A patient ambulates with an absent left heel strike and reduced left ankle dorsiflexion. Which modality and treatment intervention would be MOST appropriate?

• A. Moist heat application followed by stretching into dorsiflexion
• B. Cryotherapy application while stretching into dorsiflexion
• C. Continuous ultrasound while stretching into dorsiflexion
• D. Continuous ultrasound followed by stretching into dorsiflexion

Answer: (C)

The goal is to improve ankle dorsiflexion by lengthening the calf (gastrocnemius-soleus), which helps restore a normal heel-strike during gait. Heating the posterior calf increases tissue temperature, reduces stiffness, and raises stretch tolerance, making the stretch more effective. Applying a continuous ultrasound during the actual dorsiflexion stretch keeps the tissues warm throughout the movement, enhancing tissue extensibility and allowing a greater elongation of the plantarflexors. This combination yields the best gains in ROM and functional gait pattern.

Cryotherapy would cool the tissues and hinder stretching gains. Using ultrasound without stretching misses the opportunity to capitalize on increased tissue extensibility during the stretch. Moist heat could help, but continuous ultrasound during the stretch provides deeper, sustained heating and directly augments the stretch, making it the most appropriate choice here.