Disclosures: Steven S. Morrison, Jr.: Nothing to disclose

Case Description: 13-year-old patient with normal developmental history who presented for initial evaluation of toe walking. 1.5 years prior, patient was injured while playing basketball when someone jumped on the dorsum of his foot and caused excessive ankle inversion. He was evaluated by an orthopedist, who performed x-rays that did not reveal any fractures and diagnosed him with an ankle sprain. The sprain was treated conservatively with RICE and an ankle sleeve; physical therapy was not initiated. Following this injury, the patient began toe-walking almost exclusively on both feet. He did this because it was painful for him to dorsiflex his ankle and to transition to foot flat. He had no prior history of toe walking.

Setting: Pediatric PM&R Clinic

Patient: 13-year-old male with history of asthma but otherwise previously healthy.

Assessment/Results: On exam, the patient had normal ROM in all joints excepting a terminal end-point of -3 degrees in his right ADF and to neutral in his left ADF. In terms of gait, he had limited heel strike, and limited dorsiflexion when asked to heel walk. Brain MRI was normal. So based on our assessment, he had what was most likely a self-induced ankle joint contracture secondary to toe-walking.

Discussion: The patient certainly didn’t qualify as an idiopathic toe-walker, as his toe-walking did have a physiologic, though bizarre, origin. The child was developmentally normal and performing well at school, and had a normal neurologic exam. It is likely that he would have prevented the contracture with earlier intervention either with physical therapy or a pediatric PM&R clinic visit.

Conclusion: This case was a drastic example of what can happen with specific kinesiophobia with a patient going so far as to induce a contracture following a minor injury. This case demonstrates importance of movement and ROM exercises following minor injuries to prevent future functional limitations.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/self-induced-ankle-joint-contractures-following-an-ankle-sprain-a-case-report/