GHS (generalized hypermobility syndrome) and foot loading.

GHS: Generalized Hypermobility Syndrome

We have all seen these types of clients/patients. They have joints that have more than ample full range. It is easy for them to hyperextend their elbows and knees. They can fold over and touch their toes, everything seems lax and flexible. What they need is help gaining more control of their joints. But what about their gait ? Albeit a focal study, finally someone has looked at how these people interface the ground,

The forefoot region received higher loading in GHS clients.
So what could this mean? Does it mean they have challenges transitioning from rearfoot to forefoot? Does it mean their center of pressure is more foreward biased ? Does it mean they have to impart heavier loads through the forefoot during gait to feel stable? Are they premature heel raisers thus showing the forefoot bias increase? There are many questions here, too broad for this study, but they are the keys to understanding how the GHS body interprets movement. Regardless, it is highly suspect that these clients dominate their gait with the calf muscle complex doing plenty of extra work. We suspect they will be toe clenchers/grippers ( ie, have increased toe flexor dominance) and this can have long term impact on things like metatarsal loads, neuroma formation, bunions, lumbrical weakness, fat pad displacement, hammer toes and many other related issues that occur with premature or excessive forefoot loading. They may even have a little of that vertical bouncy gait we often discuss. We will keep our eyes open for this stuff and keep you in the loop.

J Back Musculoskelet Rehabil. 2018 Nov 2. doi: 10.3233/BMR-170973. [Epub ahead of print]
Generalized hypermobility syndrome (GHS) alters dynamic plantar pressure characteristics.
Simsek IE1, Elvan A1, Selmani M2, Cakiroglu MA2, Kirmizi M2, Angin S1, Bayraktar BA3.

To met pad or not to met pad; that is the question. 

We use these in practice all the time. Think of it as a “helper” while you are training your patient or client to have better foot mechanics. 

“It’s all about the stress transfer, so what you’re trying to do is unload a certain spot on the foot—generally the met head with a met pad—and transfer it to a more proximal region,” 

Here is a nice evidence based review:

http://lermagazine.com/cover_story/evidence-based-use-of-metatarsal-pads

Social media reader comments and questions:

Reader: You demonstrated a peroneal exercise a few days back. In addition to the use of MT pads, is it effective in supporting transverse metatarsal arch?

• The Gait Guys It can be. In our opinion, the exercises are key and the pad supports the exercises
• The Gait Guys the goal is to restore foot function so that you do not need the pad. If your client is patient and willing to work on the exercises you likely won’t need a met pad, they may help speed things up, but remember, it is a crutch and crutches can be helpful but one can get lazy in using them and not do the supportive work. We only try to use them sparingly and only when necessary.