Hayley Coulson is the Haemophilia Physiotherapist at the Lady Cilento Children’s Hospital, Brisbane
The ankle is one of the most important joints of the human lower limb and plays an integral role in our locomotion. Injury to the ankle joint can result in significant functional impairment and decreased quality of life. Unfortunately, patients with haemophilia are at an increased risk of ankle joint injury due to haemarthrosis (joint bleed), resulting in haemophilic arthropathy. The ankle is one of the most common joints affected by haemophilic arthropathy.
Several studies of people with haemophilia have shown that joint destruction identified on MRI is evident before physical signs of ankle joint destruction, such as reduced range of motion and pain.1,2 This highlights the importance of preventative measures in reducing the incidence of ankle joint injuries.
Experts have long recommended the use of ankle braces for people with haemophilia who are physically active, have a target joint or are prone to ankle injuries.3 Ankle supports such as bracing and taping have proven to be cost-effective additions in both the prevention and rehabilitation of ankle joint injuries.4 While taping the ankle does provide effective support the long-term durability of tape is poor and impacts the skin. The brace, however, provides greater protective mechanisms and reduces the risk of ankle injury.5
Using ankle support during physical activities, combined with correct management of bleeds, will decrease the risk of further joint damage. If you have been having problems with ankle injuries whilst participating in activities, then this may be a solution to your problem. We are not recommending that all people should wear an ankle brace, only if you have been having issues. Your Physiotherapist can fully assess and identify any weakness in your ankle joint, and prescribe the use of an ankle brace if needed.
Thanks to Wendy Poulsen, formerly Haemophilia Physiotherapist at the Lady Cilento Children’s Hospital, for her advice.
1. Kilcoyne R, Nuss, R. Radiological assessment of haemophilic arthropathy with emphasis on MRI findings. Haemophiilia 2003;9(Suppl 1):57-64.
2. Dobon, M, Lucia, J, Mayayo, E, et al. Value of magnetic resonance imaging for the diagnosis and follow-up of haemophilic arthropathy. Haemophilia 2003;9:76–85.
3. Mulder.K, Llinas, A. The target joint. Haemophilia 2004;10(Suppl. 4):152–156.
4. Dizon, J, Reyes, J. A systematic review on the effectiveness of external ankle supports in the prevention of inversion ankle sprains among elite and recreational players. Journal of Science and Medicine in Sport 2010;13(3):309-17.
5. Hall, E, Simon, J, Docherty C. Using ankle bracing and taping to decrease range of motion and velocity during inversion perturbation while walking. Journal of Athletic Training 2016;51(4):283-290.
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