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Use of a Static Adjustable Ankle-Foot Orthosis Following Tibial Nerve Block to Reduce Plantar-Flexion Contracture in an Individual With Brain Injury

S Blanton, PT, MPT, NCS, is Project Coordinator, EXCITE National Clinical Trial, Emory Center for Rehabilitation Medicine, Room 206, 1441 Clifton Rd, Atlanta, GA 30322 (USA)
SP Grissom, MD, is Staff Physician, Virginia Mason Medical Center Physical Medicine and Rehabilitation, Seattle, Wash
L Riolo, PT, PhD, NCS, is Associate Professor, Department of Rehabilitation Science, and Adjunct Professor, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Okla

(Sarah_Blanton{at}emoryhealthcare.org)

Background and Purpose. Ankle plantar-flexion contractures are a common complication of brain injuries and can lead to secondary limitations in mobility. Case Description. The patient was a 44-year-old woman with left hemiplegia following a right frontal arteriovenous malformation resection. She had a left ankle plantar-flexion contracture of –31 degrees from neutral. After a tibial nerve block, an adjustable ankle-foot orthosis was applied 23 hours a day for 27 days. Adjustments of the orthosis were made as the contracture was reduced. The patient received physical therapy during the 27-day period for functional mobility activities and stretching the plantar flexors outside of the orthosis. Outcomes. The patient's dorsiflexion passive range of motion increased from –31 degrees to +10 degrees. Discussion. The application of an adjustable ankle-foot orthosis following a tibial nerve block, as an addition to a physical therapy regimen of stretching and mobility training, may reduce plantar-flexion contractures in patients with brain injury.

Key Words: Ankle joint • Brain injury • Contracture • Range of motion • Static adjustable orthosis