Venous insufficiency after prolonged standing: Is joint hypermobility an important risk factor?


1 Department of Physical Medicine and Rehabilitation, Clinical Biomechanical and Rehabilitation Engineering Research Center, AJA University of Medical Sciences, Tehran, Iran

2 Department of Internal medicine , Medical School, Isfahan University of Medical Sciences, Isfahan, Iran

3 Department of Orthopedic Surgery, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran

4 Department of Pediatrics, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran


Background: Varicose veins are extremely common disease which is due to elevated superficial venous pressures. We aimed to know that if joint hypermobility causes the venous insufficiency following the prolonged standing.
Materials and Methods: This prospective cohort study conducted on the soldiers of training periods in a military base of Iran Army in Isfahan in 2013. The active-duty soldiers were first examined by a physician and their Beighton scores (BSs) were obtained. At the onset of the training period, the presence of chronic venous insufficiency was clinically evaluated according to the C class of clinical, etiological, anatomical, and pathological classification. After 3 months, soldiers with and without joint hypermobility were reexamined for manifestations of venous insufficiency based on clinical examination.
Results: Of 718 soldiers, 211 subjects were diagnosed for joint hypermobility syndrome (29.3%). The mean BS was significantly higher in hypermobility soldiers (5.5 ± 1.5) than the healthy ones (1.2 ± 1.1). Before the training period, the prevalence of spider and varicose veins in soldiers with joint hypermobility was significantly higher than healthy subjects (P > 0.001). After the training period, the prevalence of venous insufficiency significantly increased in soldiers with joint hypermobility (P > 0.001) while there was no significant difference in healthy group before and after the period of training (P = 0.25).
Conclusion: Hypermobility could be considered as a risk factor for the development of venous insufficiency, so it seems necessary to evaluate the population who need to be standing for a long time for evidence of joint hypermobility.


Khan AF, Chaudhri R, Ashraf MA, Mazaffar MS, Zawar-ul-Imam S, Tanveer M. Prevalence and presentation of chronic venous disease in Pakistan: A multicentre study. Phlebology 2013;28:74-9.  Back to cited text no. 1
Carpentier PH, Maricq HR, Biro C, Ponçot-Makinen CO, Franco A. Prevalence, risk factors, and clinical patterns of chronic venous disorders of lower limbs: A population-based study in France. J Vasc Surg 2004;40:650-9.  Back to cited text no. 2
Vlajinac HD, Radak DJ, Marinkovic JM, Maksimovic MZ. Risk factors for chronic venous disease. Phlebology 2012;27:416-22.  Back to cited text no. 3
Zahariev T, Anastassov V, Girov K, Goranova E, Grozdinski L, Kniajev V, et al. Prevalence of primary chronic venous disease: The Bulgarian experience. Int Angiol 2009;28:303-10.  Back to cited text no. 4
Brand FN, Dannenberg AL, Abbott RD, Kannel WB. The epidemiology of varicose veins: The Framingham Study. Am J Prev Med 1988;4:96-101.  Back to cited text no. 5
Kuhlmann A, Prenzler A, Hacker J, Graf von der Schulenburg JM. Impact of radiofrequency ablation for patients with varicose veins on the budget of the German statutory health insurance system. Health Econ Rev 2013;3:9.  Back to cited text no. 6
Mäkivaara LA, Jukkola TM, Sisto T, Luukkaala T, Hakama M, Laurikka JO. Incidence of varicose veins in Finland. Vasa 2004;33:159-63.  Back to cited text no. 7
Evans CJ, Fowkes FG, Ruckley CV, Lee AJ. Prevalence of varicose veins and chronic venous insufficiency in men and women in the general population: Edinburgh Vein Study. J Epidemiol Community Health 1999;53:149-53.  Back to cited text no. 8
Anwar MA, Georgiadis KA, Shalhoub J, Lim CS, Gohel MS, Davies AH. A review of familial, genetic, and congenital aspects of primary varicose vein disease. Circ Cardiovasc Genet 2012;5:460-6.  Back to cited text no. 9
Criqui MH, Denenberg JO, Bergan J, Langer RD, Fronek A. Risk factors for chronic venous disease: The San Diego Population Study. J Vasc Surg 2007;46:331-7.  Back to cited text no. 10
Azma K, Mottaghi P, Hosseini A, Abadi HH, Nouraei MH. Benign joint hypermobility syndrome in soldiers; what is the effect of military training courses on associated joint instabilities? J Res Med Sci 2014;19:639-43.  Back to cited text no. 11
  Medknow Journal  
Nazem M, Mottaghi P, Hoseini A, Khodadadi HA. Benign joint hypermobility syndrome among children with inguinal hernia. J Res Med Sci 2013;18:904-5.  Back to cited text no. 12
[PUBMED]  Medknow Journal  
Knight I, Bird HA. Joint hypermobility syndrome. BMJ 2010;341:c3044.  Back to cited text no. 13
Rabe E, Pannier F. Clinical, aetiological, anatomical and pathological classification (CEAP): Gold standard and limits. Phlebology 2012;27 Suppl 1:114-8.  Back to cited text no. 14
Criqui MH, Jamosmos M, Fronek A, Denenberg JO, Langer RD, Bergan J, et al. Chronic venous disease in an ethnically diverse population: The San Diego Population Study. Am J Epidemiol 2003;158:448-56.  Back to cited text no. 15
Chiesa R, Marone EM, Limoni C, Volonté M, Schaefer E, Petrini O. Effect of chronic venous insufficiency on activities of daily living and quality of life: Correlation of demographic factors with duplex ultrasonography findings. Angiology 2007;58:440-9.  Back to cited text no. 16
Ruckley CV, Evans CJ, Allan PL, Lee AJ, Fowkes FG. Chronic venous insufficiency: Clinical and duplex correlations. The Edinburgh Vein Study of venous disorders in the general population. J Vasc Surg 2002;36:520-5.  Back to cited text no. 17
Jawien A. The influence of environmental factors in chronic venous insufficiency. Angiology 2003;54 Suppl 1:S19-31.  Back to cited text no. 18
Fowkes FG, Lee AJ, Evans CJ, Allan PL, Bradbury AW, Ruckley CV. Lifestyle risk factors for lower limb venous reflux in the general population: Edinburgh Vein Study. Int J Epidemiol 2001;30:846-52.  Back to cited text no. 19
Ziegler S, Eckhardt G, Stöger R, Machula J, Rüdiger HW. High prevalence of chronic venous disease in hospital employees. Wien Klin Wochenschr 2003;115:575-9.  Back to cited text no. 20