title: Use of a patient-controlled stretching device to improve the ankle range of motion.
abstract: BACKGROUND
  Ankle and subtalar stiffness are widely associated with many foot and ankle conditions and functional deficits. Loss of range of motion, particularly dorsiflexion, results in significant gait dysfunction. A variety of methods have been evaluated to address this problem, including yoga, manipulation, dance training, jogging and static stretching exercises. No tools have been described that effectively and efficiently stretch the ankle and subtalar joint without requiring supervision or assistance of a trained physical therapist.
  
  
  METHODS
  Twenty-two subjects with varying foot and ankle diagnoses who had little or no improvement in range of motion after traditional assisted physical therapy were recruited from a foot and ankle orthopaedic clinic. The subjects' ankle and subtalar range of motion (ROM) in plantarflexion (PF), dorsiflexion (DF), inversion (INV), and eversion (EVR) were measured using a standard goniometer by a single physiotherapist prior to using the stretching device. The subjects were trained on the proper use of the stretching device and then instructed to use it daily for a 6-week period. Then the same examiner repeated the above measurements. Statistical analysis was performed using a two sample t-test assuming unequal variances.
  
  
  RESULTS
  There were statistically significant increases in ROM in all planes tested: DF to PF (p = 0.0052), and INV to EVR (p = 0.018).
  
  
  CONCLUSIONS
  Stretching with the device significantly increased ankle and subtalar ROM.
  
  
  CONCLUSIONS
  The stretching device can be used at home on a regular basis with minimal training and can effectively treat stiffness of the ankle and subtalar joints. It can be cost-effective when compared to use of physiotherapy services.
authors.affiliation: University of Missouri, Department of Orthopedic Surgery, One Hospital Drive, MC213, Columbia, MO 65212, USA. trevinos@health.missouri.edu
authors.forename: Saul G
authors.initials: SG
authors.lastname: Trevino
authors.forename: William L
authors.initials: WL
authors.lastname: Buford
authors.forename: Santaram
authors.initials: S
authors.lastname: Vallurupalli
authors.forename: Margaret
authors.initials: M
authors.lastname: Rowell
authors.forename: Vinod K
authors.initials: VK
authors.lastname: Panchbhavi
mesh_terms: D000328:Adult; D000368:Aged; D000843:Ankle Joint / Q000503:physiopathology*; D005260:Female; D005534:Foot Diseases / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D052580:Muscle Stretching Exercises / Q000295:instrumentation*; D011446:Prospective Studies; D016059:Range of Motion, Articular; D055815:Young Adult