Restless legs syndrome (RLS) is a constellation of symptoms of jumpy legs, and discomfort in the legs which is worse in bed and often relieved with ambulation. It is often worse in the third trimester of pregnancy and relieved after delivery. Many medical therapies have been employed, most of which make the patient drowsy thus allowing sleep to occur. Many of the symptoms of RLS are seen in patients with venous insufficiency. In patients with symptoms of RLS, one should consider the diagnosis of venous insufficiency as a contributing factor. Many patients with severe venous insufficiency and RLS symptoms experience partial or complete relief of their RLS symptoms after successful treatment of their venous problem. Patients who experience improvement or complete relief of their RLS symptoms after a trial of compression hose should have a good response to endovenous ablation of their severely insufficient superficial veins.