Gait pattern at different speeds in persons with haemophilia

Introduction Haemophilia is a congenital coagulation disorder that frequently leads to joint bleeding and subsequent limitations in mobility. The ankle and knee joints are commonly affected, influencing gait patterns. Previous studies have shown altered gait in persons with haemophilia (PwH), mostly at low walking speeds. This study aimed to investigate the impact of different walking speeds on plantar pressure distribution and joint angles at the knee and ankle in PwH with varying joint health status. Method This prospective case-control study included 30 PwH (Age: 41.3±11.8) with severe haemophilia and 31 healthy controls (CG) (Age: 41.4±12.7). Gait analyses were conducted barefoot at 3, 4, and 5 km/h using a 4D motion capture system and a pressure-sensitive treadmill. Joint status was assessed with the Haemophilia Joint Health Score (HJHS). PwH were stratified into two subgroups: PwH(minor) with better joint status (HJHS: 7.3±3.6) and PwH(major) with worse joint status (HJHS: 32.2±13.8). Plantar pressure and joint angle data were statistically analysed with respect to speed and group. Results No significant differences in maximum plantar pressure values of individual foot regions were observed between PwH and CG at any speed. However, analysis of mean vertical peak pressures during the stance phase showed that PwH(major) had significantly higher values in the first half of stance at 4 km/h (p=.039) and significantly lower values in the second half at 4 km/h (p=.003) and 5 km/h (p=.007) compared to CG ([ Fig. 2 ]). Motion capture revealed no group differences in knee flexion or extension. However, PwH showed significantly lower ankle dorsiflexion (p=.006) and a significant group-by-speed interaction for plantarflexion (p=.047). Subgroup analysis confirmed that PwH(major) had reduced dorsiflexion (p=.011) and plantarflexion (p=.041) angles at higher speeds. PwH(minor) also showed reduced dorsiflexion at 4 km/h compared to CG ([ Fig. 1 ]). Fig. 1 Comparison of joint angles while walking at different speeds between PwH(major), PwH(minor) and CG. Data presented as mean±standard deviation (min–max). PwH=Persons with haemophilia; CG=control group;*= p≤0.05 vs. CG; #=p≤0.05 vs. PwH(minor). Conclusion PwH with advanced haemophilic arthropathy demonstrated altered gait patterns at higher walking speeds, characterised by a shift in plantar pressure and reduced ankle mobility, while knee mobility remained unaffected. These findings underline the importance of preserving ankle joint function, as even minor joint limitations were reflected in gait performance. Maintaining ankle mobility may be essential for physiological gait mechanics and mobility in daily life. Therapeutic strategies such as targeted physio- and sports therapy and regular monitoring should be prioritised to delay functional deterioration and reduce the risk of long-term disability in PwH. Fig. 2 Visualisation of the average peak pressure values during the stance phase of all gait cycles at (A) 3, (B) 4, and (C) 5 km/h. N=Newton; IC=initial contact; LR=loading response; MS=midstance; TS=terminal stance; PS=pre-swing; TO=toe off;*= p≤0.05 PwH(major) vs. CG. Publication History Article published online: 17 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany