Elephantiasis nostras verrucosa is the end-stage manifestation of chronic, non-filarial, lymphatic insufficiency. While primary lymphatic disorders should be excluded, lymphoedema secondary to venous hypertension is a potentially common aetiology for this condition in developed nations. We present the case of a 62-year-old woman presenting with a four-year history of elephantiasis nostras verrucosa progressing to impairment of ambulation. Investigations for underlying pathology demonstrated the presence of bilateral chronicized deep vein thrombi, with a primary diagnosis of phelobolymphoedema being therefore retained. Following initiation of anticoagulation, wound care, and compressive bandaging, this patient was discharged to inpatient rehabilitation.