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Wednesday, December 23, 2015

Possible Hypermobility Problem: Email Advice

This was an email I just received as I am catching up on emails as a Christmas present to myself (sick I know, but somehow therapeutic to my soul). Merry Christmas and Happy Holidays to all my readers. Rich


Dr. Blake: 
I was on the podiatrym.com and saw your comment on the hypermobility of the first ray joint. 
I have bilateral foot pain for many years.  My left foot has the hypermobility more so than the right.  I have a bunion on the left.  I have had many orthotics made within six years none of them really helping.  The first podiatrist I went to in 2007, made this huge orthotics and made me wear motion control sneakers with them.  I was told that my feet were not to move in the sneakers, I feel this was a big mistake.  Perhaps this made the problem worse.  I never had this problem until I started wearing orthotics.  I also have a problem with my left hip (weak hip, core and pelvic).  My gait has is really off. 
It was not until last year when I visited an orthopedic doctor who said I have a lot of hypermobility in the forefoot and that my ligaments and tendons are too weak to support my weight.  After visiting at least six podiatrists, not one of them ever mentioned this problem with my feet.  The orthopedic doctor wants to fuse the bones in my feet.  After getting a second opinion from another orthopedic (Mass General) who said absolutely no to the fusing and not knowing how to help.  I really don’t know what to do.  My feet literally throb from pain and I feel as I am grasping the ground and my big toe joints hurt so much as they are being pounded into the ground.  I have been everywhere looking for help and cannot get the help I need.  I visited a foot doctor in Worcester and he could not figure out what to do, except offer me another pair of orthotics, but he never mentioned the hypermobility of the first ray joint. 
I have been on Dr. McClanahan’s site and purchased a pair of correct toes and have followed him on getting out of orthotics and going to minimal shoes and exercising my feet.  My feet are in so much pain from exercising and they are not getting any better.  I am so discouraged and just cannot believe no one can help. 
I was wondering if you would know of any foot doctor in the Boston area who would have been the expertise to helping me get out of pain without surgery or orthotics. 
May I ask you would strengthening the feet help with the hypermobility or am I wasting my time.  My lower legs, calves hurt so much, I have been told that the certain muscles are not functioning, as well as my glutes.  From being an athletic person to not being able to walk without pain is very discouraging.
I would appreciate if you could possible help finding a doctor who could help. 
Thank you. 

Dr Blake's response: 
     Thank you so very much for your email and I am very sorry for your struggles. There are many types of hypermobility, from mild to severe, from static to functional. Sounds like you have a severe case, although at times mild cases just spin out of control. Typically when rehabing a patient with hypermobility you find you need longer immobilization, longer periods of re-strengthening, and it takes longer to return to activity. It is a careful balance. Not too many podiatrists or orthopods believe that hypermobile patients should go without orthotics and learn ways of joint taping or splinting that helps. I have never had a hypermobile patient had a joint fused, and I am not sure what that would do to the stresses on all the other joints in the lower extremity. I would find a local PT who deals with Ehlers Danlos patients to help you first, and they may have a suitable podiatrist for you. To me, orthotics devices are crucial, although not with motion control shoes. You should see if by orthotic devices, activity modifications, anti-inflammatory measures, and perhaps assistive aids, you can re-establish a pain free environment of 0-2 pain levels. Then, spend the next year getting your feet stronger, not be walking in minimalist shoegear, but by a calculated home/gym strengthening program done daily under the instructions of the PT. I sure hope this helps you. Rich

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.