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

Wallny, T.; Brackmann, H.‐H.; Kraft, C. N.; Nicolay, Claudia; Pennekamp, P. H.

doi:10.1080/17453670610045867

Cited by 13 publications

(9 citation statements)

References 9 publications

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“…23 The current standard of care, surgical resolution of ankle equinus contracture, has been established. [1][2][3][4][5][6][7][8][9][10][11][12] However, use of a modality like the AFD could prevent the need for surgery in a significant number of patients. A previous protocol of using serial casting has been discontinued for DM patients due to the great frequency of skin breakdown and ulcerations from the casting itself.…”

Section: Discussionmentioning

confidence: 99%

“…nkle equinus is defined as the failure to achieve 10° of dorsiflexion during the gait cycle. [1][2][3][4][5][6][7][8][9][10] This disability is the result of contracture and has a significant prevalence in patients who have also been diagnosed with Diabetes Mellitus (DM), both Type 1 and Type 2. [1][2][3][4] In addition, plantar nerve neuropraxia or neurotemesis affecting the posterior tibial nerve (medial and lateral plantar nerves) causes a severe muscle imbalance between the larger and more powerful leg muscles and the intrinsic foot muscles.…”

mentioning

confidence: 99%

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Reduction of Ankle Equinus Contracture Secondary to Diabetes Mellitus with Dynamic Splinting

Lopez¹,

Kalish²,

John³

et al. 2010

FAOJ

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The Foot and Ankle Online Journal 3 (3): 2Introduction: Ankle equinus is a hereditary or acquired contracture of the triceps surae or shortening of the connective tissue causing inability of the foot to dorsiflex during gait. For the patient population with diabetes mellitus, this high plantar pressure from contracture often results in ulceration. This is frequently treated by Achilles tendon lengthening which helps to avoid infection and amputation. The purpose of this study is to examine the effect of dynamic splinting in reduction of ankle equinus contracture for patients with diabetes mellitus. Methods: A retrospective analysis was accomplished by reviewing the history of 48 patients following treatment with an ankle dorsiflexion dynamic splint. This dynamic splinting modality delivers low-load prolonged duration stretching while one sleeps. In this home therapy study, dynamic splinting was used for a mean 240 hours in the first month (5 weeks). Results: Patients showed a statistically significant change in maximal ankle dorsiflexion (P < 0.0001). The patients mean, maximal active range of motion in dorsiflexion increased by 9º in the first month. Conclusion: This modality proved effective as home therapy and should be examined in further research so that it may be employed as standard of care in treating ankle equinus contracture.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Reduction of Ankle Equinus Contracture Secondary to Diabetes Mellitus with Dynamic Splinting

Lopez¹,

Kalish²,

John³

et al. 2010

FAOJ

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“…Nevertheless, Wallny et al. [20] recently reported their experience in 23 severe haemophiliacs (mean age at surgery: 29 years; range: 12–46 years) followed‐up for a mean of 13 years after the intervention. The results showed a significant improvement of the WFH clinical score, dorsiflexion and range of motion, most evident 1 year after surgery and maintained almost unchanged at the last follow‐up.…”

Section: Achilles Tendon Lengtheningmentioning

confidence: 99%

“…Since 1969, several series of open synovectomy in haemophiliacs have been reported [20–28] although they described procedures performed mainly on knees and elbows. As open synovectomy has been effective in controlling synovitis and recurrent bleeding, it requires a large incision, prolonged hospitalization and large amounts of factor replacement and has been associated with a high infection rate and a reduced range of motion [20,23,29]; hence, it has fallen out of favour. To our knowledge, only two small studies report the results of open synovectomy of the ankle in haemophiliacs [19, 29].…”

Section: Surgical Synovectomymentioning

confidence: 99%

Orthopaedic management of haemophilia arthropathy of the ankle

et al. 2008

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Summary. Joint bleeding, or haemarthrosis, is the most common type of bleeding episode experienced by individuals with haemophilia A and B. This leads to changes within the joints, including synovial proliferation, which results in further bleeding and chronic synovitis. Blood in the joint can also directly damage the cartilage, and with repeated bleeding, there is progressive destruction of both cartilage and bone. The end result is known as haemophilic arthropathy. The joints most commonly affected are the knees, elbows and ankles, although any synovial joint may be involved. In the ankle, both the tibiotalar and subtalar joints may be affected and joint bleeding and arthropathy can lead to a number of deformities. Haemophilic arthropathy can be prevented through regular factor replacement prophylaxis and implementing physiotherapy. However, when necessary, there are multiple surgical and non‐surgical options available. In early ankle arthropathy with absent or minimal joint changes, both radioisotopic and chemical synoviorthesis can be used to reduce the hypertrophied synovium. These procedures can decrease the frequency of bleeding episodes, minimizing the risk of articular cartilage damage. Achilles tendon lengthening can be performed, in isolation or in combination with other surgical measures, to correct Achilles tendon contractures. Both arthroscopic and open synovectomies are available as a means to remove the friable villous layer of the synovium and are often indicated when bleeding episodes cannot be properly controlled by factor replacement therapy or synoviorthesis. In the later stages of ankle arthropathy, other surgical options may be considered. Debridement may be indicated when there are loose pieces of cartilage or anterior osteophytes, and can help to improve the joint function, even in the presence of articular cartilage damage. Supramalleolar tibial osteotomy may be indicated in patients with a valgus deformity of the hindfoot without degenerative radiographic findings. Joint fusion, or arthrodesis, is the treatment of choice in the advanced stages of ankle arthropathy although total ankle replacement is currently available. Early ankle replacement components were associated with a poor outcome, but as implant designs have improved, there have been successful outcomes achieved. As the ankle is a commonly affected joint in many individuals with haemophilia, it is important to add to the knowledge base to validate indications and timing of surgical and non‐surgical interventions in ankle arthropathy.

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“…Another common procedure to prevent an equinus deformity becoming fixed is Achilles tendon lenghtening [9]. Sometimes, a large osteophyte develops on the anterior part of the ankle which can cause severe pain.…”

Section: Ankle Surgery In Haemophiliamentioning

confidence: 99%

Ankle surgery in haemophilia with special emphasis on arthroscopic debridement

Rodríguez-Merchán

2008

Haemophilia

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Various conservative options are available to treat ankle problems in haemophilia, which achieve a high rate of satisfactory results in the majority of cases. They are usually employed in combination and include the use of patellar tendon bearing (PTB) orthoses and radiosynoviorthesis. The effect of the PTB orthoses is that it allows the patient to walk without weight bearing of the ankle. Radiosynoviorthesis can be performed in cases of haemophilic arthropathy of the ankle, provided there is at least a minimal degree of synovitis within the joint, with a 75% of satisfactory results. If the conservative options fail, surgical intervention can be indicated. Alternatives to total ankle arthroplasty or arthrodesis include arthroscopic debridement, removal of osteophytes of the anterior aspect of the distal tibia and peri-articular osteotomies to correct angular, rotational or translational malalignment. Ankle arthrodesis is the standard technique for end-stage ankle arthropathy. Arthroscopic debridement of the ankle with haemophilic arthropathy can offer temporary relief; however, it is important to stress to patients that the degree of improvement is limited. The complication rate in ankle arthroscopy is high compared with other joints, which is especially true for neurological complications and postoperative infections. Orthopaedic procedures are not very frequent in the haemophilic ankle, because the majority of problems can be solved satisfactorily by conservative means (radiosynoviorthesis and PTB orthosis).

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

Cited by 13 publications

References 9 publications

Reduction of Ankle Equinus Contracture Secondary to Diabetes Mellitus with Dynamic Splinting

Reduction of Ankle Equinus Contracture Secondary to Diabetes Mellitus with Dynamic Splinting

Orthopaedic management of haemophilia arthropathy of the ankle

Ankle surgery in haemophilia with special emphasis on arthroscopic debridement

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