title: Venous insufficiency after prolonged standing: Is joint hypermobility an important risk factor?
abstract: 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.
  
  
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Clinical Biomechanical and Rehabilitation Engineering Research Center, AJA University of Medical Sciences, Tehran, Iran.
authors.forename: Kamran
authors.initials: K
authors.lastname: Azma
authors.affiliation: Department of Internal medicine, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Peyman
authors.initials: P
authors.lastname: Mottaghi
authors.affiliation: Department of Orthopedic Surgery, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Alireza
authors.initials: A
authors.lastname: Hosseini
authors.affiliation: Department of Pediatrics, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Shadi
authors.initials: S
authors.lastname: Salek
authors.affiliation: Department of Internal medicine, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Roya
authors.initials: R
authors.lastname: Bina
keywords: Joint hypermobility; prolonged standing; venous insufficiency