Varicose veins can be painful or they can be painless. Varicose veins were once normal veins that became dilated (enlarged) due to failure of the one way valves in the veins. Sometimes the increased venous pressure can cause the varicose vein to ache. Due to the stagnant blood, a varicose vein can develop a superficial venous thrombosis, which can be quite painful. While many varicose veins are painless, they are still at risk for developing a superficial venous thrombosis. Varicose veins, whether painless or not, do signify the presence of venous insufficiency of the deeper veins. The evaluation and treatment of varicose veins and venous thrombosis is best performed by a vein specialist, ideally a doctor who is board certified in phlebology and board certified in surgery.