Management of equinus contractures of the ankle in haemophilia

Abstract

Equinus deformity has been a significant problem in haemophilia. It causes difficulties in walking and secondary problems in adjacent joints. There are a number of potential causes in haemophilia. A careful history, examination, and plain radiographs will determine the aetiology, which frequently is multifactorial. Hopefully, prophylactic factor replacement will reduce the incidence of such problems in the future. Prompt 'on demand' therapy will reduce the complications of articular and soft-tissue bleeds. Physiotherapy, splints, and orthotics will usually allow a full recovery of function and comfort. Rarely, surgical intervention is required to correct articular and/or musculo-tendinous problems. The choice of surgery depends upon the cause(s) of the deformity and should only be undertaken in experienced haemophilia units following careful counselling of the patient regarding the aims and nature of the operation and the patient's involvement in an effective rehabilitation programme.

Estimation of tensile properties of the Achilles tendon in haemophilic arthropathy of the ankle: case study

“…This increased stiffness is related to clinical record in patients with ankle HA, that is, decreased mobility, contractures of the muscles and tendons [3]. Finally, hysteresis and stiffness results obtained in this case report (Fig.…”

“…The consequent joint disorders, product of this bleeding, may produce capsular and tendon shortening helping to develop joint contractures [3].…”

Achilles tendon lengthening for ankle equinus deformity in hemophiliacs: 23 patients followed for 1–24 years

“…Interestingly, we found no suture insufficiencies in our patients, despite the fact that in some cases a marked lengthening of the Achilles tendon was performed. Ribbans and Rees (1999) recommended a subcutaneous technique but admitted that open surgery allows more extensive correction. They cited numerous potential complications of lengthening procedures such as wound break down, sural nerve injury, postoperative hematoma and adhesions.…”

Manual therapy in the treatment of ankle hemophilic arthropathy. A randomized pilot study

“…Articular bleeding in the ankle affects the way in which body weight is shared and leads to capsular and tendon shortening if not properly treated (Ribbans and Rees, 1999). Synovial inflammation, which arises when haemarthrosis occurs in the same joint leads to hemophilic synovitis (Valentino, Hakobyan, and Enockson, 2008), altering the biomechanics of the ankle and limiting articular range (Pearce, Smith, and Savidge, 1994).…”

“…Moreover, at least 10 of dorsal flexion are needed to walk normally (Ribbans and Rees, 1999), thus severe alteration of the ankle joint means that the gait is altered and walking becomes difficult and painful. Young people with hemophilia and recurrent haemarthrosis without adequate treatment have pain and radiological changes, which with the passage of time results in altered alignment of the lower limbs and potentially equinus and joint ankylosis (Berdel et al, 2009) leading to loss of proprioception (Hilberg et al, 2003).…”