The clinical importance and optimal management of chronic Gastrocnemius vein (GCV) incompetence have rarely been discussed. In case of an incompetent GCV with varicose degeneration, surgical management of intramuscular varicose vein may be challenging.Combined treatment using endovenous laser ablation and ultrasound-guided foam sclerotherapy for tortuous and dilated left lateral gastrocnemius vein incorporating distal muscular trunk as well as proximal main trunk, showed acceptable early outcome.Longer-term follow-up is warranted to verify the benefits from this novel non-surgical approach for deep-seated vein abnormalities.