Altered Multisegment Ankle and Foot Kinematics During Gait in Patients With Hypermobile Ehlers-Danlos Syndrome/Hypermobility Spectrum Disorder: A Case-Control Study.

Abstract

Ankle-foot problems have a considerable impact on daily functioning in patients with hypermobile Ehlers-Danlos syndrome and hypermobility spectrum disorder (hEDS/HSD). Therefore, the objective of this study was to identify alterations in multisegment ankle and foot kinematics during gait and to assess foot function and pain in these patients. Twenty-three women with hEDS/HSD and 23 healthy controls participated in this 3-dimensional gait analysis. Multisegment ankle and foot kinematics were collected using the Ghent Foot Model and analyzed with Statistical Parametric Mapping. Foot function and pain were assessed using visual analog scale scores, the Margolis Pain Diagram, and the Foot Function Index. Levels of pain and foot dysfunction were significantly higher in subjects with hEDS/HSD (P < 0.001). Kinematic curve analyses provide evidence for a hypermobile first ray, represented by a significantly increased eversion position of the medial forefoot during stance phase (P < 0.001) in subjects with hEDS/HSD compared to controls. In addition, significantly more dorsiflexion was found in the medial and lateral forefoot and the rearfoot (P < 0.001). At the midfoot, an increased plantar flexion (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 subjects with hEDS/HSD. This study is the first to apply a multisegment foot model during gait in hEDS/HSD, which confirms the characteristic hypermobility throughout the foot, especially the hypermobile first ray.