Hypermobility (Paeds)

Video notes:
Any floors in cross-body movement are far more prevalent in hypermobile population than non-hypermobile, e.g. mirroring, tripping often.
A hypermobile child can generally do everything a non-hypermobile child can do, they just get there in a different way and use different muscles. E.g. in SL balance, a hypermobile child more likely to recruit Adductor Hallucis instead of Abductor Hallucis and you see their toes claw and the big toe come in.

Treatment:
Yes, consider foot posture and orthoses as necessary, but treatment should be centred around muscle recruitment and strength. Therefore always give them the hypermobile exercises which are used in the assessment section below. Do the exercises with their shoes and orthoses on. Try each exercise a couple of times and do them all once a day. Don’t make it a chore because they will lose interest.

Assessment:
Mini-tramp:
– feet together, jump to feet wide
– skiing/scissor legs. One foot forward, one foot back. Hypermobile kids will tend to abduct their back foot for balance.
– 180 jump
– in-toe jump to out-toe and back, or “toes together, heels together”. You will usually see mirroring of the arms with a hypermobile child, due to the neuromuscular pattern.
Off the mini-tramp:
– Standing tall, hands in the air, ask them to take their right hand across their body and bring the left knee up to tap the knee. Hypermobile kids will tend to bring their right knee up instead.
– SL Hopping will be really uncoordinated with excessive torso and arm movement in a hypermobile child.
– If they skipped crawling as a baby, they need to re-learn, so teach them!

Reason why their feet are so flat is because the calcaneus plantarflexes (see video at 13:25 for demonstration), this movement “unlocks” everything the foot collapses, therefore excessive pronation. Therefore tri-planer wedge used, or “AC Kids device” from The Orthotic Factory, which is made with a central plantar skive.
AC Kids device needed till about age 8-10, then they often never need orthoses again. Conversely if they haven’t been treated from a young age, the foot becomes pathological, sore and hard to treat by about age 15.