Pedorthists must be aware of hypermobility

ORLANDO, Fla. — Hypermobility syndrome, which features joints that move beyond the normal range of motion, is relevant to pedorthists, according to a speaker at the Pedorthic Footcare Association and American Podiatric Medical Association Combined Meeting.

Patricia Ann Pande, PT, CPed, owner of Foot Centric LLC, said many pedorthists may have patients with hypermobility who do not realize it. Hypermobility is associated with flexible flat foot, but hypermobile patients do not have an easily identifiable gait; instead, they “hit the ground differently every time,” according to Pande.

Patricia Pande

“These are the people who are loose and move every which way. Their pelvis is twisted; their spine is crooked; their feet roll in; they pop, snap, crunch — all kinds of movements. They are a very difficult group to work with,” she said.

Hypermobility testing identifies these patients through six simple stretches. Like many pedorthic issues, hypermobility tends to run in families, so children can be diagnosed early.

“You have to intervene early,” Pande said. “If you let these kids go, over time they are stretching their ligaments irreversibly.”

This can lead to the shearing of joints, disc herniations, sacroiliac joint problems, degenerative joint disease, osteoarthritis in the knee or hip, and foot and ankle problems.

Hypermobility is also associated with a number of other problems, according to Pande. Many patients have multiple complaints that do not relate to their feet, and they all are connected to hypermobility.

“I have people who come to me [who] are really happy I understand that it is not just their feet. They have visual problems, esophageal problems, irritable bowel [syndrome], connective tissue problems. … All of these things often accompany [a] flexible flat foot person,” Pande said. “You really need to make sure they understand flexible flat foot often goes along with other problems, the symptoms they are feeling are real, and that not only are you going to help them hit the ground better, but you are going to help direct them to other resources.”

Although hypermobility is a challenge for pedorthists, Pande said working together is key.

“We really should be screening [for hypermobility]. We should be working together,” she said. – by Amanda Alexander


Pande P. Children and their feet. Pedorthic Footcare Association and American Podiatric Medical Association Combined Meeting; July 23-25, 2015; Orlando, Fla.

Disclosure: Pande reports no relevant financial disclosures.

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