May 2022

Altered Multisegment Ankle-Foot Kinematics in Ehlers-Danlos Syndrome

Patients with hypermobile Ehlers-Danlos syndrome and hypermobility spectrum disorder (hEDS/HSD) have significant ankle and foot problems, which impact daily functioning. In this study, researchers in Belgium sought to identify alterations in multisegment ankle and foot kinematics during gait to better assess foot function and pain in these patients.

This 3-dimensional gait analysis included 23 women with hEDS/HSD and 23 healthy controls. The Ghent Foot Model was used to collect multisegment ankle and foot kinematics, which were then analyzed with statistical parametric mapping. Visual analog scale scores, the Margolis Pain Diagram, and the Foot Function Index were used to assess foot function and pain.

The research team found that patients with hEDS/HSD had significantly higher levels of both pain and foot dysfunction (P <0.001). Kinematic curve analyses provide evidence for a hypermobile first ray in patients with hEDS/HSD, represented by a significantly increased eversion position of the medial forefoot during stance phase (P < 0.001) compared to controls. Researchers also found significantly more dorsiflexion in the medial and lateral forefoot and the rearfoot (P < 0.001). At the midfoot, an increased plantarflexion (P < 0.001) and at the level of the hallux a decreased dorsiflexion (P = 0.037) and increased inversion (P < 0.001) and abduction (P = 0.016) were found in patients with hEDS/HSD.

In their conclusion, the authors note that this is the first study to apply a multisegment foot model using gait analysis in this patient population and that it confirms the hypermobility that is characteristic throughout the feet of these patients, in particular, the hypermobile first ray.

Source: Vermeulen S, De Mits S, De Ridder R, et al. Altered multisegment ankle and foot kinematics during gait in patients with hypermobile Ehlers-Danlos Syndrome/Hypermobility Spectrum Disorder: a case-control study. Arthritis Care Res (Hoboken). 2022;74(5):841-848.

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