Related Experiment Video
Updated: Apr 18, 2026
A Murine Tail Lymphedema Model
Published on: February 10, 2021
Bilateral lower extremity inflammatory lymphedema in Air Force basic trainees: clinical and epidemiologic study of a
Kevin A Fajardo1, Patrick Keller2, Todd Kobayashi3
110th Aeromedical Squadron, US Air Force Academy, Colorado Springs, Colorado.
Importance:
This observational study characterizes a new clinical condition identified in 55 military trainees.
Objective:
To determine the incidence and underlying cause of bilateral lower extremity inflammatory lymphedema in Air Force basic trainees.
Design, Setting, And Participants:
An observational study was conducted at Lackland Air Force Base in San Antonio, Texas. Participants included 14 243 Air Force basic trainees who entered training between September 2011 and January 2012 and the 55 trainees (0.4%) who developed bilateral lower extremity inflammatory lymphedema that occurred during the 8½-week basic training course. Two modifiable risk factors were evaluated: vaccine reaction and newly issued military footwear (combat boots and boot socks).
Interventions:
During November 2011, all new trainees wore only white socks and running shoes rather than the issued military footwear. During December 2011 and January 2012, the scheduled administration of tetanus/diphtheria/acellular pertussis and meningococcal vaccines, respectively, was delayed by 1 week for all new trainees. A full medical record review was conducted for every confirmed case of bilateral lower extremity inflammatory lymphedema.
Main Outcomes And Measures:
Identification of incident cases, symptom onset, antimicrobial treatment, immunization reaction, laboratory studies, specialty referral, and biopsy.
Results:
Fifty-four of the 55 incident cases (98%) of bilateral lower extremity inflammatory lymphedema occurred during the first 120 hours of training. Alterations in the timing of the military footwear used and selected vaccine administration had no effect on the incidence of new cases. Two participants (4%) experienced symptom onset before receipt of the vaccines. Oral antimicrobial medications were not found to speed symptom resolution compared with conservative treatment measures (P = .34). One incident case was diagnosed as leukocytoclastic vasculitis by tissue examination.
Conclusions And Relevance:
Multiple training-related risk factors were ruled out as sources of bilateral lower extremity inflammatory lymphedema. Cases are likely secondary to prolonged standing with resultant gravity-dependent venous congestion and inflammatory vasculitis. The potential roles of undiagnosed venous reflux disease and the military physical training environment in these cases remain to be elucidated.
Related Concept Videos
01:23Peripheral Artery Disease V: Postoperative Nursing Management
01:27Assessment of the Cardiovascular System III: Palpation
Jugular Venous Pressure (JVP) Measurement
Position the patient at a thirty- to forty-five-degree angle or in a semi-fowler's position. Look for the highest point of pulsation in the internal jugular vein and measure the vertical distance to the angle of Loius or sternal angle. A normal JVP is 3-4 cm above...
01:15Veins of Lower Limbs
Formed by the union of the medial and lateral plantar veins, the posterior tibial vein, rising through the calf muscle, assimilates the fibular vein. The anterior tibial vein, a superior extension of the foot's dorsalis pedis vein, merges with the posterior tibial vein at the...
01:21Peripheral Arterial Disease II: Clinical Manifestations and Diagnostic Evaluation
01:15Development of the Lymphatic System
The first lymph sacs to form are the paired jugular lymph sacs located at the junction of the internal jugular and subclavian veins. From these sacs, lymphatic capillary plexuses extend to the thorax, upper limbs, neck, and head, eventually forming lymphatic vessels. Each jugular lymph sac maintains a...
01:16Lymphatic Vessels and Lymph Transport
This one-way system allows fluids, solutes, and even pathogens to enter but prevents their return to the intercellular...