Which joints are most lax in children with Down syndrome?

• A. Knees and elbows
• B. Ankles and hands
• C. Hips and feet
• D. Shoulders and wrists

Answer: (C)

Children with Down syndrome often have generalized ligamentous laxity and hypotonia, so joints move more than normal. The hips and feet tend to be the most lax because these weight‑bearing, distal joints rely on a combination of ligament integrity and muscle support, which is reduced. Hip laxity shows up as excessive abduction and external rotation with a loose joint capsule, increasing instability risk and potential dysplasia. In the feet, laxity leads to flat arches and overpronation due to loosened ligaments around the arches and joints of the foot. This pattern helps explain why hips and feet are typically the most lax in these children. In rehab, focus on strengthening the hip stabilizers and trunk, improving foot posture and ankle control, and using supportive footwear or orthotics as needed to enhance stability.