Flat Feet, Loose Ankles: Foot Work for Hypermobile Bodies

There is no cure and no quick fix for hypermobility, and I won't pretend otherwise. But feet are highly trainable. Once you understand how the work gets divided between your ligaments, your joint positions, and the slow-twitch postural muscles — the dark meat, as opposed to the white — it changes which exercises are worth your time and how they have to be done.

Ana Kokaurova · Certified Advanced Rolfer® · Stott-Certified Pilates Instructor
VASIE® Pilates Instructor Trainer · Teaching since 2002

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The Deep Dive

A client who brought her orthotics in a bag

Diane was fifty-one when she came into the studio. She brought two pairs of custom orthotics with her, one from 2009 and one from the year before, and she wanted me to look at them. I asked to watch her walk first.

She had been told she had flat feet at around twelve. She could put her palms flat on the floor without bending her knees, which she mentioned in passing. She rolled her right ankle roughly twice a year, usually stepping off a curb. By the end of a teaching day her feet ached, and nothing in the day explained it.

Her last physical therapist had given her towel scrunches, single-leg balance on a folded mat, and calf raises. She did them daily for six weeks and checked the dates off the handout. At three weeks her arches were sore. At four weeks she rolled the ankle again. She assumed she had been doing them wrong.

Diane is a composite. She stands in for about a dozen clients whose histories are close to interchangeable, and I have written her that way deliberately.

Her program was not bad. It was built for a different foot.

I am not going to tell you her physical therapist was wrong. Towel scrunches do target the intrinsic muscles of the foot. Calf raises do build the posterior chain. Single-leg balance does load the proprioceptive system. For a foot whose ligaments hold, that program usually works, which is why it gets prescribed as widely as it does.

Diane's ligaments do not hold in the same way. That single difference changes three things: which muscles have to do the job, how much load they can tolerate while they are learning to do it, and how fast she is allowed to move while they learn. Nobody had told her that in thirty-nine years.

I notice it because of how I was trained. Rolfing® work puts my hands on fascia for hours every week, and a hypermobile midfoot gives further and gives sooner before the tissue picks up load. Stott training taught me to modify precisely, which is what makes that observation useful rather than just interesting. VASIE® is what those two produce together.

Two systems hold an arch up. Yours relies on one of them more.

The passive system is the shape of the bones, the ligaments strapping them together, and the plantar fascia running from heel to toes like a tie-rod. It works without any input from you.

The active system is muscle. Tissue crosses underneath the foot, holds tension across it, and adjusts continuously as you move.

In most feet the passive system carries the larger share. Bone geometry and ligament stiffness hold the structure and the muscles fine-tune it. A stone arch works this way: the blocks press against each other and the shape stands whether or not anything is paying attention.

Hypermobile collagen is more extensible, so the passive restraints give further under the same load. The arch then behaves more like a suspension bridge. It stands because cables are holding tension across it, and cables need tensioners that are working. When the tensioners go quiet, the deck sags. In a foot, that sag is the navicular dropping, the heel rolling inward, and the midfoot lengthening over the course of a day. It is why Diane's feet hurt at four in the afternoon and not at eight in the morning.

Her arch needs more from the active system than an average foot does. The active system is also the harder of the two to reach on purpose.

The muscles doing the job are ones you cannot feel

Tibialis posterior runs down behind the inner ankle and fans out beneath the arch. Peroneus longus runs down behind the outer ankle and crosses under the foot to meet it. Together they form a stirrup slung beneath the midfoot. Below them sit the intrinsic muscles: small, layered, and almost entirely outside conscious control.

These are postural stabilizers, and they are a different kind of muscle from the ones you can flex on request. I use the poultry comparison in class because it is accurate and nobody forgets it. Dark meat is slow-twitch, endurance tissue that holds a bird upright all day. White meat is fast, powerful tissue for short bursts. Your calves behave more like white meat. The muscles slung under your arch are dark meat. They are built to work reflexively, at low effort, for hours, without being asked.

Ask them to work on command and you get a substitute. When I used to say "lift your arch," I would watch the toes curl. The foot shortens, a ridge appears along the inside edge, and it looks like an arch. It is a grip. The long toe flexors are performing a voluntary contraction in place of a reflexive one. Hold it and the foot cramps. Release it and nothing has changed, because nothing was trained. I stopped using that cue years ago, and VASIE® instructors are trained to cue in a way that allows the right muscles to come on rather than demanding that they do.

Calf raises have the opposite problem. They load gastrocnemius and soleus, which are large, superficial, and already dominant in a compensating body. Strengthening the dominant muscles does not restore the timing of the quiet ones. In my experience it widens the gap. Stretching has a related issue: it lengthens tissue that in Diane's case was already long.

Load and speed are the variables nobody adjusts

The deep stabilizers do not simply fail to contribute under demanding conditions. They reduce their activity further under load, under speed, and under full bodyweight.

This is the reason the Pilates reformer is built the way it is. Lower the load and muscles that had gone quiet begin firing again. Most foot programs are prescribed standing, at full bodyweight, at whatever tempo feels natural. That is the condition under which those muscles are least available to you.

A repeatedly rolled ankle reports less accurately

An ankle that has been rolled many times, or partially subluxed, has degraded joint position sense. The receptors that report where the joint sits in space are less reliable than they should be.

This is why I do not tell hypermobile clients to listen to their bodies. The signal is the part that is compromised. Proprioception has to be rebuilt from the outside, through precision, external feedback, and repetition. It is trainable. It is not something you can locate by paying closer attention.

The effects do not stop at the foot

VASIE® takes an organizing premise from Structural Integration: the position of one segment determines what is available to the segments above it. When the arch drops, the talus and tibia rotate inward, the femur follows, and the pelvis absorbs the difference.

Diane did not book about her feet. She booked about her right SI joint, which had been going out every few months for two years. The orthotics were an afterthought in her bag. That sequence is common enough that I now look at feet regardless of what someone books for.

Joint neutral is the difference that makes it hold

Of the six differences that define VASIE®, the one governing foot work is joint neutral.

Every joint sits between opposing muscles, agonist and antagonist. At the ankle and midfoot, tibialis anterior and posterior pull one direction and the peroneals pull the other. When tone across that pair is balanced, the joint rests in its neutral position, which is the position of least strain and best mechanical efficiency. When tone is lopsided, and in a hypermobile foot it usually is, the joint sits off center and the ligaments take over a job muscle was supposed to do. Ligaments are not contractile. They cannot adjust. They can only be stretched, and Diane's stretch more easily than most.

We build joint neutral by developing tone at the ends of a range, so that both sides of the joint learn what the other is doing. For a hypermobile body there is a qualifier I am strict about: the range is a controlled one, not your anatomical end range. Loading the outer limit of an already-loose joint is how flares happen. The work sits well inside available range, where tone can build without asking tissue to lengthen any further.

Done consistently, this produces a change you do not have to maintain. The foot begins defaulting toward neutral, not because you are thinking about your arch but because the nervous system has been trained to put it there. We call it sticky exercise. In my experience the skill survives time off, weight change, and injury.

What the work looks like on the floor

Most foot work happens lying down or seated, with the foot on a strap, a bar, or the reformer footbar. Load is kept low by design, so that the stabilizers stay involved. Movements are small and slow.

Slow is a requirement, not a comfort measure. Move faster than the stabilizing muscles can respond and the large movers take over, which returns you to the program that did not work. A good share of my job in a foot class is asking people to go slower than feels productive.

The cues are to press through specific parts of the foot rather than to lift anything. Pressing the toes into the floor raises tone through the deep core chain. The feet are one of a small number of semi-voluntary entry points into an otherwise involuntary system, which is why the method starts here and why feet get a full month at the base of the sixteen-week cycle.

Instructors walk the room continuously. You cannot see your own foot mechanics, and in a hypermobile body you cannot reliably feel them, so someone has to tell you what is happening. That is a large part of what the class is for.

Helen, an online client, described her second week this way:

That is an accurate description of the early stage. The foot is not stronger yet. It is available: sensation exists where there was none, which is what has to happen before tone can be trained.

Where Diane ended up

She still owns the orthotics. She wears them for long days on hard floors and for hiking, with the agreement of the podiatrist who prescribed them.

The change took months. In the first few weeks she reported articulation, meaning the sense that her foot had parts rather than being one piece that ended at the ankle. Around month four the way she stood in class changed enough that I could see it from across the room without cueing her. She has not rolled the right ankle since that first winter, though one client over a few years is an anecdote and not evidence. Her SI joint, which is what she originally came in about, settled considerably.

What she said is what I hear most often from clients in her position: she wished she had known this ten years earlier.

Honest expectations

Weeks to notice articulation in a foot that used to feel like a single block. Months for that foot to default to a better position without your attention on it. The VASIE® cycle runs sixteen weeks and comes around three times a year. Feet are the foundation month, and what you build there carries into every month above it. I am not going to tell you it takes three weeks. It does not, and you have probably been told that before.

Questions I get asked

Is Pilates safe if I'm hypermobile?

It depends on how it is taught. Mat classes at full bodyweight and flowing tempo tend to aggravate unstable joints, because load and speed are the two conditions that suppress the stabilizers you need. Low-load, slow, small-range work with hands-on correction is a different proposition. Before you book anywhere, ask how the studio modifies for hypermobility. How specific the answer is will tell you what you need to know.

Why do my feet hurt more after strengthening exercises?

Usually because the exercise recruited the wrong muscles. Gripping with the toe flexors to simulate an arch, or loading the outer limit of a loose joint, will both produce soreness without producing stability. When a client reports arch soreness after foot work, I read it as a signal to reduce load and slow down.

Will I ever get out of my orthotics?

Some clients substantially reduce their reliance on support. Others keep using it and have a foot that works better inside it. Both are good outcomes. It is a decision to make with the clinician who prescribed them.

Ana Kokaurova is a Certified Advanced Rolfer®, a Stott-certified Pilates instructor, and a VASIE® Pilates Instructor Trainer. She has been teaching since 2002 and co-developed the VASIE® method, Van Alstine Structural Integration Exercise, which combines the principles of Rolfing® Structural Integration with the exercise system developed by Joseph Pilates.

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