Treatment of upper motoneuron plantarflexion contractures by using an adjustable ankle-foot orthosis.
OBJECTIVE
To assess the effectiveness of an adjustable ankle-foot orthosis in the treatment of plantarflexion contractures after central nervous system injury or disease.


METHODS
Prospective, nonrandomized, interventional trial.


METHODS
University medical center's acute inpatient rehabilitation hospital.


METHODS
Nine ankles with plantarflexion contractures that could not be passively reduced to less than neutral position occurring in 6 patients with stroke or other acquired brain injury.


METHODS
To assure differentiation between spastic deformity and true contracture, patients received a 2% lidocaine block of the posterior tibial nerve. The adjustable ankle-foot orthosis was then applied on the affected ankle for 23 hours per day for 14 days. Adjustments to increase dorsiflexion passive range of motion (PROM) ranged from 0 degrees to 4.5 degrees and were attempted every 48 to 72 hours.


METHODS
Dorsiflexion PROM at the ankle with the knee extended.


RESULTS
Increased PROM (average, 20.1 degrees; range, 6 degrees--36 degrees ) was statistically significant (p =.0078). Complications related to pressure with erythema or blister formation associated with pain occurred in 44% of treated ankles at some time during the 2-week trial period.


CONCLUSIONS
Plantarflexion contractures can be significantly reduced by using the adjustable ankle-foot orthosis with minimal complications.
Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, USA. sgrisso@emory.edu
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Grissom
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Blanton
D000328:Adult; D000843:Ankle Joint; D001930:Brain Injuries / Q000150:complications* / Q000503:physiopathology; D003286:Contracture / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation*; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009989:Orthotic Devices; D011446:Prospective Studies; D016059:Range of Motion, Articular; D018709:Statistics, Nonparametric; D020521:Stroke / Q000150:complications / Q000503:physiopathology