National Physical Therapy Examination (NPTE) Practice Exam

What is an appropriate modification for accommodating a plantar flexion contracture during gait training?

1. Use of a heel lift

2. Electrical stimulation of the tibialis anterior

3. Use of dorsiflexion assist ankle-foot orthosis

4. The addition of a metatarsal pad

The correct answer is: Use of a heel lift

Using a heel lift is an appropriate modification for accommodating a plantar flexion contracture during gait training because it helps to compensate for the limited dorsiflexion that occurs when there is a contracture in the plantar flexors. A heel lift alters the biomechanics of the lower extremity during the gait cycle, allowing the foot to maintain better alignment and reducing the risk of tripping. By elevating the heel, it can facilitate a more favorable position for the foot during the stance phase, making it easier for the individual to achieve a more functional gait pattern despite the contracture. In contrast, electrical stimulation of the tibialis anterior might promote some activity in the muscle, but it does not directly accommodate the contracture during weight-bearing activities like walking. Using a dorsiflexion assist ankle-foot orthosis can help provide additional support for dorsiflexion, but it is typically more pertinent for situations where there is an inability to achieve dorsiflexion rather than accommodating an existing contracture. The addition of a metatarsal pad adjusts pressure distribution under the foot rather than addressing the underlying contracture itself, which may not provide the necessary support for improving gait mechanics in the presence of plantar flexion limitation.