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Exercise Alone May be Enough after Ankle Fracture

Physical therapists need more information to help them with patients who have ankle joint stiffness after casting for bone fractures. Knowing how to stretch the muscles to regain motion is important. Is five minutes of stretching enough? Would 10 minutes be better? If 10 minutes is good, what about 30 minutes?

In this study there were three groups of patients with plantar flexor contractures. Plantar flexion contracture means the foot is stuck in a slightly pointed position. The patient can't pull the toes up toward the face as far as normal. Group one was treated with exercise only. Group two had exercise plus short duration stretching. Patients in group three did exercise plus long duration stretching.

All patients were seen by a physical therapist and did a home program, too. Everyone did 30 repetitions daily of ankle, stepping, and balancing exercises. Patients in the short stretch group did ankle stretching exercises for six minutes every day. The stretches were held for 30 seconds. The patient did them 12 times daily.

The long-stretch group used a wedge under the foot for 30 minutes at a time. They could be standing or sitting while stretching. Everyone in all three groups got advice and gait training. Measures of success included pain, walking speed, stepping rate while going up or down stairs, and satisfaction with treatment.

The results of this study show that stretching to increase ankle motion after casting for an ankle fracture is no better than exercise alone.

Anne M. Moseley, PhD, et al. Passive Stretching Does Not Enhance Outcomes in Patients with Plantarflexion Contracure after Cast Immobilization for Ankle Fracture: A Randomized Controlled Trial. In Archives of Physical Medicine and Rehabilitation. June 2005. Vol. 86. No. 6. Pp. 1118-1126.

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