Background: In most of Western and European countries, reimbursement for the treatment of vein disorders depends upon the severity of the disease. This is currently evaluated according only to skin appearance (normal skin, edema, cutaneous changes and finally ulceration). Aim: In this study, the occurrence of skin damaging was evaluated by ultrasonography in varicose legs with apparently normal skin (excluded from reimbursement in many countries). Methods : Only legs with extensive varicose veins were considered (reflux originating from the saphenofemoral junction and descending along the great saphenous vein down to the lower leg). US findings fom the varicose leg were compared to those from the contra lateral healthy limb. Results: In 13/18 varicose legs, skin changes related to inflammation were observed: dermal edema, subcutaneous edema, dermal or subcutaneous infiltration. In these legs, scoring for venous symptoms resulted higher than in the remaining 5 legs. Discussion: Sonography demonstrated the occurrence of cutaneous and/or subcutaneous inflammation in varicose legs with apparently normal skin. These objective signs correlate to heavier symptoms and greater limitation in working, domestic and social activities. Possible forensic and insurance implications are finally discussed
