked to define venous insufficiency in plain terms, Parkinson kept it simple:
"Blood's getting pushed up towards the heart, but then some of it's leaking back down. That's what venous insufficiency is."
Risk begins with family history and builds from there.
"It starts out being somewhat hereditary," Parkinson said. From there, she pointed to weight and to the two occupational patterns she sees most: long hours standing and long hours sitting.
"There's obesity, standing on your feet on hard surfaces for long periods of time. Even people who are sitting for long periods of time, such as truck drivers and office workers, are at much higher risk for venous insufficiency."
Research confirms both patterns. Mayo Clinic identifies family history, obesity, and standing or sitting for long periods as primary risk factors. A review published by the National Library of Medicine adds age 55 and older, pregnancy, tobacco use, prior deep vein thrombosis, and a sedentary lifestyle, and notes that roughly 150,000 new cases of chronic venous insufficiency are diagnosed in the United States each year.
If you spend your workday on a concrete floor or behind a wheel, that is not a minor detail in your medical history. This is a significant part of the vein health conversation.
Parkinson drew a distinction that matters for anyone deciding whether to be concerned:
"If somebody has spider veins, those are on the very surface of the skin. Just because somebody has spider veins doesn't necessarily mean they have venous insufficiency that will cause issues. Sometimes they do go hand in hand," she explained.
"The larger veins, like the varicose veins, are more of a medical issue. Spider veins, even though they're annoying and nobody likes them, they're not really causing a whole lot of damage."
Spider veins are thin red lines or web-like networks close to the skin's surface, while varicose veins are bulging and twisted and often look like cords on the leg. Both trace back to valves that no longer close properly, which is why the two can appear together.
The practical takeaway: spider veins are worth asking about, and varicose veins are worth getting scanned for.
The most quotable line of the segment was also its most useful for a broad audience:
"Your calf muscle is really the heart of your leg. It's the pump, so it helps with circulation."
This vividly describes how venous return works. Harvard Health Publishing explains that leg veins constantly fight gravity, and that calf muscle contractions during walking and calf raises propel blood upward, functioning as a natural pump. A review published by the National Library of Medicine found that ankle movements and walking are the most effective ways to increase blood velocity in the leg veins.
Parkinson's advice for desk workers is built around that calf muscle pump:
For symptoms that have already started, Parkinson named the same three at-home measures:
"Wearing compression, elevating the legs, and increasing walking."
These steps manage symptoms. They don't repair failed valves, which is why persistent symptoms still warrant evaluation by a board-certified vein specialist.
Parkinson was direct about the cost of waiting, and this part of the interview carried the most gravity:
"If venous insufficiency goes untreated for long periods of time, it can cause a lot of things that people don't realize: chronic swelling, skin changes, skin discoloration, and even lead to venous ulcers, which are extremely, extremely hard to heal. Unfortunately, I often see patients when they're already at that stage. They just didn't realize that there was something they could do about it earlier."
Venous ulcers are difficult to heal, and the data supports how difficult. The National Library of Medicine reports that approximately 40 percent of patients experience ulcer recurrence despite standard treatment. Cleveland Clinic notes that venous stasis ulcers heal poorly and carry infection risk.
The disease progression is gradual, which makes it easy to ignore. Swelling becomes routine. Skin near the ankle turns reddish-brown and leathery. By the time an open sore appears, the disease has been active for years.
For anyone weighing whether to come in, Parkinson walked through the appointment step by step.
It starts with imaging.
"On our initial visit, what we do is a very extensive ultrasound. The ultrasound itself takes approximately 45 minutes. Basically, we're mapping out all the veins in the legs, looking at the flow, seeing if there's backward flow."
From there, patients meet with a nurse to review medical history. Then Parkinson or lead vein physician, David M. Fortenberry, MD, FACS, SVS, reviews the ultrasound findings with the patient directly. "We'll show them exactly what we found, and then we come up with a plan to fix things."
All Center for Vein Restoration vein clinic locations offer minimally invasive, office-based procedures including radiofrequency ablation, laser ablation, VenaSeal, and ultrasound-guided foam sclerotherapy.
The reason most patients hesitate to seek treatment is cost, and her answer was unambiguous:
"If we determine that there is a medical reason for venous insufficiency, if a patient has symptoms, then it is absolutely covered under insurance."
She returned to it at the end of the segment when asked what she wishes more people understood.
"I think it's just a hesitation for people to come in and get it checked out. Why not get it checked out? It is covered under insurance. And of course we do treat spider veins as well, even though it's considered more cosmetic. We do treat the spider veins. So just get it checked out."
Asked what keeps her in vein care, Parkinson described the moment treatment changes a patient's day-to-day life.
"I see people who have gotten to the point where it has really affected their daily lives, and it's so hard. So when I see somebody, and I see a smile on their face when we get done with treatments, and they're like, oh my gosh, I can finally sleep at night because of the restless legs, or I feel like I can walk without hurting and do so many more things. That's why I do what I do."
Leg swelling, aching, heaviness, night cramps, and restless legs are not normal and not the result of simple aging. Effective outpatient treatments are available, most take about an hour in a comfortable office setting, and most are covered by insurance when symptoms are present.
Anna Parkinson, APRN, MSN, FNP-C, holds a Master of Science in Nursing, is a family nurse practitioner, holds Family Nurse Practitioner (FNP-C) certification through the American Academy of Nurse Practitioners Certification Board, and holds Advanced Practice Registered Nurse licensure. She sees patients at Center for Vein Restoration in Dothan, Alabama.
Q: My leg veins do not hurt. Do I still need them checked?
A: Discomfort is not the only sign of venous insufficiency, and the absence of pain does not rule it out. Swelling that comes on by evening, night cramps, restless legs, itching, and skin that has started to darken near the ankle are all indicators that valves may be failing. An ultrasound is the only way to see whether blood is flowing backward, since the visible vein on the surface doesn't show what the deeper system is doing.
Q: I have spider veins but no bulging veins. Is that a problem?
A: Not necessarily. Spider veins sit on the surface of the skin and often cause no damage on their own. They can, however, appear alongside underlying venous insufficiency, which is why an evaluation is worthwhile if you also have swelling, aching, or cramping. Spider veins that bother you cosmetically can be treated as well.
Q: I stand on concrete for ten hours a shift. What can I do during the workday?
A: Engage the calf pump on a schedule rather than waiting for a break. Squeezing your calves or doing calf raises at intervals moves blood upward, and shifting your weight and walking short distances keeps circulation from stalling. Graduated compression stockings worn through the shift help meaningfully, and elevating your legs when you get home reduces the swelling that accumulates during the day.
Q: Will insurance pay for treatment, or is this considered cosmetic?
A: When an evaluation documents venous insufficiency and you have symptoms, treatment is generally covered by insurance, including Medicare and Medicaid. Purely cosmetic spider vein treatment is typically not covered. The ultrasound at the first visit establishes medical necessity, which is why the evaluation is the right starting point rather than guessing about coverage.
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