Physiotherapists inherit the consequences of the first weeks after a stroke, a brain injury or a spinal cord injury twice over.

The first consequence is at the ankle itself. A foot that has spent weeks driven into plantarflexion by tone and gravity arrives in the rehabilitation gym short of the range it needs. A foot that cannot reach plantigrade cannot take weight properly, and everything that needs attention (standing practice, transfers, gait work) gets harder.

The second inherited problem relates to the skin. A heel pressure ulcer acquired during the acute phase can halt weight-bearing for weeks or months, right at the point in recovery when time matters most. Every day that the patient remains in bed results in loss of muscle mass. We also know that such an ulcer, even when healed, is much more likely to recur due to changes in the tissue's mechanical properties.

Most writing about heel pressure relief devices treats these as separate problems, one belonging to tissue viability and one to physiotherapy. In my experience, if we want continuity of care, they are best considered as part of the same problem seen from two directions, and the device on the end of the bed is where they meet. This article is about that meeting point, including some evidence that does not say what many people assume it says.

In this article, we have outlined the implications of equinus contracture, a condition that often affects stroke patients and can cause significant physical disability. We've addressed the limitations of commonly used orthotic solutions and introduced the 654SKG DDA Orthosis, a dynamic device designed to prevent and even reverse heel contractures.

This orthosis ensures tissue health and corrects biomechanics, making it a valuable tool for various clinical applications. The article also provides guidelines for its proper use and stresses the importance of consulting with healthcare professionals before starting to use any device for the treatment or prevention of equinus contracture.