Your concern
Swollen, heavy legs
A symptom with a precise timetable: worse in the evening, better overnight.
The sensation of heavy, swollen legs that «pull» towards evening is one of the commonest reasons for a phlebology visit, and it has a feature that makes it recognisable: its pattern through the day. In the morning the legs are normal, over the hours the swelling increases, in the evening the sock leaves a mark at the ankle, and overnight everything subsides.
That rhythm is not a detail: it says gravity plays a part, and points towards a problem of venous return. It worsens with prolonged standing, with heat, and in jobs where you stand or sit for many hours without moving.
The point at which the reasoning leaves «it happens to everyone» is asymmetry. Swelling involving one leg only, appearing rapidly, with calf pain, warmth or redness, is not evening tiredness: it is a picture to be assessed without delay. Likewise, swelling that does not subside at all overnight deserves different assessment, because that missing rhythm is itself information.
One leg only, suddenly, does not wait
This is the most important distinction on this page. Swelling from venous insufficiency is typically bilateral and follows the rhythm of the day: a visit can be arranged calmly. Swelling appearing rapidly in one leg only, especially with calf pain, warmth, redness or increased firmness, is a different picture and must be assessed at once, not at the next opportunity. The same applies if it appears after a period of prolonged immobility, surgery or a long journey.
How it shows
- Heaviness and swelling increasing through the day
- Sock marks at the ankle in the evening
- Improvement after a night's rest or with legs raised
- Worsening with heat and prolonged standing
- Night cramps or tingling
- Appearance of visible veins or thread veins
How we proceed
- 1Phlebology visit: pattern through the day, symmetry, risk factors
- 2Clinical assessment of the venous circulation of the legs
- 3Vascular ultrasound where indicated (performed at the Siena clinic)
- 4Advice on compression, movement and posture
- 5Treatment of thread veins or varicose veins where appropriate
Available treatments
- Phlebology visit
- Vascular ultrasound (Siena)
- Compression therapy
- Sclerotherapy
Book a visit
Our specialists will evaluate your case and define the most suitable treatment plan.
Book in FlorenceBook in SienaSiena · Firenze
Where to find us
Frequently asked questions
Do compression stockings really help?+
Yes, and they are often the most effective measure in venous insufficiency, provided they are the right class and worn in the right way and at the right time: they go on in the morning, before swelling forms, not in the evening when it is already there. A stocking chosen at random in a pharmacy can be useless or uncomfortable enough to be abandoned, which is one reason the prescription is given at a visit.
Is a vascular ultrasound always needed?+
Not always: in many cases clinical assessment is enough to plan the pathway. The examination becomes useful when it is necessary to understand how the deep and superficial circulation work before deciding on treatment, or when the picture is atypical. In our organisation vascular ultrasound is performed at the Siena clinic: it is one of the services not available at both sites, and we prefer to say so here.
Is walking good or does it make it worse?+
It is good, and this needs saying because many people cut back movement exactly when it is most needed. The calf muscles work as a pump pushing blood upwards: walking activates it, while standing still or sitting for long periods is the worst condition. Resting with the legs raised makes sense at the end of the day, not as a substitute for movement.
Related reading
Have a question? Let's talk.
Book a first visit: the physician will evaluate your situation and guide you to the most suitable treatment.
Book a phlebology visit