Update on the use of orthotics in hemophilia.

The availability of concentrated coagulation factor has dramatically changed the effects of hemophilia on the musculoskeletal system. Limb angular deformities, on the whole, can be prevented by intensive medical and surgical care, but hemarthroses result in constantly changing joint circumferences and ranges of movement. Orthoses provide little protection against hemarthrosis and the unstable configurations contraindicate the use of rigid orthotic devices. Modern treatment protocols call for early and adequate factor replacement and physiotherapy. As an adjuvant to this form of therapy, anatomically constructed elastic joint supports and/or transcutaneous electric nerve stimulation (TENS) have been used.