Leg swelling after 50: when is it a vein problem?

Ankle swelling is one of the most common complaints I see, and one of the most commonly dismissed. “It’s just age.” “I stand a lot.” “It goes down overnight.” All plausible — and often correct. But swelling is also the earliest visible sign of chronic venous insufficiency, and the difference matters because early venous disease is far easier to treat than late venous disease.

Clues that the veins are involved

A few patterns raise the likelihood that leaking vein valves are behind the swelling:

• Swelling that is worse in one leg than the other
• Heaviness or aching that builds through the day and eases with elevation
• Visible varicose veins, or a fan of small veins around the ankle
• Itching, dryness or darkening of the skin at the lower calf and ankle
• Night cramps or restless legs

Swelling in both legs that is equal and soft may point elsewhere — the heart, kidneys, medications, or lymphatics — which is exactly why assessment matters rather than assumption.

What assessment involves

A duplex ultrasound scan maps the veins and shows, in real time, whether the valves are refluxing. It is painless, takes about twenty minutes, and in my clinic is done during the consultation itself. From there, treatment ranges from compression and lifestyle measures to walk-in, walk-out procedures that close the faulty vein under local anaesthesia.

The practical takeaway

Swelling that is persistent, one-sided, or accompanied by skin changes deserves a scan, not a shrug. Vein disease is progressive, but it progresses slowly — which means there is almost always a good moment to intervene early. The best time to look is when the ankle first starts telling you something.