The Management of Foot and Ankle Arthropathy

The primary prophylaxis is the best way to protect haemophilic patients from synovitis and arthropathy in foot and ankle. By the replacement of the deficient factor, haemophiliacs requiring orthopedic surgery of the foot and ankle may successfully and safely undergo such type of surgery. Radiosynovectomy is a very effective procedure able to induce the decrease of frequency and intensity of bleedings related to synovitis. On average, the number of haemarthroses may diminishes up to 65%. If three consecutive radiosynovectomy procedures, repeated at six-month intervals, fail to lessen the synovitis, arthroscopy should be performed. In such cases, large osteophytes may develop on the anterior aspect of distal, causing severe pain and impingement. Open or arthroscopic osteophyte removal (queilectomy) should be considered. Achilles tendon lengthening in cases of fixed equinus deformity represents another common procedure in haemophilic subjects. In the case of advanced haemophilic arthropathy of the ankle, the first option is the arthroscopic debridement. In severe cases three further options are available: ankle distraction by means of external fixation (arthrodiastasis), ankle fusion (tibiotalar and/or subtalar), and total ankle replacement.

Keywords: Ankle fusion, Arthropathy, Arthroscopic synovectomy, Conservative treatment, Chemical synovectomy, Foot and ankle, Haemophilia, Rehabilitation, Radiosynovectomy, Removal of osteophytes, Surgical treatment, Total ankle replacement.