In patients with chronic venous insufficiency, which finding is likely on physical exam?

In patients with chronic venous insufficiency, hyperpigmentation near the ankles is a common finding during a physical examination. This occurs due to the accumulation of hemosiderin, a pigment derived from hemoglobin, which leaks into the interstitial tissues as a result of venous stasis and increased pressure in the veins. Over time, this causes a brownish discoloration of the skin, particularly around the ankle area, which is a hallmark sign of chronic venous issues.

The other options do not typically exhibit the same prominence in chronic venous insufficiency. Capillary refill time is not specifically related to venous insufficiency and more commonly assesses peripheral perfusion. Cold and pale skin may indicate arterial insufficiency rather than venous issues, as chronic venous insufficiency usually leads to warm and swollen extremities due to fluid accumulation. Thickened toenails can occur for various reasons, including fungal infections or aging, but are not specific to chronic venous insufficiency and can be found in many other conditions.