Hemophilic arthropathy of the foot and ankle.

The major deformities in hemophilic arthropathy of the foot and ankle fall into the three groups of equinus, varus, and cavus. These pathologic positions develop through a repetitive pattern of intra-articular and intramuscular bleeding within the area of the distal calf, foot, and ankle. Appropriate infusion therapy with factor VIII concentrate and factor IX concentrate plus splinting, bracing, and logical rehabilitative maneuvers can delay or prevent the advent of permanent deformity. The actual articular damage seems to be directly related to the release of digestive enzymes from leukocytes, synovial cells, and other blood products. These pathologic mechanisms appear to be similar to those recently described in explaining joint destruction in rheumatoid and degenerative arthritis. The indication for certain reconstructive orthopedic procedures in these situations are given and case examples provided. Total joint replacement in the area of the foot and ankle in hemophilia has been considered for certain patients by the authors but not attempted as yet.