Hindfoot malalignment in adults with haemophilic ankle arthropathy: The importance of early detection and orthotic treatment

Introduction Haemophilic arthropathy (osteoarthritis secondary to haemophilia) of the ankle may result in painful hindfoot malalignment. Purpose To analyse hindfoot alignment in subjects with haemophilic arthropathy of the ankle and evaluate the response (improvement of pain, function and alignment)...

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Bibliographic Details
Published in:Haemophilia : the official journal of the World Federation of Hemophilia 2019-05, Vol.25 (3), p.500-508
Main Authors: De la Corte‐Rodriguez, Hortensia, Rodriguez‐Merchan, Emerito Carlos, Alvarez‐Roman, Maria Teresa, Martin‐Salces, Monica, Jimenez‐Yuste, Victor
Format: Article
Language:English
Subjects:
Ankle
haemophilia
Hemophilia
hindfoot
insoles
malalignment
orthoses
Osteoarthritis
Pain
Statistical analysis
treatment
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Summary:Introduction Haemophilic arthropathy (osteoarthritis secondary to haemophilia) of the ankle may result in painful hindfoot malalignment. Purpose To analyse hindfoot alignment in subjects with haemophilic arthropathy of the ankle and evaluate the response (improvement of pain, function and alignment) to the orthotic treatment prescribed in patients with malalignment. Methods The study included 163 patients with haemophilia, all of them over 16 years of age. Hindfoot alignment and footprint were analysed in patients with and without haemophilic arthropathy of the ankle (as determined by the Pettersson score). Response to the use of an orthosis was evaluated at 6 months by means of the AOFAS Ankle‐Hindfoot Scale. Results Fifty‐six (59.5%) patients with haemophilic arthropathy presented with concomitant  hindfoot malalignment. The most common abnormality was a valgus alignment combined with a neutral footprint. In 14 cases, valgus was associated with a pes planus or a pes cavus. Only 5 patients without haemophilic arthropathy (7.2%) presented with some form of malalignment. The differences between the groups were statistically significant. The probability of having malalignment increased with the degree of arthropathy. Patients with haemophilic arthropathy and malalignment were treated with an orthosis, with insoles as the most commonly used alternative (86%). Such treatment significantly improved patients’ pain and function‐related scores on the AOFAS Ankle‐Hindfoot Scale. Conclusion Given the high rates of valgus malalignment in subjects with haemophilic arthropathy of the ankle, and the good response rates obtained following individualised orthotic treatment, it seems reasonable to routinely evaluate hindfoot alignment in this group of patients.
ISSN:1351-8216
1365-2516
DOI:10.1111/hae.13680