The most recognized physical signs of venous insufficiency are spider veins and varicose veins. However, if venous insufficiency is unrecognized or inadequately treated, physical signs often progress and may include lower extremity swelling, skin pigmentation and thickening (stasis dermatitis), external hemorrhage from varicose or spider veins and possible ulceration. Stasis dermatitis is related to scarring of the skin and fat to the underlying muscle where the skin takes on a woody texture and is prone to injury and has difficulty healing. These skin changes are also referred to as lipodermatosclerosis, and is a significant risk factor in the development of recurrent skin infections and eventual venous ulcerations. Venous ulcers are typically the result of incidental skin trauma which have difficulty healing because of the unhealthy nature of the skin and extra fluid in the tissues which impairs the delivery of oxygen to the wounds. Small tears and simple wounds may fester for months and gradually grow larger. Early evaluation of the venous system is important in establishing the underlying cause of these wounds and in expediting the most effective treatment plan. Once the underlying venous condition is treated and the edema or swelling is corrected, oxygen can be transported to the tissues better resulting in healthier tissue and more rapid closure of the wound. Repeated wound care center visits and elaborate protocols including hyperbaric oxygen and repeated surgical debridement are unnecessary in the majority of cases of venous ulcers if the underlying cause is identified early and treated appropriately.