Patients with PTS experience aching pain, heaviness, swelling, cramps, itching, or tingling in the affected limb. Symptoms may be present in various combinations and may be persistent or intermittent. Typically, symptoms are aggravated by standing or walking and improve with resting, leg elevation, and lying down. Signs that may be noted on physical examination of the limb include edema, perimalleolar or more extensive telangiectasia, brownish pigmentation, and venous eczema . Secondary varicose veins may occur, and brawny, tender thickening of the subcutaneous tissues of the medial lower limb known as lipodermatosclerosis may develop. A feared complication is the development of one or more venous leg ulcers, which require close medical attention and often recur. Leg ulcers can be precipitated by minor trauma and are characteristically chronic, painful, and slow to heal.