Computerized pedobarography in the characterization of ankle-foot instabilities of haemophilic patients.
Among the most common clinical manifestations of haemophilia are joint haemorrhages. This study aimed to verify whether repetitive ankle haemarthrosis is associated with instability of the rear foot. We evaluated haemophilic patients with repetitive bleeding in the ankles, 39 of type A and four of type B, whose mean age was 16.1 years. All presented a functional gait, without the need for motion assistance devices. The number of rear-foot and ankle haemarthrosis episodes during the 6 months prior to the study was verified from the medical records of each patient. After verifying the alignment of the rear foot of the patients, we evaluated the subjects through computerized pedobarography with the f-scan system, emphasizing the study of the trajectory of the centre of pressure (COP) with each step taken. All patients received functional orthoses according to the results of these examinations, and were re-evaluated 1 week and 6 months after being fitted. The number of haemarthrosis episodes at the rear foot and the ankle was compared with the occurrence of joint bleeding within the previous 6 months. In the first examination, the COP trajectory showed that all the 43 patients studied had some sort of instability. Six months later, a significant reduction in the frequency of spontaneous bleeding events (P<0.001) concerning the rear foot and the ankle was observed. This method of evaluation was useful to identify joint instabilities, allowing the best prescription of orthoses to improve stability in the rear foot and the ankle.
Division of Rehabilitation Medicine, General Hospital, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil. donaldo_jorge@ig.com.br
D
D
Jorge Filho
L R
LR
Battistella
C
C
Lourenço
D000293:Adolescent; D000328:Adult; D000843:Ankle Joint / Q000503:physiopathology*; D001696:Biomechanical Phenomena; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D005684:Gait; D006365:Heel; D006395:Hemarthrosis / Q000150:complications*; D006467:Hemophilia A / Q000150:complications* / Q000503:physiopathology; D002836:Hemophilia B / Q000150:complications / Q000503:physiopathology; D006801:Humans; D007593:Joint Instability / Q000175:diagnosis / Q000209:etiology* / Q000534:rehabilitation; D008297:Male; D008875:Middle Aged; D009989:Orthotic Devices; D011312:Pressure; D012720:Severity of Illness Index; D012815:Signal Processing, Computer-Assisted; D016474:Weight-Bearing