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01-12-2013 | Review | Uitgave 1/2013 Open Access

Journal of Foot and Ankle Research 1/2013

Interventions for increasing ankle joint dorsiflexion: a systematic review and meta-analysis

Journal of Foot and Ankle Research > Uitgave 1/2013
Rebekah Young, Sheree Nix, Aaron Wholohan, Rachael Bradhurst, Lloyd Reed
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Electronic supplementary material

The online version of this article (doi:10.​1186/​1757-1146-6-46) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

RY performed the data searches, performed all quality assessments and data extractions and drafted the manuscript. SN was involved with study design, performed meta-analysis and data calculations and revised the manuscript. AW performed quality assessments and assisted with manuscript revisions. LR was involved with study conception and design, and assisted with manuscript revisions. RB was involved with the study conception and design and assisted with manuscript revisions. All authors read and approved the final manuscript.



Ankle joint equinus, or restricted dorsiflexion range of motion (ROM), has been linked to a range of pathologies of relevance to clinical practitioners. This systematic review and meta-analysis investigated the effects of conservative interventions on ankle joint ROM in healthy individuals and athletic populations.


Keyword searches of Embase, Medline, Cochrane and CINAHL databases were performed with the final search being run in August 2013. Studies were eligible for inclusion if they assessed the effect of a non-surgical intervention on ankle joint dorsiflexion in healthy populations. Studies were quality rated using a standard quality assessment scale. Standardised mean differences (SMDs) and 95% confidence intervals (CIs) were calculated and results were pooled where study methods were homogenous.


Twenty-three studies met eligibility criteria, with a total of 734 study participants. Results suggest that there is some evidence to support the efficacy of static stretching alone (SMDs: range 0.70 to 1.69) and static stretching in combination with ultrasound (SMDs: range 0.91 to 0.95), diathermy (SMD 1.12), diathermy and ice (SMD 1.16), heel raise exercises (SMDs: range 0.70 to 0.77), superficial moist heat (SMDs: range 0.65 to 0.84) and warm up (SMD 0.87) in improving ankle joint dorsiflexion ROM.


Some evidence exists to support the efficacy of stretching alone and stretching in combination with other therapies in increasing ankle joint ROM in healthy individuals. There is a paucity of quality evidence to support the efficacy of other non-surgical interventions, thus further research in this area is warranted.

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