Evaluation of serial casting to correct equinovarus deformity of the ankle after acquired brain injury in adults

Singer BJ, Jegasothy GM, Singer KP, Allison GT. Evaluation of serial casting to correct equinovarus deformity of the ankle after acquired brain injury in adults. Arch Phys Med Rehabil 2003;84:483-91. Objective: To determine the potential short-term benefit of serial plaster casting in the management of equinovarus deformity associated with acquired brain injury. Design: Prospective uncontrolled interventional trial. Setting: Inpatient rehabilitation facility in Australia. Participants: Sixteen patients (19 limbs) with equinovarus deformity or deteriorating ankle range of motion associated with severe plantarflexor and invertor muscle overactivity underwent serial plaster casting over an 18-month period. Interventions: Below-knee plaster casts were reapplied weekly to increase joint range and muscle extensibility. Main Outcome Measures: Precasting goniometric measures of maximal ankle dorsiflexion range (in knee extension and flexion) were compared with 4 subsequent test occasions (after initial cast, midpoint of casting, after final cast, 1wk after removal). The amount and type of assistance required to perform a standardized wheelchair-to-bed transfer before and 3 months from commencement of casting were also compared. Results: Subjects who underwent the serial casting regimen had significantly improved ankle range (knee flexed mean, 18[deg]; knee extended mean, 16[deg]; P[lt].0001); 13 subjects reduced their need for transfer assistance (P[lt].0015). Conclusion: Serial casting appears to be effective, at least in the short term, in reducing the equinovarus deformity that occurs after acquired brain injury. Greater ankle mobility was associated with improved transfer independence in the majority of subjects.