What is the MOST appropriate therapeutic position for a patient with extensive burns to the lower extremities to reduce contracture risk?

• A. Supine with the knees extended and the toes pointing toward the ceiling
• B. Prone with a pillow on the dorsum of the feet and ankles
• C. Sidelying with hips and knees slightly flexed using pillows between the legs
• D. Hooklying with a pillow between the knee

Answer: (A)

Burn scar tissue tends to shorten tissues if joints are held in a shortened position during healing, so the goal is to keep the lower extremity joints in extension or neutral to prevent contractures. Lying on the back with the legs straight keeps the knees in near-full extension, and having the feet pointed upward toward the ceiling places the ankles in dorsiflexion. This combination minimizes shortening of the hamstrings, quadriceps, gastrocnemius-soleus complex, and plantarflexors, reducing the risk of knee and ankle contractures as healing progresses. Positions that place the hips, knees, or ankles in flexion or plantarflexion promote shortening of those tissues and increase contracture risk, which is why those alternatives are less protective.