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Kinematics and kinetics of people who are hypermobile

Discussion in 'General Issues and Discussion Forum' started by NewsBot, Jan 21, 2015.

  1. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
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    Kinematics and kinetics of people who are hypermobile. A systematic review
    Alexander V. Bates, Caroline M. Alexander
    Gait and Posture; Article in Press
     
  2. Admin2

    Admin2 Administrator Staff Member

  3. fetefestive

    fetefestive Member

    Unless you perform tests to find STJ transverse axis then you won't find interesting patterns like this one below.

    Scenario: 30y.o. female, benign jt hypermobility syndrome, laterally deviated STJ axis, FPI +8, Tailor's bunions, HAV Cl.1 (Manchester scale), 30deg. post. pelvic tilt, genu varum, tibias distally twisted, lots of internal thigh rotation during swing.

    We know the foot is pronated but evidently influenced less from the RF. Therapeutic goal? Increase locking of CC jt during midstance to create more of a rigid lever? I don't see a lot of hypermobile patients where I work.

    My gut instinct is: 1. medial skiving really would only be useful for severely medially deviate STJ trans. axis, 2. 4deg. medial post probably appropriate for the degree of pronation seen in gait & abductory twist, 3. increase cast MLA control (one of the few cases where it really is needed c.f. medially deviated STJ axis), 4. cuboid notch to attempt to get a bit more locking action, 5. forefoot lat. post to encourage propulsion.

    What I know I don't want to do: Overly rely on medial RF posting to solve problems in gait which I suspect lie more dominantly in MTJ ligament laxity.

    I'm not entirely confident with how I would deal with this clinical picture let alone put these principles in place on someone else. After lots of conversations with colleagues about the subject noone seems ready to commit to a foundation approach since the mechanics are atypical for a pronated foot.

    Any suggestions? Apart from a good physio ;)
     
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  4. efuller

    efuller MVP

    I would agree that a medial heel skive should not be used in a laterally deviated STJ axis foot. However, you need to figure out why this laterally deviated STJ axis foot is pronating. Is your axis palpation technique off or is there some other cause of STJ pronation. Often, folks with a lateral STJ axis will use their peroneal muscles to prevent supination to end of range of motion. In these feet you can see the peroneal tendons are tight in static stance.

    In laterally deviated STJ axis feet, the constant peroneal contraction can cause medial column overload and symptoms. These feet can be helped by increasing the pronation moment from the ground. This will do two things, it will increase lateral forefoot load (decreasing medial forefoot load) and reduce the high stress on the peroneal muscles. A cuboid notch could increase lateral forefoot load. You could also try a lateral heel skive. You could also obviate the need for a cuboid notch by having an intrinsic forefoot valgus post.

    The intrinsic forefoot valgus post is something that was classically thought to "lock" the midtarsal joint. However, I like the explanation of increasing lateral forefoot load better than the explanation of "locking" the MTJ. After all, how do you lock and MTJ? What is locking of the MTJ and how does it help medial column symptoms?

    Eric
     
  5. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
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    Reliability and minimal detectable change of gait kinematics in people who are hypermobile
    Alexander V. Bates, Alison H. McGregor, Caroline M. Alexander
    Gait and Posture; Article in Press
     
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    NewsBot The Admin that posts the news.

    Articles:
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    Foot Ankle Int. 2017 Jun 1:1071100717709567. doi: 10.1177/1071100717709567.
     
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    NewsBot The Admin that posts the news.

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    NewsBot The Admin that posts the news.

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    NewsBot The Admin that posts the news.

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    Gait biomechanics in joint hypermobility syndrome: a spatiotemporal, kinematic and kinetic analysis
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    22 February 2020
     
  10. NewsBot

    NewsBot The Admin that posts the news.

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    DOES PLANTAR PRESSURE AND LOADING PATTERN VARY WITH JOINT HYPERMOBILITY IN YOUNG FEMALES?
    Serife Seyma Torgutalp, Naila Babayeva, Ömer Özkan, Seval Yılmaz, Gürhan Dönmez, Feza Korkusuz
    J Am Podiatr Med Assoc. 2020 Jul 22;18-146
     
  11. NewsBot

    NewsBot The Admin that posts the news.

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    Joint hypermobility and preschool-age flexible flatfoot
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