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Podopaediatric Track Round-up

Podopaediatric Track Round-up

Cylie Williams.jpg

Victoria Whitehear

The podopaediatric track focused on hypermobility, with the additions of idiopathic toe-walking and GALLOP (gait and lower-limb observation of paediatrics) assessment. Saturday morning’s practical session focused on reflexes, which caught out some conference-weary pods with slightly abnormal reflexes following their Friday night out! 

Dr Cylie Williams walked us though the correct use of the patella hammer and how much more accurate this needs to be for the smaller tendon size in children. She also guided us through the various useful assessments of torsion and range of motion in the lower limb. Separately, she spoke on the identification of idiopathic toe-walking and her work on the evidence-base for treatment, which she will be publishing soon.

Dr Jill Ferrari broke down the new criteria for Hypermobility Ehlers Danlos Syndrome (hEDS) and the newly titled Hypermobility Spectrum Disorder (HSD), which replaces the term Benign Joint Hypermobility Syndrome (BJHS). The inclusion of the word ‘spectrum’ represents the variety in the disorder, demonstrated by Hypermobility Syndromes Association trustee, Hannah Ensor. 

Hannah’s activity is severely curbed by hypermobility and her related condition, Postural Orthostatic Tachycardia Syndrome (POTS). She is assisted by a wheelchair and uses a cooling vest to be able to stay upright long enough to speak publicly. Her elbows do not hyperextend in the sagittal plane, but do demonstrate transverse motion, with the radius and ulna appearing to subluxate on the humerus. She only scores 1 on the Beighton score.

Hannah reminded us that while Beighton scoring is useful, it assesses too few joints, and sometimes in the wrong planes, to give the whole picture; especially as the spectrum now includes an array of linked symptoms, such as gastric problems, anxiety issues, POTS, and skin hyperextensibility and fragility. Podiatrists are perfectly placed to assess and diagnose hypermobility and we were all encouraged to try using the 2017 criteria for hEDS and HSD.