Department of Physical Medicine and Rehabilitation, La Paz University Hospital-IdiPaz, Madrid, Spain.
Department of Orthopaedic Surgery, La Paz University Hospital-IdiPaz, Madrid, Spain.
Haemophilia. 2019 May;25(3):500-508. doi: 10.1111/hae.13680. Epub 2019 Jan 21.
Haemophilic arthropathy (osteoarthritis secondary to haemophilia) of the ankle may result in painful hindfoot malalignment.
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.
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.
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.
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.
踝关节血友病性关节病（血友病继发骨关节炎）可导致后足疼痛性对线不良。
分析踝关节血友病性关节病患者的后足对线情况，并评估对线不良患者接受矫形治疗的反应（疼痛、功能和对线改善）。
本研究纳入了 163 名年龄均在 16 岁以上的血友病患者。对有和无踝关节血友病性关节病（根据 Pettersson 评分确定）的患者进行后足对线和足印分析。通过 AOFAS 踝关节-后足评分评估 6 个月时使用矫形器的效果。
56 名（59.5%）有踝关节血友病性关节病的患者存在同时存在后足对线不良。最常见的异常是外翻对线合并中立足印。在 14 例中，外翻与平足或高弓足有关。仅有 5 名（7.2%）无踝关节血友病性关节病的患者存在某种形式的对线不良。组间差异具有统计学意义。随着关节病程度的增加，出现对线不良的概率增加。对有血友病性关节病和对线不良的患者采用矫形器治疗，最常使用的替代方法是鞋垫（86%）。这种治疗显著改善了 AOFAS 踝关节-后足评分的疼痛和功能相关评分。
鉴于踝关节血友病性关节病患者中存在较高的外翻对线不良发生率，以及个体化矫形治疗获得的良好反应率，对该组患者常规评估后足对线似乎是合理的。
