Plantar refers to the bottom of the foot. A plantar flexion contracture involves the foot, toes and ankle and prevents normal foot movement. A contracture occurs when the muscles, ligaments, tendons and skin shorten and tighten causing restriction of movement in that area. The connective tissue, which is normally elastic, loses its elasticity impairing use of the joint. The fluid-filled spaces surrounding the joints dry up and cause fibre to form.
The Causes of a Contracture
Plantar flexion is a movement that involves pointing the foot downward. Several conditions can cause a contracture to develop in this area. These include birth defects, Huntington's disease, muscular dystrophy, cerebral palsy, nerve damage such as a stroke or spinal cord injury, burns, damage to the skin and lack of use. Plantar flexion contractures often occur in people who are bedridden, confined to a wheelchair or have had a cast on the foot for a long time. In these situations the joints aren't being exercised properly as weight bearing and normal movement aren't occurring.
How to Monitor the Foot
The University of Maryland Medical Center recommends closely monitoring the appearance of the ankle, feet and toes. Contact the doctor if a contracture appears to be developing. Watch for poor circulation, a bended, twisted or stiff appearance of the foot or a decrease in range of motion. Early intervention helps in reducing the possible permanent damage of a plantar contracture. By closely monitoring the feet for problems early treatment can be initiated.
Preventing a Contracture
A contracture is less likely to develop if the feet receive adequate range of motion, exercise, proper positioning and stretching during an immobile period or on a regular basis if a chronic illness is involved. Range of motion exercises performed by a physical therapist, caregiver or as part of a self-care routine are essential in the prevention of contractures. The Research and Training Center on Independent Living recommends providing support for the feet and frequently repositioning the body through the day as part of a preventive routine.
Treatment of a Contracture
Approximately eight muscles are involved in plantar flexion movement of the foot. If a contracture has developed in these muscles medical intervention is necessary. Casting, splinting or surgery may be required to stretch the effected muscles and ligaments. Surgery is performed in severe cases that have not responded to other treatment. The surgical procedure depends on the muscles involved and requires a period of non-weight bearing and splinting after the procedure. Results vary and can sometimes lead to a weakness in the ankle and foot that impairs mobility.
- The University of Kansas: Contractures; The Research and Training Center on Independent Living.
- Harris County Hospital:Strategies to Prevent Heel Ulcers and Plantar Flexion Contractures in Ventilated Patients; Tina Meyers, RN: October 2008.
- University of Maryland Medical Center: Contracture Deformity- Overview; Linda Vorvick, MD; August, 2008.