All patients were treated with the JASTM Ankle orthosis (Joint Active Systems, Effingham, Illinois) pictured in Figure 1. The device is based on the principles of static progressive stretch and is operated by the patient. A knob adjusted by the patient can range the device from 55 degrees of dorsiflexion to 45 degrees of plantar flexion. Patients were initially seen in the office for proper fit-ting of the brace and instructions on how to use the device. After all questions were answered, they were given detailed instructions and a phone number to call if they had any questions or problems with the device. The
treatment protocol consisted of wearing the ankle orthosis for 30 minutes a day for a week. Patients were instructed to use the knob to advance dorsiflexion of theflexion and dorsiflexion were instructed to perform the same 30 minute range-of-motion exercise after 15 minutes of rest from the previous dorsiflexion exercise. During the second week of treatment, they were instructed to perform the range-of-motion exercises twice a day. device until they felt tension, but not pain at the tibiotalar joint. They were then told to advance the knob every 5 minutes into further flexion until they felt the same tension.Patients with stiffness in both plantar flexion and dorsiflexion were instructed to perform the same 30 minute range-of-motion exercise after 15 minutes of rest from the previous dorsiflexion exercise. During the second week of treatment, they were instructed to perform the range-of-motion exercises twice a day.