Hypermobility

Many people do not realize that general aches and pains in the feet and body may be associated with hypermobility.  Although hypermobility is common in Singapore, it is relatively unknown and is often found in association with flat feet.

There are two types of hypermobility syndrome:

• The first type is a localized condition that affects specific joints. Joint hypermobility is a condition featuring joints that easily move excessively over the normal range of motion common to the individual’s age, gender and ethnicity.
• The second type is more of a generalized hypermobility affecting bones and soft tissue. This may be accompanied by musculoskeletal symptoms such as arthritis, muscle pain, or internal disruption to the joints (internal derangement). More severe forms of this hypermobility syndrome are associated with underlying conditions like Marfan Syndrome, Ehrler-Danos Syndrome and Muscular Dystrophy.

Hypermobility is more common among women than men and also tends to run in families. Asians are also more prone to have hypermobility due to a defect in the Tenascin-X gene, which is also responsible for the higher incidence of hypermobility in Singapore.

A significant portion of painful adult flat foot is due to joint hypermobility, as the arch of the foot collapses upon weight bearing. Other symptoms include, but are not limited to

1. pain in the joints
2. weak or ineffective muscles
3. clumsiness or lack of coordination
4. problems with gait
5. difficulty in writing
6. clicking joints
7. back pain
8. frequent ankle sprains and injuries
9. tripping and falling easily, particularly for kids.

If you suspect you have hypermobility, you can do a simple test at home by moving your joints. For each joint that can successfully bend beyond the stated amount you gain one point. Each point adds up to a Beighton score:

1. With your knees straight, you are able to put your palms flat on the floor
2. Each of your elbow that you can bend backwards (beyond 180 degrees)
3. Each knee that you can bend backwards (beyond 180 degrees)
4. Each thumb you can touch to your forearm when bent backwards
5. Each little finger that you bend backwards (more than 90 degrees)

The maximum number of points is 9. For young adults a result of 6 or more indicates joint laxity otherwise known as hypermobility.

Not everyone requires treatment for hypermobility, if they do not suffer any symptoms or experience lowered quality of life, there may be little need for treatment. In fact, there are some who make use of their hypermobility to be successful in their careers or hobbies in areas such as gymnastics, ballet and dance. However, those with hypermobile joints should be careful to avoid injuries from overextension.

For others, hypermobility can be a source of pain or discomfort that if left untreated, may lead to deterioration of quality of life. Some of the consequences of hypermobility include the following conditions-

1. Scoliosis
2. Malalignment syndrome
3. Osteoarthritis
4. Tendinopathies
5. Recurrent sprains and dislocations
6. Chronic pain syndrome

Treatment options for hypermobility vary. While there is a tendency for hypermobile people to try and stretch to relieve some of the muscle tension or pain they are experiencing, this is not advisable as they could further increase flexibility and laxity. The tension occurs because some of the muscles surrounding the joint are working to compensate for the hypermobility. Once the hypermobility is addressed, the discomfort should improve.

Instead of over stretching, patients are advised that strengthening is needed. Regular exercise and conditioning of muscles is recommended as it can help to protect and support the joints. Joints not supported by strong muscles run a higher risk of developing osteoarthritis.

Podiatry is also an avenue that hypermobile persons can explore to increase joint stability. This is where orthotics come into play. Placing an orthotic device under the feet changes the way the rest of the body moves. Incidences of ankle or foot sprains can be reduced, and the orthotics also assist to realign the feet, knees and hips. The orthotics also provide support in the case of flat feet caused or exacerbated by hypermobility, and can also lower the likelihood of tendinopathies and arthritis.

If hypermobility is causing too much pain, and neither strengthening nor orthotics are helping, surgical options to help stabilize the joints from within should be explored. In this case, it is advisable that the hypermobile person consult with an orthopaedic surgeon.

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