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Standing on the Job

March 1, 2020

Standing on the JobNurses, doctors, teachers, hairdressers, bank tellers, assembly line workers, even lobsterman – there are many occupations where people are on their feet for hours on end. These jobs often take a physical toll, especially on the legs and feet. One reason for discomfort in the lower extremities is poor circulation, but what exactly does that mean?

The major parts of the circulatory system (also known as the cardiovascular system) are the heart, arteries, and veins. The heart pumps blood to the arteries, which take the oxygenated blood to all parts of the body. Healthy veins carry deoxygenated blood back up to the heart, the “muscle pumps” in our feet and calves helping the blood to travel against gravity.
If you are standing on your feet all day, your circulatory system isn’t working as efficiently as it should. If you have venous (vein) issues, the problem can be exacerbated.

In leg veins, there are valves that open to allow the blood to flow one way: up. If the valves in the veins become damaged, some blood will flow back into the legs or feet and “pool” there resulting in a feeling of heaviness, leg pain, varicose veins, or other symptoms. This is sometimes referred to as venous congestion or reflux.

Recognizing the Symptoms
One of my patients, Karen, is a Physical Therapist and Orthopedic Certified Specialist at a hospital in Wells. Her tasks vary depending on her caseload, but on average Karen is on her feet 80% of the day. At first Karen noticed “very unsightly bulging veins” in her legs, behind the knees and at the ankles. But there were other symptoms showing up that she did not realize were warning signs of venous disease. By the end of the workday her feet and legs would be extremely tired and, many times, swollen. She began having leg cramps at night. A runner, she also realized that running wasn’t feeling as good as it used to, either during or afterward.

Karen’s leg problems – both visible and not-so-obvious – gradually became worse, until a new condition presented itself, one she affectionately named “twitchy legs.” She said she could not stop moving her legs, even when just sitting on the couch watching TV. “I started having this annoying thing happen more and more where I constantly had to fidget,” she said. “I could not stop moving my legs, even when I was just sitting on the couch watching TV.”

She didn’t put all the pieces together until she was talking to one of her patients who had also experienced symptoms before she sought vein treatment. After an a-ha moment, Karen came into my practice for a consultation. A diagnostic ultrasound confirmed venous reflux; the vein valves in both legs were not functioning properly, her left leg worse than the right leg. The treatment plan included endovenous laser ablation (EVLA) to fix the reflux in Karen’s left leg and ultrasound-guided sclerotherapy to treat the source of the dysfunctional vein valve on the right leg. She described both procedures as “a piece of cake.” After a few months, the leg twitching and nighttime cramping were 90% gone and Karen’s stamina at work had improved tremendously.

Varicose Veins
Karen’s experience is far from unique. Several studies in the past five years have attempted to investigate the prevalence of varicose veins among professionals who work long hours on their feet. In 2015, research reported in the International Journal of Nursing Practice looked at the relationship between the occupational and demographic hazards that characterize varicose veins and their intensity among nurses. A cross-sectional study was carried out among 203 nurses from three hospitals in Amol, Iran. “Varicose veins of the legs among nurses—Occupational and demographic characteristics” found that the prevalence of varicose veins (of varying degrees) was 72.4%, with women having a higher prevalence compared with men (77.9% vs. 56.9%). According to the study, a patient’s occupation can be among the factors that intensify vein disorders. Blood hydrostatic force in standing position along with other intrinsic factors such as heredity can contribute to varicose creation because upwards blood pumping takes place with muscle contraction. Standing is worse than walking for varicose patients and hydrodynamics pressure does not help blood discharge in this state.

Treatment & Solutions
My number one suggestion for people on their legs all day is to wear a good, trusted brand of graduation compression stocking. After years of wearing compression almost daily, I have tried a variety of brands and styles and I encourage patients to find the right fit for them. In addition to preventing leg swelling and fatigue, wearing compression can also be a good diagnostic tool. If the compression makes a profound difference in how a patient’s legs feel, it may be aiding a “hidden” venous issue, one that could be very treatable.

Dr. Cindy Asbjornsen is the founder of the Vein Healthcare Center in South Portland, Maine. Certified by the American Board of Venous and Lymphatic Medicine, she cares for all levels of venous disease, including spider veins, varicose veins, and venous ulcers. She is the only vein specialist in Maine to be named a Fellow by the American College of Phlebology. You can contact Dr. Asbjornsen at 207-221-7799 or