The patients’ legs should be examined standing and lying. While standing the veins over the long and short saphenous distribution are observed and palpated for varicosities. The superficial long saphenous vein runs in the medial aspect of the leg to the groin. The superficial short saphenous vein runs on the posterior margin of the calf from the ankle to the knee.
The superficial veins join the deep veins at the saphenofemoral valve just below the inguinal ligament in the groin, but also through perforating veins along their length. The competence of the saphenofemoral valve can be assessed by Trendelenburg’s test, where the valve is compressed by pressure on the groin with the leg elevated. The patient stands while continuing compression on the groin. If the varicose veins in the leg do not recur on standing, the valve is incompetent. If the varicosities return during compression of the groin, the perforator veins are incompetent.
A variation of this test uses a ligature around the upper thigh and calf to localise which perforators are incompetent. If the varicosities only return on release of the ligature, the valves of the superficial veins are incompetent.