Any physios or podiatrists around?

[Ciaroscuro]

My daughter (15) has hyper mobility in her ankles and one ankle is particularly bad at rolling in (see uneven wear on her shoes, below). She now has orthotics which she wears in every shoe except the black pair below, which are vionic shoes with supportive insoles.

Two things...I am a bit concerned at the uneven wear even in orthotic shoes and with insoles, should I go back to podiatrist?

And also, she is complaining about side of knee and round behind the knee pain in that left leg that rolls in, sometimes the pain extends up into her hip as well. This pain comes and goes. She does have crohns disease that can cause joint pain but I am wondering if it might be mechanical to do with gait and what I should do about it?

Obviously ( I’m sure you would) check with gp first . But has she been given any physio at all? My friends son was given exercises to do at home and one of them was a balance board to strengthen the ankle .

Also taped it up .

Annoyingly photos not attaching...will try again a bit later.

No, no physio offered, but we did see a podiatrist (privately) not a physio

Made pics smaller....

The whole thing could be connected. Ankle turns in, extra strain on knee and hip. Orthotics aren't a cure. A physio can give exercises that will strengthen each part of the leg from hip down. (Also small of back, if she's lopsided). The trouble is if she has been compensating for the ankle, she will have picked up bad gait habits that the orthotics won't necessarily address.

So do you think asking for a physio referral would be sensible?

yes absolutely , I think it would pay dividends. Also why can’t she wear the orthotics in these shoes? Is there no room? Can you get her different black shoes( guessing school shoes) f they are the shoes she wears the most she should have them in. but she will also need strengthening exercises .

See a podiatrist and biomechanics in NHS then physio that knows hyper mobility as some are rubbish. Foot and ankle strength is really important , try the stretchy band exercise on you tube for flat feet (can’t link) and as has crohns too, are you sure it’s not hyper mobile Ehlers Danlos, as diagnosis when young will save being fobbed off for years!

Vionics have built in arch support insoles. The podiatrist recommended them.

See an osteopath. Far better than physio in my experience!

How old are those black shoes?
The sole material looks soft on them too.
Ultimately insoles position the foot but she needs to build up the muscles to stabilise her ankles. Even more so if she is hyper mobile and the ligaments are lax.
Standing and balancing on tip toe, and then one leg tip toe ( up hold for count of 5 and down) is a good start.

I bought them in June so she's worn them to school in June, July and September.

Thanks, will try tip toes. The podiatrist told us to buy stretchy bands (which we did) but we don't know what tension level to use or quite what to do with them.

Definitely not an expert here but first thing is the sole of the left shoe is obviously worn and either needs to be mended or replace the shoes. They may be only 3 or 4 months old but are no longer doing the job.

She needs to be monitored by a GP. Good luck.

Podiatrist sounds useless. She needs a proper set of strengthening exercises, and to be shown how to do them effectively.

You need to see a good podiatrist who can take measurements and create bespoke inserts and recommend the correct footwear or alternatively scan her feet to make moulded inserts specifically for her feet. It is likely that one arch is higher than the other so moulded inserts should be used. They're not cheap. Approx £350 -£450
Exercises are crucial and strengthening the ligament exercises should be religiously done 3/4 times a week.
The long term effects if neglected could be knee and hip replacement and spinal issues at a later stage in life. Approx mid 30's - 40's onwards, not good if you're a mother with children.

So if you are unsure what exercises to do, look up any pre pointe exercises for ballet. All about building strength in ankles/legs and pulling out of her hips. You should also encourage lots of core strength exercises. Any dance studio that's offers conditioning would be a good class to join if she doesn't do exercises at home. Also an Acro class that's taught by a qualified Acrobatic Arts teacher as they focus on strengthening the body. I'm a hyper mobile (EDS) middle aged woman and I wish I'd done strength training from childhood as I might not be in constant pain with my joints now. Huge difference in the past year though since I started!

The podiatrist said he wouldn't recommend the bespoke ones quite yet as she is potentially still growing and may grow out of them - though she hasn't grown in the past 10 months or so.

Who would advise us on which ligament exercises to do? Would we be looking at private physio?

How hypermobile is she? Does she have any of the other typical EDS symptoms?
Crons is more common in those with EDS.
I'd be asking for referral to rheumatology if it fits, and they will have thier own physio etc.
Gastrointestinal problems in hypermobile Ehlers-Danlos syndrome and hypermobility spectrum disorders https://share.google/L5mEId3rGvBoT9WZg

She needs to see an Orthotist who specialises in this.

I don't think she has other major issues. Her dad has knees that banana backwards and his ankle also turns in, though not as much. She crawled, doesn't use excessive pressure when writing, doesn't loop her hand or complain about hand fatigue. I will mention it at her next appointment though, thanks for flagging.