Background: The significance of recognizing and locating incompetent perforating veins for treating the patients with varicose vein and venous ulcers is well established. Several methods of diagnosing incompetent perforating veins have been evaluated in the past, however, none show satisfactory accuracy in predicting incompetent perforating veins. Clinical examination with digital palpation of fascial defects is the most widely used method. These fascial clefts are generally thought to keep up a correspondence to incompetent perforating veins. Further evidence is obtained when digital pressure relief on the defect leads to filling of superficial varicose veins or if a tourniquet applied beneath the defect prevents it. The purpose of the present study was to compare clinical examination with that of Doppler venous study in the diagnosis of incompetent perforating veins of lower limbs.  Methods: This is a Cross-sectional comparative study which was carried out in  50 patients with lower limb varicose veins admitted to the department of general surgery in RIMS,Ranchi. They were evaluated by clinical tests and Doppler ultrasound.   Results: Sensitivity and specificity of colour Doppler for SFJ and SPJ is 100% while for perforators is 91.58%. Specificity of clinical examination for SFJ is 100% and for perforators 60%. Sensitivity of clinical examination for SFJ is 90% for perforators 60%.  Conclusions: From this study and results, it shows that doppler ultrasound evaluation of the varicose veins should be done for accurate diagnosis in all patients before planning surgery.