Lax foot ligaments occur when ligaments in the foot are too ‘loose’, or lax. This condition can occur in any area of the body, including the feet, and may become a source of chronic, long term pain. The term “double jointed” is often applied to this condition and is often referred to as generalized joint hypermobility. While children generally experience reduced hyper-laxity as they grow older adults over forty years of age who have maintained the condition often experience recurring joints problems and often suffer from chronic pain. Interestingly, joint hypermobility frequently occurs in relation to chronic fatigue syndrome and fibromyalgia.
Lax Ligaments: Causes
Lax ligaments may have a genetic basis and can therefore be passed on from one generation to the next. It often reveals itself at a very early age. Joint hypermobility is often found in concert with genetic disorders such as Down’s syndrome, Marfan syndrome, and Ehlers-Danlos syndrome.
Hypermobility may also result from joint injuries that cause damage to ligament tissue as well, as they may be overly stretched or torn. If a ligament is torn and does not heal properly even when treated with immediate methods such as RICE (Rest, Ice, Compression, Elevation) it may become lax and fail to provide adequate support to the surrounding joints. When this occurs the injured party is often vulnerable to further injury of the immediate area as well as other parts of the body, particularly those used to compensate for injury and weakness.
Lax Ligaments: Symptoms
Lax ligaments are easy to identify. When extreme hypermobility is present the joints found in the elbow and knees can typically be bent past the neutral position. Extreme flexibility, such as the ability to place the palms of the hand on the floor when bending at the waist or touching the forearm with the thumb, are easily observed.
While pain or other uncomfortable symptoms may not be present in people with lax ligaments it often happens that foot and ankle problems develop over time. These problems can become uncomfortable and even debilitating and include the following conditions:
• Flexible Flatfoot: Lax ligaments in the foot typically lead to the arch becoming flat while the surrounding bones and joints retain normal function. Flexible flatfoot cannot be diagnosed in children under the age of three as virtually all children pass through this phase. Children typically outgrow this flexibility their ligaments in their feet develop and become stronger. It is only when the ligaments remain lax into later development that it is considered an improper condition. A small portion of children with flatfoot experience pain after physical activity, but the majority will continue to function normally and without undue discomfort. Foot problems such as arthritis, tendonitis, and other complications may develop in the future but most children with flexible flatfoot function perfectly well throughout their development.
• Ankle sprains: Ankle sprains are a common injury that often results from improper foot placement (particularly at the moment when the foot makes contact with the ground), physical activity on irregular or uneven surfaces, underdeveloped muscles, or footwear with a notably high or unstable heel. Lax ligaments may also increase the risk of a sprained ankle as there is less stability in the joint. Symptoms of a sprained ankle usually develop immediately after injury and may include swelling, redness, bruising, and the inability to place pressure on the foot due to pain.
• Osteoarthritis: This degenerative condition is linked to the presence of lax ligaments as hypermobility may decrease the patient’s ability to react to extreme joint positioning. This inability to sense joint position can lead to excessive wear and tear that leads to degenerative conditions such as osteoarthritis. Injured joints also have a tendency to premature arthritis as there is the tendency for the joint to tighten up or stretch permanently, both of which facilitate varying degrees of laxity in the neighboring joint. This looseness tends to lead to joint instability, which is often a facture in the development of premature osteoarthritis.
Lax Ligaments: Diagnosis
The easiest way to diagnose ligament/joint laxity is through an assessment of the patient’s range of motion. An example of this is testing to see how far the patient’s finger will bend into a backward position; should it bend comfortably back more than 90 degrees then the ligaments are considered lax.
The Beighton score is also frequently used for diagnosis; one point is issued for each elbow and knee that is extendable beyond 10 degrees; for each thumb that can be bent forward at the wrist to make contact with the forearm; for each fifth finger that bends backward beyond 90 degrees; for the ability to place the palms on the floor without bending the knees. When using the Beighton system the patient is determined to be hypermobile with a score of five points or more, however, it is still possible the patient may have lax ligaments even they score less than five points on the test.
The patient will also be examined for connective tissue disorders and the presence of joint mobility conditions. For instance, patients suffering from Ehlers-Danlos syndrome often have skin that is highly elastic and fragile and must be treated alongside any joint issues. Should the patient show symptoms of one or more of these conditions an echocardiogram, ophthalmologic examination, and/or additional forms of testing will also be pursued.
Lax Ligaments: Treatment
Loose ligaments and hypermobility generally do not cause discomfort on their own, however, they may contribute to musculoskeletal problems that do cause problems that need to be addressed. When complications occur due to laxity conventional treatments are typically the primary recourse, with physiotherapy and pain medication being forerunners in treatment. Strengthening the muscles and ligaments through prescribed exercises may also provide relief of symptoms.
Patients suffering from joint laxity that has been genetically inherited are discouraged from pursuing activities that involve hyperextension of the joints and tendons, high impact exercises, and overly intense resistance training. All of the aforementioned activities may increase the risk of subluxation and dislocation. Myofascial release, which is soft tissue therapy applied through heat, massage, or precise stretching techniques, will often have a positive impact on muscle problems and reduce pain levels. Long-term fitness programs based on low-impact, low-resistance weight training that increases in repetitions and frequency over long periods of time is often recommended to help stabilize loose joints.
This type of workout, when diligently pursued, may help to reduce pain levels, help safeguard against future deterioration, and perhaps delay the development of arthritis. Surgical intervention is rarely used in attempt to stabilize loose joints as the results are temporary and provide minimal relief.
While lax ligaments are generally a mild problem to contend with flexible flatfoot can, and often does, cause long-term problems. If left untreated it can lead to long-term disability and the development of osteoarthritis. The use of orthotic devices will help to stabilize the foot and ankle, which will greatly reduce the risk of injury and will help protect against damage to the joints. Stretching exercises—applied to the heel cord in particular—may initially be uncomfortable but will help rectify tightness of the calf and lower limb muscles, which relieves pressure and imbalances throughout the foot. If pain symptoms are present the underlying cause of the discomfort will be determined before treatment is pursued. Conservative treatment is typically at the forefront of most plans, as surgical intervention is not usually recommended for the treatment of joint hypermobility, Marfan syndrome, or Ehlers-Danlos syndrome.
Sprained ankles are a common complication of lax foot ligaments and hypermobility in the joints of the lower limbs. Both sprains and general ligament injury benefit greatly from early treatment using the RICE method (Rest, Ice, Compression, Elevation). Both pain and swelling are usually reduced when this treatment is applied early on. Once the swelling has subsided it will be possible to perform a physical examination to pinpoint the exact nature of the injury, the ligaments involved, and the severity of the injury. Surgical intervention to repair lax foot and/or lower limb ligaments may be considered if the injury is severe enough but in most cases conservative treatments will be pursued first. While hypermobility in the rest of the body is not usually cause for concern lax foot ligaments may cause problems and when complications or pain symptoms arise they should be examined by a foot doctor or podiatrist to help prevent further damage or injury.
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