Restless Leg Syndrome & Other Leg Symptoms

You finally sit down to relax after a long day, and then it starts. That relentless, crawling, impossible-to-ignore urge to move your legs. Or maybe it is the aching and heaviness that sets in by afternoon, or the leg cramps that jolt you awake at night. Whatever form your symptoms take, they are affecting your sleep, your comfort, and your quality of life.

What many people do not realize is that a significant number of these leg symptoms, including restless leg syndrome, have a treatable underlying cause: chronic venous insufficiency. At Miller Vein, our board-certified specialists evaluate and treat vein disease throughout Michigan, helping patients find relief from symptoms they have often struggled with for years. If your legs have been keeping you up at night, it may be time to look at your veins.

When symptoms start interfering with daily life, restless legs treatment can resolve the underlying problem.

The Connection Between RLS and Vein Disease

Here is what many people, and even many physicians, do not know: venous insufficiency is a clinically documented and frequently overlooked cause of restless leg syndrome.

Curious to learn more? Read the real culprit behind many RLS cases on our blog.

A large sleep study found that 50% of individuals with RLS also had venous reflux or venous insufficiency. Other studies have found even higher rates of overlap. More importantly, study after study has demonstrated that 87% of RLS patients treated with endovenous ablation experience meaningful improvement in their RLS symptoms. One study found that 89% of patients saw their RLS score decrease by at least 15 points on a scale of 0 to 40, a clinically significant improvement.

Your provider may also recommend sclerotherapy injections where appropriate.

This means that for many RLS sufferers, the right treatment is not a neurological medication. It is a vein evaluation to reduce symptoms.

Before accepting a long-term prescription for RLS, a venous reflux workup should be completed. If vein disease is identified and treated, symptoms (even severe symptoms) often resolve or improve substantially without the side effects and long-term risks associated with medication.

Patient Stories to
Legs Like New®

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I was extremely happy with my results. I was treated with Sclerotherapy. Before and after pictures are incredible! I was very self-conscious about how my legs looked and always wore long capris in the summer to cover them. I wish I had done this sooner. The staff was very professional, friendly, and knowledgeable. They made me feel very comfortable.

— Diane D.

The staff was wonderful and really took my concerns and put my mind at ease. I would definitely recommend them to everyone. Staff on time, and had my ultrasound done and saw the doctor and was out of the office start to finish 90 minutes, was first visit. The Dearborn office was wonderful.

— Theresa H.

My experience was amazing. I got there a little bit early, I was taken right back. Everybody was very nice, explained everything to me as they went. I would recommend Miller Vein to anybody; they are fantastic.

— Stacie N.

Very friendly staff and very thorough. They explained everything as they went through the different steps during the appointment. I felt very at ease here. I am very happy I chose them.

— Angela H.

What Is Venous Reflux and Why Does It Cause RLS Symptoms?

To understand why vein disease causes so many different leg symptoms, it helps to understand what venous reflux actually is and what it does to the body.

Normally, the veins in your legs use one-way valves to push blood upward against gravity, from the feet back to the heart. Every time your calf muscles contract, they help drive blood through these valves. When the valves are working properly, blood flows in one direction only.

When those valves weaken or fail, blood is allowed to flow backward and pool in the lower legs. This backward flow is called venous reflux, and the resulting condition is chronic venous insufficiency (CVI). The pooled blood increases pressure within the veins and the surrounding tissue, reducing oxygen delivery to the muscles and skin, triggering inflammation, and producing the wide range of symptoms that patients with CVI experience.

This is why venous insufficiency does not produce just one symptom. It creates a cascade of effects throughout the lower leg that can manifest as aching, swelling, skin changes, cramping, restlessness, fatigue, or even open wounds, depending on the severity of the reflux and how long it has been present.

Common Leg Symptoms of Chronic Venous Insufficiency

Chronic venous insufficiency produces a wide spectrum of symptoms. Many patients present with several of these simultaneously and have attributed them to aging, long work hours, or simply being on their feet. Understanding the full range of CVI symptoms helps you recognize when your legs may be trying to tell you something important.

Heaviness and Fatigue

A persistent sense of heaviness or weighted legs, as though your legs are working harder than they should, is one of the earliest and most consistent signs of CVI. Blood pooling in the lower legs increases pressure and reduces circulation, leaving the muscles tired and sluggish even without significant physical activity.

Aching and Pain

A dull, deep ache or throbbing pain in the legs, often intensifying after prolonged standing or sitting, is caused by the increased venous pressure as blood struggles to return upward. The discomfort typically improves with leg elevation and worsens as the day goes on.

Swelling (Edema)

Swelling in the ankles and lower legs is a direct result of fluid accumulating in the tissue as venous pressure rises. CVI is actually the most common cause of secondary lymphedema in the legs. Swelling associated with CVI typically builds throughout the day and partially resolves overnight when the legs are elevated.

Throbbing

Some patients describe a pulsating or throbbing sensation in the affected legs, particularly after periods of inactivity or at the end of the day. This reflects the pressure changes within the poorly functioning veins.

Itching, Burning, or Tingling

Inflammation in and around the affected veins produces sensations of itching, burning, or pins and needles in the lower legs. These symptoms can come and go, worsen with heat, and are sometimes mistaken for nerve-related conditions.

Leg Cramping

Nocturnal leg cramps and cramping after prolonged standing or sitting are frequently linked to poor venous circulation. When blood flow is impaired, muscles may not receive adequate oxygen and nutrients, leading to painful, sudden muscle contractions.

Restless Legs

As discussed above, the uncomfortable creeping, crawling, or aching sensations of restless leg syndrome can be directly linked to venous insufficiency in a significant proportion of cases. RLS symptoms driven by CVI are often successfully resolved with vein treatment.

Skin and Vein Changes Associated with CVI

As CVI progresses and venous pressure chronically damages the surrounding tissue, visible changes to the skin and veins develop. These changes are important clinical markers of disease severity and should prompt a thorough vein evaluation.

Varicose Veins

Enlarged, twisted, rope-like veins visible beneath the surface of the skin are the most recognizable sign of venous disease. They develop when weakened vein walls can no longer contain the pooled blood. Varicose veins can be painful and tender, and they signal underlying venous reflux that needs to be addressed.

Spider Veins

Smaller, web-like networks of red, blue, or purple vessels near the skin’s surface often accompany CVI. While they are less symptomatic than varicose veins, they frequently indicate elevated venous pressure in the surrounding tissue.

Skin Discoloration

Brownish or reddish discoloration around the ankles and lower legs is caused by iron deposits from red blood cells that have leaked out of the distended, high-pressure veins into the surrounding tissue. This discoloration is a sign of more advanced venous disease.

Lipodermatosclerosis

Chronic inflammation and fluid accumulation can cause the skin and underlying tissue of the lower leg to harden, thicken, and tighten, a condition known as lipodermatosclerosis. The affected skin may feel firm, and the lower leg can take on an inverted-bottle shape in severe cases. This is a significant warning sign of advanced CVI.

Dermatitis

Dry, itchy, flaky, or scaly skin on the lower legs and ankles, sometimes called eczema of the legs or stasis dermatitis, is a direct result of chronic venous inflammation. It is frequently misdiagnosed or undertreated as a simple skin condition when the real cause is the underlying vein disease.

Venous Leg Ulcers

Open, slow-healing wounds near the ankle are the most serious complication of untreated CVI. Venous leg ulcers develop when chronic venous pressure causes tissue breakdown, cutting off the oxygen and nutrients the skin needs to stay intact. They are painful, prone to infection, and can become chronic and recurrent without appropriate vein treatment. Addressing the underlying CVI is essential for achieving lasting wound closure.

What About RLS Medications?

For patients whose RLS is not caused by venous insufficiency, or whose vein treatment does not fully resolve their symptoms, medication may be appropriate. However, it is important to understand the current medical landscape around RLS medications before accepting a prescription.

Dopamine agonists were previously the most commonly prescribed medications for RLS. They are no longer recommended as a first-line treatment. The reason is a well-documented phenomenon called augmentation, a drug-induced worsening of RLS over time that occurs with long-term dopamine agonist use.

Augmentation causes RLS symptoms to begin earlier in the day, become more severe, spread to other parts of the body, and onset more quickly with rest. Long-term use of dopamine agonists also carries the risk of impulse control disorders.

Alpha-2-delta ligands, such as gabapentin and pregabalin, are currently the recommended first-line pharmacological treatment for RLS when a venous workup has been completed and has not identified a treatable vein cause. These medications can be effective but carry their own side effect profile, including fatigue, dizziness, sedation, peripheral edema, and weight gain.

TOMAC: A Novel Non-Pharmacological Option

For patients with moderate to severe RLS that has not responded to other treatments, a novel device-based therapy called tonic motor activation (TOMAC) is available. The TOMAC device is worn bilaterally on the legs over the peroneal nerve at the head of the fibula. It modulates the nerve signals in the lower leg and activates the tibialis anterior muscle, mimicking the neural signals associated with voluntary leg movement, which is the mechanism that naturally relieves RLS discomfort.

How We Evaluate Leg Symptoms at Miller Vein

Every evaluation at Miller Vein begins with a thorough consultation covering your symptoms, their timing and severity, your medical and family history, and any prior treatments you have tried. This conversation matters because it helps us understand the full picture of what you have been experiencing, not just the most obvious visible signs.

The centerpiece of our diagnostic workup is a duplex ultrasound examination, a non-invasive, painless imaging study that visualizes blood flow through the veins in real time. The ultrasound allows us to identify venous reflux, map the affected vessels, and assess the severity of valve dysfunction in both the superficial and deep venous systems.

This is especially important for patients who have been evaluated or treated elsewhere for symptoms like RLS or peripheral neuropathy, because vein disease can be present and symptomatic without any visible surface veins. The ultrasound sees what a visual exam cannot.

Based on the evaluation findings, we develop an individualized treatment plan tailored to your specific anatomy, symptoms, and goals. If venous reflux is identified as a contributing cause of your symptoms, treating it is the first and most important step.

Leg Symptom Care Across Michigan

Miller Vein offers expert vein evaluation and treatment for restless leg syndrome and all CVI-related leg symptoms at eight convenient locations throughout Michigan. We see patients at:

• Auburn Hills
• Dearborn
• Grand Rapids
• Holland
• Macomb
• Novi
• St. Clair Shores
• Troy

Our RLS and Vein-Related Leg Symptom
Treatment Options

The cornerstone of treatment for vein-related leg symptoms is addressing the underlying venous reflux. Modern vein treatments are gentle, performed entirely in the office under local anesthesia, and allow most patients to walk out and resume light activity the same day. Some of the treatments we offer include

Endovenous Thermal Ablation Varithena Ultrasound-Guided Foam Sclerotherapy Microphlebectomy

Endovenous Thermal Ablation Varithena Ultrasound-Guided Foam Sclerotherapy Microphlebectomy

Thermal ablation is the primary treatment for venous reflux in the great or small saphenous veins. A thin catheter is inserted into the affected vein under ultrasound guidance and delivers controlled heat energy that causes the vein to close and seal. Blood naturally reroutes through healthier surrounding vessels, and symptoms related to venous pooling improve significantly in the weeks following treatment.

Miller Vein uses industry-leading technologies, including ClosureFast (radiofrequency ablation) and VenaSeal (medical adhesive closure), to perform this procedure with minimal discomfort and rapid recovery.

Varithena is an FDA-approved, injectable foam sclerotherapy specifically designed for the treatment of varicose veins caused by great saphenous vein reflux. It is an excellent option for veins that are not well-suited to thermal ablation due to their anatomy.

For varicose and reticular veins that are not visible at the surface but are contributing to symptoms, ultrasound-guided foam sclerotherapy allows precise, targeted treatment of deeper vessels. The foam medication displaces blood from within the vein and causes it to close.

For larger surface varicose veins, microphlebectomy allows direct removal through tiny puncture-sized openings in the skin without stitches. It is performed under local anesthesia with minimal scarring and rapid recovery.

Microphlebectomy

Frequently Asked Questions About Restless Leg Syndrome

Board-Certified Specialists That Practice with Care

Our dedicated Team

Dr. Rana Burek, DO

Jeffrey H. Miller, MD

Jennifer Malicke, DO

Krista M. Bannon, MD

Madeline Paquette, DNP

Michael E. Lulenski, MD

Robin Doak, CLT

Steven K. Wang, MD