Building a Stronger Foundation: How Podiatry Can Help People with HSD & EDS

Hypermobility Spectrum Disorder (HSD) and Ehlers-Danlos Syndromes (EDS) can affect the way joints are supported and controlled throughout the body.

For many people, the challenge is not simply that their joints move more. It is that the body must work much harder to control that movement.

Ligaments provide passive stability around our joints, helping hold them in position without requiring constant muscular effort. When those ligaments are more flexible, the muscles and tendons around the joint often must take on more of the stabilising work.

Over time, that extra work can add up.

And because the feet form the foundation for standing and walking, this is often where the effects become particularly noticeable.

The cost of compensation

The foot is designed to move. A certain amount of pronation, or rolling inwards, is a normal and important part of walking, helping the foot adapt to the ground and absorb load.

In a hypermobile foot, this movement can sometimes become excessive, happen too quickly, or continue for longer than is helpful. The muscles around the foot and ankle will have to work harder to control the movement and provide a stable base.

For some people, this can present as:

o   Aching or burning fatigue after standing or walking

o   Feet that become increasingly tired as the day goes on

o   Recurrent ankle rolling or sprains

o   A feeling that the ankle may give way

o   Difficulty tolerating longer periods of standing or walking

o   Pain or fatigue after everyday activity

Someone may still be able to complete a full day at work, go shopping or walk several kilometres, but it can come at a greater physical cost. By the end of the day, that extra effort may show up as pain, fatigue or a flare-up that takes time to recover from.

The effects can also extend beyond the foot and ankle. As the foot rolls inwards, movement occurs through the lower leg and can influence how the knee and hip move during walking. In someone whose joints are already more mobile, this can add to the amount of movement the body needs to control further up the chain.

This does not mean every knee, hip or back problem begins at the feet. The body works as a connected system, and the feet are one part of that system. When the foundation is better supported, there may be less need for compensation elsewhere.

Think of it like a tent

A useful way to picture this is to imagine the foot and ankle as a tent.

Ligaments work a little like the ropes that hold the tent firmly in position. When those ropes are taut, they help keep the structure stable with very little effort.

In a hypermobile foot, those ropes may have more slack.

The tent can still stand, but the poles, much like your muscles and tendons, must work harder to keep everything upright.

It can also become more sensitive to a gust of wind.

That gust might be a long shift on your feet, an uneven surface, a quick change of direction, a long walk or a particularly active weekend.

The body can often cope with these demands, but it may be doing far more work in the background to achieve it.

Supportive footwear, custom-made orthotics and, where required, devices such as custom Ankle Foot Orthoses (AFOs) can work a little like adding extra stakes and support poles.

They do not replace what the body does. They provide additional stability, so the muscles and other supporting tissues do not have to work quite as hard to keep everything controlled.

Why the right support matters

A well-made custom-made orthotic or AFO does not just aim to relieve pain in the moment. It can change how much work the foot must do across an entire day.

If the muscles around the foot and ankle need to do slightly less stabilising work with every step, that difference can accumulate over thousands of steps.

Less compensation can mean less fatigue by the afternoon, fewer flare-ups after a long shift or a big weekend, and greater confidence when walking or exercising. For someone experiencing recurrent ankle instability, the right support may also improve confidence when navigating uneven ground or activities where the ankle has previously felt unreliable.

With hypermobility, though, the right amount of support matters. Too little may not provide enough stability, while too much may restrict movement unnecessarily or create discomfort.

That is why precision and customisation are important.

A custom-made orthotic should not be based simply on whether someone has a flat foot or a high arch. It should consider how the person moves, their level of joint mobility and instability, where symptoms occur, their footwear, everyday activities and what they are hoping to achieve.

Two people with HSD or EDS may have very similar-looking feet but require very different levels of support.

The aim is not to provide the most support possible. It is to provide the right support for that individual.

Research also supports the potential benefits of podiatric intervention in people with hypermobility. A 2023 study investigated the effect of custom-made orthotics in children and adolescents with generalised joint hypermobility and lower-limb pain. After one month, participants reported significant improvements in pain, quality of life, fatigue and functional endurance, with these benefits maintained over the three-month study period.

These findings highlight that supporting the feet have an impact beyond foot posture alone, helping to improve comfort, endurance and day-to-day function.

Podiatry at Connected Health Alliance

At Connected Health Alliance, podiatry looks at the feet and ankles as part of the bigger picture.

The aim is to understand how you move, where your body may be compensating and how this is affecting the activities that matter to you.

A comprehensive assessment includes looking at your foot posture, joint mobility, ankle stability, walking pattern, footwear and how your symptoms change with different activities. From there, the management plan is built around you, your needs and your goals.

That may include:

o   Footwear advice

o   Custom-made orthotics

o   Ankle bracing

o   Custom AFOs where greater support is required

o   Strategies to improve stability and reduce unnecessary mechanical load

o   Working alongside other members of your healthcare team

But the device itself is not the end goal.

The goal might be being able to walk further without needing to recover afterwards.

It might be getting through a workday with less pain and fatigue.

It might be feeling more confident on uneven ground, returning to exercise, keeping up with family and friends, travelling, shopping or simply spending more time on your feet without constantly thinking about them.

For someone living with HSD or EDS, improving foot and ankle stability can contribute to greater independence, confidence and quality of life.

Building from the ground up

HSD and EDS can affect many areas of the body, which is why management is often multidisciplinary. Podiatry is one part of that wider picture, but the feet are the foundation for much of what we do every day. By improving support, reducing unnecessary mechanical demand and helping the feet and ankles function more efficiently, podiatry can play an important role in making everyday movement more comfortable and sustainable. A more stable foundation can mean greater confidence in movement, improved independence and more capacity to do the things that matter to you.