Clinical Implications of Plantarflexion Contracture in a Patient with Epidermolysis Bullosa: A Case Report

Background: Epidermolysis Bullosa is a rare skin disease with the hallmark of extensive blistering and scarring in response to mechanical trauma and friction. Scar formation can result in joint contracture that can affect functional mobility. Movement compensations from the contracture can result in decreased participation and increased pain. Surgical intervention followed by rehabilitation therapy may be required to release the contracture and restore safe functional mobility. Case Description: A 17-year-old male received physical therapy after surgical release of his right heel cord contracture secondary to a diagnosis of Epidermolysis Bullosa. The patient initially demonstrated a compensatory gait pattern that resulted in decreased endurance and increased knee pain as functional ambulation was regained during the plan of care. Intervention: Due to the underlying skin disease, the patient could not tolerate typical range of motion restoration techniques including soft tissue mobilization, joint mobilization, or aggressive stretching. Thus, range of motion was addressed through weight-bearing activities. Outcome: The patient’s ankle range of motion improved by 36 degrees, the primary outcome measure assessed. Improvements in functional strength and endurance were observed using the 6-minute walk and 30 second sit to stand tests. Discussion: Contractures at the ankle are common in patients with Epidermolysis Bullosa due to the nature of the skin disease. Rehabilitation and restoration of motion is complicated by the fragility of the skin. The clinician must be able to implement creative interventions to help restore range and function but also protect the patient from further blistering and scarring. This case presents one approach that was well tolerated and resulted in improved outcomes