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. DESIGN: Prospective, nonrandomized, interventional trial. SETTING: University medical center's acute inpatient rehabilitation hospital. PARTICIPANTS: 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. INTERVENTION: 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. MAIN OUTCOME MEASURES: 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. CONCLUSION: Plantarflexion contractures can be significantly reduced by using the adjustable ankle-foot orthosis with minimal complications.[1]References
- Treatment of upper motoneuron plantarflexion contractures by using an adjustable ankle-foot orthosis. Grissom, S.P., Blanton, S. Archives of physical medicine and rehabilitation. (2001) [Pubmed]
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