We experienced two cases of anterior tibial varicose veins caused by intraosseous venous drainage anomaly. Case 1 was a 62-year-old man who had a localized protrusion on the anterior surface of the left tibia for 10 years, which began to cause pain one month ago. CT revealed dilated veins penetrating the left tibia, and symptoms improved after surgical treatment. Case 2 was a 74-year-old woman who developed pain in the right lower leg two weeks ago. Colour doppler echography showed refluxing blood flow from a cortical bone defect, and CT confirmed veins penetrating the tibia. Surgical treatment also improved her symptoms. Anterior tibial varicose veins caused by bone perforators due to intraosseous venous drainage anomaly are relatively rare.