One of many problems when the neurologic system is damaged are ankle contractures. A contracture is where the soft tissue structures surrounding a joint shorten causing loss of movement.
What Causes a Contracture?
There are several factors that can lead to an ankle contracture (in the soft tissue surrounding the ankle):
Weakness – weakness in the muscles that lift the foot up (anterior tibialis).
Spasticity – involuntary muscle contraction in the muscles that point the foot down (posterior tibialis, soleus, and gastrocnemius).
Weakness and spasticity – in most cases it is a combination of both weakness and spasticity.
How do you prevent an ankle contracture?
In most cases, ankle contractures are preventable. Here is how you prevent a contracture from occurring:
- Stand and stand often – standing stretches the muscles on the back of the lower leg. In contrast, lack of standing keeps the foot pointed and causes the muscles on the back of the leg to shorten
- Wear a night splint (a splint that holds the foot in a flexed position) consistently – A night splint is a brace that keeps the ankle dorsiflexed and revents the muscles on the back of the leg from adaptively shortening.
- Wear your ankle foot orthosis (AFO) consistently during the day (even when you are not walking)
- Stretch, stretch, stretch. Even on the days you do not feel like it and/or it is not comfortable.
I know that last one seems a little harsh (to some of you) but trust me on this. I bet every person that ends up with a contracture wishes they would have stretched a little more. Why? Because stretching the ankle to prevent a contracture is far LESS painful compared to treating an ankle once it has developed a contracture.
What is the treatment for an ankle contracture?
Treatment options can be divided into two categories…conservative treatments (non invasive/non-surgical) and invasive procedures (surgery).
Conservative Treatments:
- Stand and stand often (with full body weight on the involved leg)
- Start wearing a night splint.
- In severe cases, (and for those of you who can’t stand) talk to your doctor about possibly getting a standing frame
- Start wearing your AFO consistently. If it is uncomfortable, schedule an appointment with your orthotist to have it adjusted so that it is comfortable.
- And of course, start stretching, stretching, stretching (even if it is not comfortable).
If I sound like I am repeating myself, that is intentional. Because the last resort, when all else fails, is surgery.
Surgery
Surgical management involves a procedure called a soft tissue release. And let me be the first to tell you, surgery is MORE painful. Not only that, surgery places you at risk for a whole slew of other problems.
And let’s be honest, if you didn’t do the stretches to prevent this, will you be on board with the painful process of stretching after surgery?
Anyway, let me jump off my soap box and pull up a chair……………..
Us therapists sometimes get a bad rap. I have been told that (those on the outside) call us “torturers”, pain inducers, “pain therapists”…etc. Please comment with any I may have left out 🤷🏻♀️. And these are just the ones that are rated PG.
But in all seriousness, your therapist really does want the best for you. And a good therapist will find the path of least resistance.
Meaning, find methods of treatment that are the most effective AND the least painful.
So, if you aren’t doing any of the above “prevention strategies”, be honest with your therapists. They can only help you if they have all the information.
And in most cases they have a plan “b”, “c”, “d”, “e” and “f” of how to modify an activity (to make it more tolerable).
Because in my opinion the only accurate nickname for a physical therapist is……..MacGyver 😬🙃