Incompetent perforating veins (IPV) of the lower limb are known to be an important cause for delayed healing of venous leg ulcers and recurrence of varicose veins after surgery of the lower limb. The treatment of IPV is a major issue in clinical practice. In this article, the authors briefly describe the pathogenesis of IPV, address the procedures as well as the pros and cons of the open division of perforating veins, subfascial endoscopic ligation of perforating veins (SEPS) and percutaneous ablation of perforating veins (PAPS), and indicate that minimally invasive techniques are becoming prevalent in the treatments of IPV. The authors intend to provide reference for the treatments of IPV in clinical practice.