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

Grissom SP, Blanton S. Treatment of upper motoneuron plantarflexion contractures by using an adjustable ankle-foot orthosis. Arch Phys Med Rehabil 2001;82:270-3. 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° to 4.5° 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°; range, 6°-36°) 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.