Symptoms of Ice cold feet plus heaviness in legs strongly linked to varicose veins: Study

Hypersensitivity to the cold, especially ice cold feet, as well as a feeling of heaviness in the legs, are linked to the presence of varicose veins, finds a large study published in the open access journal Open Heart.

Cold hypersensitivity is often underestimated as a subjective symptom, say the researchers.

Varicose veins are usually caused by impaired functioning of the deep or superficial veins, and the perforator veins (short veins that link the superficial and deep venous systems in the legs).

The prevalence of varicose veins ranges from 2% to 30% in adults, with women at higher risk. And symptoms include sensations of heaviness, aching, throbbing, and itching; restlessness in the legs; fluid retention and swelling; muscle cramps; and leg ulcers in severe cases.

Previously published research indicates that heightened sensitivity to cold may be associated with varicose veins, note the researchers. To explore this further, they mined data covering the period January 2008 to December 2020 inclusive from the Taiwan Biobank, the largest genetic and population-based database in Taiwan.

In all, 8782 participants aged between 30 and 70 with moderate and severe varicose veins were included in the analysis. They were quizzed about their hypersensitivity to cold in their feet and the extent to which they felt heaviness in their legs.

And information on potentially influential factors was collected on sex, diet (vegetarian), age, cigarette smoking, alcohol intake, regular exercise, weight (BMI), education level, job type (predominantly standing or sedentary), and presence of diabetes and high blood pressure.

In all, 676 participants said they had moderate to severe varicose veins.

Of the total number of participants, 5888 said they weren’t hypersensitive to the cold, just under 6% (340) of whom had varicose veins.

Of the remainder, 1535 participants said they were moderately hypersensitive to the cold, just over 9% (144) of whom had varicose veins; and 1359 said they were extremely hypersensitive to the cold, just over 14% (192) of whom had varicose veins.

Statistical analysis showed that moderate to severe cold hypersensitivity was associated with a 49%-89% heightened likelihood of varicose veins compared with no hypersensitivity.

Similarly, 4 times as many people with varicose veins had heavy legs as those without the condition.

Job type was also an influential factor: jobs involving prolonged standing were associated with a 45% higher likelihood of varicose veins.

The association between cold hypersensitivity and heavy legs was significant.

In the absence of cold hypersensitivity, the likelihood of varicose veins and heaviness in the legs was 7 times greater than in those who didn’t report leg heaviness.

Among those who did report this symptom, the likelihood of varicose veins was 90% higher for those with moderate cold hypersensitivity, and more than 3 times as high among those reporting extreme hypersensitivity to the cold.

And compared with those reporting neither cold hypersensitivity nor heaviness in the legs, moderate and severe cold hypersensitivities were associated with an 80% and more than doubling in the likelihood of varicose veins, respectively.

This is an observational study, and as such can’t establish causal factors. It also relied on subjectively assessed self report rather than clinical assessment, added to which no information was available on any forms of treatment for varicose veins.

But the researchers point out: “Healthcare providers frequently underestimate the gravity and implications of varicose veins, leading to their neglect, and there is usually a gap in understanding the comprehensive spectrum of linked symptoms.”

They add: “In clinical practice, the sensation of coldness is usually relegated to a secondary position among the many varicose vein symptoms. This relegation is attributed to its subjectivity and the consequent ease with which it can be overlooked.

“However, our study showed the presence of a moderate-to-severe degree of hypersensitivity to cold in the lower extremities, which has hitherto been underestimated as a subjective symptom associated with varicose veins.

“Of note is the significance of the concurrent symptoms of heaviness and cold feet. When these symptoms coexist, the likelihood of confirming the presence of varicose veins is notably amplified compared with individuals without such symptoms.”

Reference:

Cheng-Ken Tsai, Hsuan-Yin Wu, Oswald Ndi Nfor, Disline Manli Tantoh, Wen-Yu Lu, Yung-Po Liaw - Cold hypersensitivity in the lower extremities: an underappreciated symptom in patients with varicose veins: Open Heart 2025;12:e002909.