Treatment of upper motoneuron plantarflexion contractures by using an adjustable ankle-foot orthosis.

Abstract

To assess the effectiveness of an adjustable ankle-foot orthosis in the treatment of plantarflexion contractures after central nervous system injury or disease. Prospective, nonrandomized, interventional trial. University medical center's acute inpatient rehabilitation hospital. 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. 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. Dorsiflexion PROM at the ankle with the knee extended. 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. Plantarflexion contractures can be significantly reduced by using the adjustable ankle-foot orthosis with minimal complications.