Hypotonia and Ligamentous Laxity in feet in those with Down syndrome

This is something that I think many parents are not aware of in their children with Down syndrome. It is however very common and worth discussing. My son is a perfect example of flat feet and the abnormalities in the feet of kids with Down syndrome. Up until recently we were told  not to worry, it is not that bad. Well now it is beginning to slow him down. So it is time to address it. I would never have dreamed of waiting so long but my son is also very tactile defensive. Without proper therapy it has been a challenge to let anyone near his feet. I have been working hard with him though, playing little games with him about his feet, and I think he is better but it is still going to be a challenge. His feet are becoming worse and he is going through shoes very quickly. You can tell by the way he walks and the way his shoes are wearing down that there is something wrong. What causes flat feet in children with DS? Individuals with DS are at risk for foot problems due to hypotonia and ligamentous laxity. Both characteristics contribute to joint hypermobility. This means the foot bones are not properly stabilized and aligned for standing and walking. Without taut ligamentous support, the heel  tilts inward and the surrounding bones  follow. When the inside borders of the feet collapse to the ground, it gives the appearance of no arch (see photo). The degree of flat feet varies from person to person. If it persists without treatment, the child may have further ankle and joint deformity. Long-term use of this standing and walking pattern will lead to pain. We took my son to see the orthopedic and he x-rayed both his feet. He did say that his feet were significantly flat and were rotating in. The doctor also stated that since his feet were not hurting him the only recommendation that he has is for some really good shoes with good arch support. He stated that there is a surgical procedure they can do to tighten the ligaments. This can be a painful surgery and if he is not hurting why put him through that. This doctor who comes highly recommended did not even suggest therapy for him. He said that there was a lot of controversy on this subject between therapists and the orthopedic. So for now we are going to take his advice.  Th doc did make sense in certain areas.  My concerns though is how he is beginning to slow down. He is not as active and I find him taking every opportunity to take his shoes off.   I also have mixed thoughts due to the literature that I have come across in doing my reasearch.  Some state that it is necessary to receive therapies, lifts, sometimes even braces. Then others like this doc state that good supporting shoes are all you need. So for the time being we will go with the good shoes unless my son complains otherwise or until we can resume physical therapy. Ways To Strengthen The Ankles & Develop The Arch It is suggested that a few exercises/ activities can help develop tendons, muscles, and ligaments. Of course, I don’t think these exercises are a guarantee that an arch will develop, but if it will improve muscle tone in the legs and feet, I’m all for it.

  • Walk barefoot on soft uneven surfaces – Sand on the beach is a good example if you live near a beach. Since we do we take every opportunity to let him walk on the beach.
    • we can create soft uneven surfaces indoors using blankets and pillows or a bed mattress on the floor. Walking barefoot on the grass is also an option .
  • Walk with shoes on both level and uneven hard terrains, such as the driveway, gravel road, or rocks.
  • Pushing a weighted toy/ object – This requires him to push-off more with his feet to move forward. A
  • Activities where he needs to tiptoe and maintain the position for a few seconds at a time.

Special Shoes? Custom shoes, arch supports, or braces prevent flat feet from worsening and alleviate pain (only in cases of severe flat feet) but they don’t help develop an arch or correct a problem. Whether CJ needs orthotics or not remains is irrelevant he still needed arch supports and hopefully, the off-the-shelf kinds will work just fine.  Shoes with a flexible sole are recommended for kids learning to walk.  For CJ we went with New Balance because of the significant arch support they had. Plus they came in wide.  The cheap brands that you might find at Wal-Mart or other stores are not recommended.  Stride Rite is another brand that was recommended. I would love to hear your thoughts on this. Does your child also have issues with Flat Feet and Ligamentous Laxity ? Some of the resources that I cam across are http://www.oandp.com/articles/2011-04_01.asp  – This article agree with providing the bracing support http://www.dsnetworkaz.org/PDF/PREP/part_ix.pdf – This documentation was written for educators, but has some amazing information in it.  Like some exercises that you can do at home to help with Hypotonia http://ndsccenter.org/resources/general-information/ds-news-articles/how-to-treat-flat-feet/  – National Down syndrome Congress also support external devices for support in the feet.

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2 comments for “Hypotonia and Ligamentous Laxity in feet in those with Down syndrome

  1. Trish
    August 27, 2013 at 1:03 pm

    My daughter, who happens to have DS, is 23 and has AFO’s that she has to wear daily due to basically the same issues your son has…but hers have progressed to become very painful so we had to intervene. Unfortunately, the AFO’s have not solved the pain issue. I think due to a delayed intervention & treatment ( which I can only blame myself for unfortunately), she now has other issues that have evolved out of the foot and ankle problems involving her hips, knees and ankles. We suspect she has polyarticular arthritis & are in the early stages if addressing and treating it. She also has SPD so the challenges have been magnified as she absolutely hates for her toes or feet to be touched. Best of luck in whatever course of action you pursue. In my opinion, early intervention of any kind is really the most proactive approach you can take, at least until medical advances are made to address the foot and ankle issues of those with Down syndrome.

    • downsyndromenwfl
      August 28, 2013 at 1:19 am

      Thank you so much for your comment!
      So sorry to here that your daughter has had such a difficult time.
      You are right. There is not enough concern or research within the medical community on this issue.
      I am concerned that my son will also have issues with his hips and knees, ect due to the issue with his feet.
      We have not gotten any further with the medical community since I wrote this blog. I do stretching exercises with him and we are sure to have good shoes on him at all times.
      Early intervention is great but my son has had this issue all along and early intervention did nothing.
      I think it is one of those issues that just needs to be put in the limelight for doctors to take it more seriously.

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