Using Orthotics with patients with Hyper-Mobility
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I have always treated patients with various degrees of hyper-mobility syndrome. The mantra from our clinic was stable orthotics, strengthening exercises, no stretching, and prolotherapy when indicated. This approach was so helpful to so many. It was amazing the number of patients on stretching programs with hyper-mobility syndrome that came into our office that were not getting better. Here, I am presenting 4 articles on the subject.
This first paper discusses the prevalence of patients with hypermobility syndrome involving over 30% of the population. This paper is very thorough, but only mentions one paper that touches on the effect of foot orthotics (OTC ones). Below is this mentioned paper, and I have copied the results of their findings. Designing stable orthotics was my primary role to the 1000’s of these patients in our multi-disciplinary clinic. My orthotic mantra: Always make them more stable.
https://pubmed.ncbi.nlm.nih.gov/29156379/
“Results: Gait appeared more synchronised, with a reduction in step length and width variability, when participants were provided with orthotics. The variation was greatest when participants were asked to walk slower. Double stance was significantly less at slower speeds when orthotics were added
CONCLUSION: Results of this study indicate that orthotics have a definite immediate influence on gait patterns in patients with JHS (joint hypermobility syndrome). Future studies should investigate the long-term effects of orthotics in this population and include outcome measures for symptoms such as pain.”
Since I have followed these patients for years with orthotic devices, I can say that the long term effects of orthotic devices on hypermobility syndrome is life changing.
https://pubmed.ncbi.nlm.nih.gov/30412480/
Conclusion: The forefoot regions received a higher load in GHS (generalized hypermobility syndrome) during gait. This could be useful in clinical evaluation of the foot in GHS, preventing potential injuries of lower extremity, and also in processes related to decision making for foot orthotics and/or rehabilitation protocols.
Most patients with hypermobility syndrome in my practice had elongated achilles tendons on flexibility testing. This acts to delay heel off as the weight of the body moves forward putting more ground reactive force at the heel and forefoot (harder to push off).
https://pubmed.ncbi.nlm.nih.gov/35945775/
The results demonstrated no correlation between joint hypermobility and preschool-age flexible flatfoot when flatfoot was defined with Staheli PAI and joint hypermobility with the Beighton score. Even with 2 new methods, the thumb-to-forearm test and thumb-thrust test, to define joint hypermobility, we still found no correlation between preschool-age flexible flatfoot and joint hypermobility.
The world outside podiatry does not understand the biomechanics involved with a flexible flatfoot in a child–forefoot varus, internal malleolar torsion, equinus, metatarsus primus elevatus, etc. Therefore, connecting hypermobility directly to flexible flat feet made sense to them, but that theory did not prove out. I am sure there are some cases with hypermobility syndrome and flexible flat feet, but it is not well correlated.
