Hemophilia (A) and (B) are x-linked recessive bleeding disorder which result from deficiency of factor (VIII) or factor (IX) genes leading to prolonged bleeding . Hemophilia in female rare, though affecting female off spring from affected father and carrier mother. The bleeding episodes into affected ankle joint will irritate the synovial membrane and lead to hyperemia of The synovium. The hyperemic synovium forms reactive granulation tissue and undergoes fibrosis and villous formation. The reactive granulation tissue extend over and absorbs the articular cartilage the deposition of iron within the cartilage will interfere with nutrition and lubrication of articular cartilage which become soft, yellowish and mechanically unable to with stand stress . Destruction of sub chondral bone is common . During growth period, because of hyperemia. the epiphyses of affected joints become enlarged asymmetrical producing gross deformity (varus hind foot with fixed plantar flexion) . * The most common presenting picture is hemarthrosis or bleeding into joint in which the affected ankle joint becomes hot, swollen painful and tender with restricted range of motion specially the dorsi-flexion, in chronic condition and due to deformities the joint becomes held in varus hind foot and fixed plantar flexion position . Pseudo tumors represent serious sequale of hemophilic arthropathy, the patient present clinically by painless swelling around distal tibia in calf muscle, the mass continue to grow and may press over near by structures . The surrounding muscles become atrophic and fibrosed. The pathological fractures, as well as chronic ligaments laxity of ankle joint are very common clinical presentation the most important tool for diagnosis of such disease is laboratory investigations : Prolonged partial thrombo plastin time and prothrombine consumption all other coagulation, bleeding time and platelets functions are normal . The radiological findings may also help in diagnosis in which the affected ankle joint space becomes narrowed with large effusion and excessive sclerosis and marked joint destruction . the chronic deformities such as : varus hind foot may be detected also by X-Ray . The most important line of management of such cases is replacement therapy by the deficient factor and plasma. Nowadays, after the availability of these deficient clotting factors, the surgical interference becomes possible to control such hemophilic arthropathy cases . The synovectomy either open or athroscopic for diseased synovial membrane of ankle joint remains the first option and it gives a high success rate . If the synovectomy failed, we may do ankle arthrodesis to relief the pain. In some centers in Europe, they perform total ankle arthroplast but the results still not encouraging. The synoviorthesis represents the most recent technique to control hemophilic ankle arthropathy. The synoviorthesis means : destruction of synovial tissue by injection of radio nuclide materials under local anaesthesia, it could be done in the out patient clinics with high rate of success.