From swollen ankles to bruises on his hands: Here's what venous insufficiency is and why Trump suffers from it.

Donald Trump's swollen ankles, captured by photographers while the president was sitting on a stage, as well as the marks on his hands, are a sign of "chronic venous insufficiency," as the presidential staff explained. This is a condition, especially common in people over 70, linked to a possible alteration of the veins, in which blood is unable to "return" to the heart, pooling in the venous system of the legs and causing swelling and other symptoms. According to the White House, after days of speculation about photographs showing bruises on the president's hand, Trump underwent a "comprehensive examination," which included a diagnostic vascular study, spokeswoman Karoline Leavitt said. "All results were within normal limits... and the president remains in excellent health," the White House press secretary added.

When we talk about venous insufficiency, however, explains Fortunato Maiolo , angiologist and specialist in vascular surgery, the variety of conditions is enormous. The stages can range from a preclinical phase characterized by a feeling of heaviness, cramps, and tingling in the lower limbs, to more serious situations with leg ulcers. In general, "we talk about venous insufficiency with veins that dilate and, consequently, the valves function less. In fact, we have valves along the entire venous circulation that allow blood to return from the lower limbs to the heart." In "a preclinical stage, there is no edema, you can have varicose veins, heaviness, without swelling in the legs. This is because the lymphatic system is activated, drawing more lymph toward the center, thus helping to avoid edema." These problems can be caused, for example, by "cardiac, renal, or dysproteinemia problems, which are linked to alterations in the quantity and quality of proteins in the blood, particularly plasma proteins," adds Maiolo.

Among the various causes, "from what we can gather from images and behaviors we've seen in the media, I would rule out heart failure, given the president's expressed vitality," the expert observes, "which is hardly compatible with these cardiac issues, as we recently saw at the Chelsea awards ceremony." Leg swelling from chronic venous insufficiency, in any case, "is compatible with the president's lifestyle, who tends to—between plane rides, meetings, and desk work—sit for long hours and can barely walk (the main treatment for leg swelling)," the angiologist emphasizes. Furthermore, chronic venous insufficiency is extremely common, she recalls, "more so in women because estrogen decreases the elasticity of the venous walls, which then dilate. This dilation impairs the function of the valves that allow blood to return from the legs to the heart. But even in men, these veins can deteriorate as they age. This is also because people walk less and less, have problems with their support (knee or ankle osteoarthritis), and, with little walking, their legs inevitably tend to swell."

In more advanced stages, however, "we have a decompensation of this circulation. The lymphatic system can no longer draw the lymph back, and therefore we have swelling." Having swollen legs, however, does not necessarily mean having an insufficiency; the pathological disorder must be distinguished from the functional one. The problem can also be linked to "poor foot support," or to "remaining seated or standing for many hours. We all have," the angiologist emphasizes, "experienced international flights where we remain uncomfortably seated for long periods, and, once we disembark, our legs are a bit swollen because, remaining seated for a long time in a confined space, we have no venous return." The solution is "physical activity," Maiolo recommends, "especially walking. This is because under the sole of the foot we have what's known as the 'Lejar venous sole,' a sort of sponge. Every time we put our foot down, this sponge 'squeezes,' sending blood upward. Furthermore, we have another peripheral heart during physical activity: the calf, by contracting, 'squeezes' the veins, thus returning the blood to the heart."