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Prolonged standing, vasculitis likely causes of lymphedema in military basic training

Prolonged standing, venous congestion and inflammatory vasculitis were the likely causes of bilateral lower extremity inflammatory lymphedema in Air Force basic trainees, with other training-related risk factors ruled out, according to recently published study results.

Researchers conducted an observational study of 14,243 Air Force basic trainees who entered training between September 2011 and January 2012 at Lackland Air Force Base, San Antonio, Texas. During the 8 ½-week course, bilateral extremity inflammatory lymphedema was developed by 55 of the trainees (0.4%). Vaccine reaction and newly issued military footwear (including combat boots and boot socks), defined as modifiable risk factors, were evaluated.

As an intervention, in November 2011, all new trainees wore only white socks and running shoes instead of issued military footwear. Scheduled administration of tetanus/diphtheria/acellular pertussis and meningococcal vaccines, respectively, was delayed by 1 week during December 2011 and January 2012. Confirmed cases of bilateral lower extremity inflammatory lymphedema received a full medical record review.

Ninety-eight percent of the bilateral lower extremity inflammatory lymphedema cases happened during the first 120 hours of basic training. There was no effect on the incidence of new cases with alternations to military footwear or timing of selected vaccine administration. Symptoms onset were experienced by two participants (4%) prior to receiving vaccines. Symptom resolution was not found to be quicker with the use of oral antimicrobial medications when compared with conservative treatment (P=.34). Tissue examination was used to identify one incidence case as leukocytoclastic vasculitis.

“Although the investigation did not definitely identify the cause of lymphedema, our findings ruled out many potential causes and detected a previously undescribed, but potentially preventable, disorder,” the researchers concluded.

Disclosure: The researchers report no relevant financial disclosures.