Evaluation of the child with ligamentous laxity.

Many opportunities for participation in the care of children with ligamentous laxity have been described in this article. The podiatric physician must determine his or her contribution based on knowledge, experience, and interest. Each podiatric physician is not necessarily expected to be familiar with all of the diseases and treatments described here. Novice podiatrists should be mandated to recognize only the presence of ligamentous laxity and be familiar with an appropriate referral pattern. In addition to the previously listed podiatric concerns, Hobson has described some specific concerns in even the most basic podiatric treatment. He recommends the use of skin adherents to avoid wrinkling and tearing the skin of individuals with Ehlers-Danlos syndrome. He also reiterates research that has determined a resistance to local anesthetics in these individuals. He further provides some detail for the manufacture of appropriate orthoses. Continuing education may be obtained through a variety of sources. These may include not only traditional podiatric courses and conferences, but also similar venues offered by clinicians in other specialties. Also, courses and conferences held by organizations with a special interest in these unusual disorders can be educational and rewarding. The author has found interactions with this patient population rewarding. The patients and their families are often exceptionally knowledgeable regarding their illness because most have experienced many years with unsatisfactory medical help and delayed or incorrect diagnoses. Most of these families are also extraordinarily grateful for the concern and interest expressed by the clinician. They are particularly impressed when the health care professional has at least a cursory knowledge of their unusual disorder. As a member of the Ehlers-Danlos National Foundation Medical Advisors Panel, the author has contact with world-renowned geneticists, rheumatologists, and other specialists. The leader of the organization has pointed out that patients have found that podiatric clinics provided during the national meetings are often one of the most appreciated aspects of those meetings. He stated that although podiatrists may not cure the disease, small improvements in the everyday lives of these patients add up to a significant contribution. The author hopes that this article will stimulate further interests in the care and understanding of individuals with ligamentous laxity. It is further hoped that experience with these individuals will translate to the broader population who experience milder disorders of hypermobility.