Normally there is a series of one-way valves in the leg veins that allow for blood flow through the veins back toward the heart during muscle contraction. When functioning properly, these valves open and close in sequence, preventing blood from refluxing back down the leg. When the valves become leaky and open in the opposite direction venous blood begins to pool in the leg and the pressure rises in the veins below the knee. Since veins are thin walled, components of the blood eventually may leak out of the veins into the surrounding tissues.Initially this may be limited to water and protein, causing swelling, which worsens as the day progresses and is usually more significant with standing or sitting. Over time, red blood cells and white blood cells may also leak out of the veins into the skin and fat around the ankle leading to discoloration of the skin and eventually, scarring of the skin and fat to the underlying muscle. This condition is known as stasis dermatitis or lipodermatosclerosis (fat and skin scarring), and is a significant risk factor in the development of venous ulcerations and recurrent skin infections. Many unsuspecting patients may seek the advice of a dermatologist for this condition and be unsuccessfully treated with a variety of creams. Thus, it is of paramount importance to investigate varicose veins not only to determine the presence and severity of underlying venous insufficiency, but also to perform treatment earlier in the disease process and reduce the risk of future complications.