Gait Analysis of the Hemophilic Ankle With Silicone Heel Cushion

Seuser, A.; Wallny, T.; Klein, Heiko; Ribbans, William J; Schumpe, G.; Brackmann, H.-H.

doi:10.1097/00003086-199710000-00015

Cited by 22 publications

(37 citation statements)

References 2 publications

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“…Previous studies [1,[3][4][5][6][7][8][9][10]14] reported satisfactory results from the standpoint of a decreased bleeding frequency and pain of the knee, especially when synovectomy was carried out in early stages, and this might hold true for the ankle as well. Montane et al [14] and Greene reported that synovectomy of the ankle reduces transfusion rates and increases motion in a series of five patients, whereas the radiological score did not deteriorate over a 5-year follow-up, other results are scanty [3,5].…”

Section: Discussionmentioning

confidence: 97%

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Outcome of surgical concepts in haemophilic arthropathy of the hindfoot

Panotopoulos¹,

Hanslik-Schnabel²,

Wanivenhaus³

et al. 2005

Haemophilia

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The ankle is one of the most frequent joint affected by haemophilia, in the second decade of life it can be considered as the most common site for haemophilic arthropathy. The aim of this study is to evaluate the results of 15 surgical interventions of the hindfoot performed on 11 patients. Twenty-seven of 70 male patients suffering from haemophilia were treated for haemophilic arthropathy of the hindfoot. We performed 15 operations on 11 patients with a mean age of 33.5 (range: 10-53) years. The surgical treatment consisted of 15 operations, 12 of which concerned the talocrural joint (six synovectomies, three radiosynoviorthesis, four arthrodeses, one achilles tendon lengthening) and one the talocalcaneonavicular joint (one triplearthrodesis). The arthrodeses of the talocrural joint were undertaken by screw, the triplearthrodesis by clamp fixation. The synovectomies were all late synovectomies and performed by open means. The mean follow-up period was 32.0 (range: 12-84) months. The mean age at surgery was 29.6 (range: 8-51) years. No perioperative complications were registered when adequate replacement therapy was carried out. The consolidation of the arthrodeses was accomplished within 8-12 weeks. All synovectomies stopped or reduced significantly recurrent joint bleeding. With both procedures we achieved pain relief and walking ability improvement. The aim of synovectomy is to reduce bleeding episodes. If synovectomy can halt the progression of the haemophilic arthropathy is controversially discussed, especially when surgery was carried out in the presence of an established arthropathy. If synovectomy fails, the arthrodesis proves to be a good treatment option.

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Section: Discussionmentioning

confidence: 97%

“…Previous studies [1,3–10,14] reported satisfactory results from the standpoint of a decreased bleeding frequency and pain of the knee, especially when synovectomy was carried out in early stages, and this might hold true for the ankle as well. Montane et al .…”

Section: Discussionmentioning

confidence: 97%

Outcome of surgical concepts in haemophilic arthropathy of the hindfoot

Panotopoulos¹,

Hanslik-Schnabel²,

Wanivenhaus³

et al. 2005

Haemophilia

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“…Using ultrasound motion analysis allowing for kinematic measurement of the tibiotalar and subtalar joints, Seuser et al. [31] reported the first study evaluating the efficacy of a conservative orthopaedic treatment in patients with ankle arthropathy. More recently, Stephensen et al.…”

Section: Discussionmentioning

confidence: 99%

“…Most likely because of recruitment difficulties, relatively few studies have focused on gait disorders in patients with haemophilia. Using ultrasound motion analysis allowing for kinematic measurement of the tibiotalar and subtalar joints, Seuser et al [31] reported the first study evaluating the efficacy of a conservative orthopaedic treatment in patients with ankle arthropathy. More recently, Stephensen et al [32] published the first 3DGA study integrating both kinematic and kinetic variables in children with haemophilia.…”

Section: Gait Analysis As a Joint Assessment Tool In Patients With Hamentioning

confidence: 99%

Natural progression of blood‐induced joint damage in patients with haemophilia: clinical relevance and reproducibility of three‐dimensional gait analysis

et al. 2010

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A major complication in haemophilia is the destruction of joint cartilage because of recurrent intraarticular and intramuscular bleeds. Therefore, joint assessment is critical to quantify the extent of joint damage, which has traditionally been evaluated using both radiological and clinical joint scores. Our study aimed to evaluate the natural progression of haemophilic arthopathy using three-dimensional gait analysis (3DGA) and to assess the reproducibility of this technique. We hypothesized that the musculoskeletal function was relatively stable in patients with haemophilia. Eighteen adults with established haemophilic arthropathies were evaluated twice by 3DGA (mean follow-up: 18 +/- 5 weeks). Unexpectedly, our findings revealed infraclinical deterioration of gait pattern, characterized by a 3.2% decrease in the recovery index, which is indicative of the subject's ability to save energy while walking. A tendency towards modification of segmental joint function was also observed. Gait analysis was sufficiently reproducible with regards to spatiotemporal parameters as well as kinetic, mechanical and energetic gait variables. The kinematic variables were reproducible in both the sagittal and frontal planes. In conclusion, 3DGA is a reproducible tool to assess abnormal gait patterns and monitor natural disease progression in haemophilic patients.

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“…Insoles should be full‐length and moulded to the patients’ specific requirements; use of off‐the‐shelf orthoses is not recommended . In the context of haemophilia, silicone heel cups have not been shown to possess adequate shock absorption properties and may lead to further joint impairment . Given that in these cases, the deformity is located mainly in the hindfoot, the insole must apply torque to the hindfoot by means of a wedge, whose size will vary as a function of hindfoot flexibility (Figure ).…”

Section: Methodsmentioning

confidence: 99%

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

et al. 2019

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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.

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Gait Analysis of the Hemophilic Ankle With Silicone Heel Cushion

Cited by 22 publications

References 2 publications

Outcome of surgical concepts in haemophilic arthropathy of the hindfoot

Outcome of surgical concepts in haemophilic arthropathy of the hindfoot

Natural progression of blood‐induced joint damage in patients with haemophilia: clinical relevance and reproducibility of three‐dimensional gait analysis

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

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