The classic definition of varicose veins are that they are bulging enlarged twisted blood vessels that are greater than 4 mm. and are clearly visible through the skin. Venous ultrasound allows for the viewing of veins below the surface of the skin and any vascular technologist will tell you that not all varicose veins are visible to the naked skin.
Pain in the legs is classically attributed to arterial disease or spinal injuries. Often venous disease is not considered for chronic leg pain. Vein disease is very gradual in nature and often the symptoms increase with age. So a patient may feel that their knee pain is due to their knees when it may very well be related to venous insufficiency.
Recent advances in vein treatment and more access to outpatient vein care have shed light on this subject. Patients are finding that taking care of the veins first increases mobility and even complications when having orthopedic surgery later. Acute pain in the legs can be a sign of a more serious concern. Always consult your physician if you have acute pain for no reason.