Peak pressure during gait in patients with severe haemophilia: A controlled cross-sectional study

Jamil Hmida; Thomas Hilberg; Sebastian Koob; Natascha Marquardt; Dieter C Wirtz; Frank A Schildberg; Johannes Oldenburg; Andreas C Strauss

doi:10.1016/j.gaitpost.2022.01.008

Peak pressure during gait in patients with severe haemophilia: A controlled cross-sectional study

Gait Posture. 2022 Mar:93:26-31. doi: 10.1016/j.gaitpost.2022.01.008. Epub 2022 Jan 14.

Authors

Jamil Hmida¹, Thomas Hilberg², Sebastian Koob³, Natascha Marquardt⁴, Dieter C Wirtz³, Frank A Schildberg³, Johannes Oldenburg⁴, Andreas C Strauss³

Affiliations

¹ University of Wuppertal, Department of Sports Medicine, Moritzstraße 14, 42117 Wuppertal, Germany. Electronic address: jamil.hmida@gmx.de.
² University of Wuppertal, Department of Sports Medicine, Moritzstraße 14, 42117 Wuppertal, Germany.
³ University of Bonn, Department of Orthopaedics and Trauma Surgery, Venusberg Campus 1, 53127 Bonn, Germany.
⁴ University of Bonn, Institute for Experimental Haematology and Transfusion Medicine, Venusberg Campus 1, 53127 Bonn, Germany.

PMID: 35051714
DOI: 10.1016/j.gaitpost.2022.01.008

Abstract

Background: Patients with severe haemophilia suffer from bleeding-related joint changes in which the ankle joint is most frequently affected. In the resulting gait changes, the forefoot is involved by reducing the foot pressure. However, it is unclear which changes in foot pressure are present in the individual's foot zones.

Research question: The aim of the study was to determine whether compensation mechanisms are present in the foot zones regarding the peak pressure under dynamic conditions and to identify possible underlying mechanisms for gait changes.

Methods: In a controlled cross-sectional study, a pedobarography was performed during gait with a standardized speed (3 km/h) in patients with haemophilia (PwH;n = 40) and healthy controls (Con;n = 40). Pressure pain thresholds (PPT) were detected, and Haemophilia Joint Health Score (HJHS) was performed to determine the current joint status.

Results: PwH showed a decreased peak pressure in metatarsals II-IV and heel compared to Con. Patients with major-affected ankle joints (determined with the HJHS) showed a decreased single-step length, stride-length and stride-time. Accordingly, the cadence was increased by 10 ± 11 steps/min in PwH compared to Con. Furthermore, PwH showed decreased ankle range of motion (ROM) in HJHS and an altered pain perception due to reduced PPT.

Significance: PwH showed a changed gait pattern in peak pressure compared to Con. A restricted rolling behavior, which might be caused by movement restrictions and pain sensation, leads to reduced pressure in the center forefoot, resulting in a shorter stride-length. Future therapies should focus on maintaining joint mobility for better rolling behavior and improving ankle joints' stability to achieve a balanced load between the midfoot, heel, and forefoot. The use of insoles adapted to our data, based on group differences between PwH and Con, could be supportive in this case.

Keywords: Ankle; Arthropathy; Joint changes; Maximum pressure; Pedobarography.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Ankle Joint
Cross-Sectional Studies
Foot
Gait
Hemophilia A* / complications
Humans
Pain