CN117731470A - Joint loosening appliance for distal lower limb - Google Patents

Abstract

A joint loosening instrument for a distal lower limb includes a frame with a hinge, a cable pulley system, a talar strap, a heel support, a foot orthosis, and a baseplate.

Description

Joint loosening appliance for distal lower limb

Background

Joint loosening is a type of manual therapy that is typically performed by a physical therapist in a physical therapy setting or clinic. It involves the passive movement of a particular joint using the force, direction and technique of a skilled application. The physical therapist may loosen the affected joint with his or her hands, or may alternatively use certain tools (including straps) to help provide the desired therapeutic effect.

The particular type, magnitude, speed, and frequency of joint loosening performed depends on several factors, including the treatment objective, the type of objective joint, and the anatomy of the person. The primary effects of joint loosening include pain relief, improved range of motion, and improved quality of joint movement itself (i.e., joint kinematics).

Posterior sliding or translation is a type of joint loosening technique that is primarily indicated by increasing the range of dorsiflexion motion of the ankle. In performing this joint loosening, the patient lies on his back with the legs supported on a table and the heels above the edges. A therapist standing on one side of the patient may stabilize the leg with his or her head-side hand or use straps to secure the leg to the table. The therapist then places the palmar aspect of his or her other hand's jaw over the talus just distal to the fixation. Pulling force can be applied in the caudal direction by wrapping his or her finger and thumb around the foot to stabilize and hold the ankle in a resting position, and sliding the talus posteriorly relative to the tibia by pushing against the talus (class I-IV).

The optimal ankle dorsiflexion range of motion is critical to normal daily functions including, but not limited to walking, going down stairs, squatting and balancing, as well as more dynamic movements including, but not limited to running, jumping and diversion. The ankle joint must meet the environmental and activity requirements of a person through a complete normal range of motion to avoid injury to the ankle and other joints, tendons, and muscles and other tissues through the kinetic chain. Medical providers often seek to restore ankle dorsiflexion to treat dysfunction and prevent future injury.

While medical providers focus on manual joint loosening (as a form of passive mobility treatment for musculoskeletal conditions, such as altered joint mechanics of a person's ankle), more and more patients are seeking to create, strengthen, improve, restore and recover ankle dorsiflexion range of motion and forefoot thrust through unassisted use of externally applied orthopedic devices or orthoses.

Disclosure of Invention

One exemplary embodiment relates to an articulation loosening instrument having a frame including spaced apart double struts defining a front opening between the struts to substantially receive a subject's lower leg, ankle, and foot. The double struts may be disposed opposite each other parallel to each other, and each strut may include an inwardly facing side. The first and second struts of the dual struts may each be pivotally hinged to the first and second brackets of the frame.

In a variation of the joint loosening instrument, the instrument may comprise: a talar belt having a tensioner to stabilize the talus of a human subject, and a cable pulley system including a cable and at least one pulley body with an axle. The pulley body may be mounted on the frame. The cable may include a first end and a second end, wherein the first end may be coupled to the first end of the talar band. The cable may be threaded in a posterior direction from the first end of the talar belt to engage at least a portion of the pulley body. The cable may then be threaded in a proximal direction from the pulley wheel body along an inward facing side of the first strut. The second end of the cable may be coupled to the first strut toward the proximal end of the first strut.

In other variations of the joint loosening apparatus, the apparatus may include a foot orthotic configured to at least partially receive a foot of a human subject. The foot orthotic may be removably coupled to the base plate. The base plate may be coupled to the first and second brackets of the frame with the double struts substantially perpendicular to the frame.

In a further variation of the articulation loosening apparatus, the apparatus may include a heel cradle mounted to the base plate. The heel cradle includes a back support that is adjustably repositionable to substantially receive at least the heel of a human subject.

In yet a further variation of the joint loosening apparatus, the human subject pushes at least a portion of their knee forward toward the distal end of the foot, resulting in pivotal actuation of the dual strut to tension the cable pulley system.

Other advantages, features and functions of embodiments of the joint loosening instrument having the features discussed herein will become readily apparent and better understood in view of the following description and accompanying drawings. The following description is not intended to limit the scope of the joint loosening instrument, but instead merely provides exemplary embodiments for ease of understanding.

Drawings

Corresponding reference characters indicate corresponding parts throughout the several views of the drawings.

FIG. 1 is a top right side perspective view of an articulation loosening instrument in accordance with an embodiment of the present disclosure;

fig. 2 is a left side view of a talar band showing a joint loosening instrument according to an embodiment of the present disclosure;

fig. 3 is a left side view illustrating the range of dorsiflexion motion of the talar strap and ankle in accordance with an embodiment of the present disclosure;

fig. 4 is a left side view of a joint loosening appliance externally applied by a subject in accordance with an embodiment of the present disclosure;

FIG. 5 is a left side view of a joint loosening instrument, wherein a subject performs a range of ankle dorsiflexion motion, in accordance with an embodiment of the present disclosure;

FIG. 6 is a top right side perspective view of the top side of the foot orthosis of the joint loosening apparatus, according to an embodiment of the present disclosure;

FIG. 7 is a top right side perspective view of the bottom side of the foot orthosis of the joint loosening apparatus, according to an embodiment of the present disclosure; and

fig. 8 is a left side view of a joint loosening appliance externally applied by a subject while wearing a non-slip shoe, according to an embodiment of the present disclosure.

The drawings described herein are for illustration purposes only and are not intended to limit all possible implementations. The drawings are not necessarily drawn to scale, but are instead drawn to provide a better understanding of their components and are not intended to limit the scope, but rather to provide an exemplary illustration. In accordance with the present disclosure, exemplary embodiments of the joint loosening instrument and components thereof are illustrated and in no way limit the structure or configuration employed by other orthopedic devices and orthoses and components thereof.

Detailed Description

Embodiments of a joint loosening instrument are described herein and illustrated in the accompanying drawings. The joint loosening apparatus may be used in environments where it is desirable to diagnose, prevent, monitor, treat, alleviate or compensate for injuries; however, the illustrative examples provided are not intended to exclude embodiments of joint loosening appliances that may or may not have been approved for public use and commercial distribution. The joint loosening instrument may include components that may be removable and replaceable and that may be cleaned and reused.

Embodiments of a joint loosening instrument for stabilizing and supporting the lower leg, ankle, and foot are provided. In each of the embodiments, features provided for one side of the device may be provided on the other side of the device. In this way, it is intended that any of the embodiments of the joint loosening devices described herein may be used on the right or left calf, ankle and foot with any suitable reconfiguration of the components deemed necessary for the device to support and stabilize the proper fit, form and function of the left or right distal lower limb. Although the illustrated embodiment shows the cable pulley system disposed on the medial side of the articulation loosening apparatus when used on a right ankle, the apparatus may alternatively be configured with the cable pulley system on the lateral side when used on a right ankle and may be similarly reconfigured from side to side with respect to a left ankle.

In addition, embodiments of a joint loosening instrument are provided for stabilizing ankle joints that have been weakened by injury or other diseases. The appliance is configured to be properly tightened by all users, including the elderly or infirm.

In accordance with the present disclosure, embodiments of the joint loosening apparatus are particularly applicable to a person's ankle joint and a person's talus, and may be sized to accommodate different types, shapes, and sizes of the person's ankle joint and limbs.

According to the present disclosure, the various joint loosening instrument embodiments described herein, or components thereof, may be divided into sections represented by general anatomical terms for the human body. Such anatomical terms are provided to distinguish the various elements of the device embodiments from one another, and should not be taken as limiting the scope of the present disclosure.

Embodiments of the joint loosening apparatus may be considered to fall within the anterior and posterior sections of the anterior-posterior plane. The anterior-posterior plane generally corresponds to the coronal or frontal plane of a person's leg. Thus, the rear side or element is located behind the front-rear plane, while the front side or element is located in front of the front-rear plane. In addition, with respect to embodiments of the joint loosening instrument, the aspect of loosening the body part (i.e., pushing the body part from anterior to posterior) occurs in a sagittal plane intersecting the frontal plane.

The terms medial and lateral are relative terms that are generally understood to refer to a position relative to a longitudinal or sagittal plane of the body. Thus, elements located near the midline of the body are referred to as medial, and those elements away from the midline are considered as lateral.

The term inward or inner as used herein is used to distinguish between the sides or faces of the implement that may be directed toward the inside or outside of the implement and specifically adjacent to the legs of the subject using the device. Rather, the term outward or outward may be used to refer to the side of the device opposite the inward side.

According to embodiments of the joint loosening apparatus, the terms rigid, semi-rigid, and flexible may be used herein to distinguish between features of portions of the frame and the foot orthotic. The term rigid is intended to mean that the frame is substantially inflexible. In the context of rigid frame members, it is intended to indicate that they may break if bent with sufficient force. On the other hand, the term flexible is intended to mean that the feature is capable of repeated bending. The term semi-rigid may mean that the element is capable of supporting a load bearing article with some deformation to the element, but may be used to define such flexible characteristics as substantially returning to an original molded shape without permanent deformation.

Embodiments of the joint loosening apparatus may also be considered in terms of the strength of the loosening. Intensity variables are classified in a classification system, for example, translational glide looseness classification has five stages (I-V stages), ranging from small amplitude movements or I-stages at the beginning of the usable range of motion of the joint, to small amplitude high speed thrusts or V-stages at the end of the usable range and within its anatomic range (maneuver).

Referring now to the drawings, wherein like reference numerals designate like structure throughout the specification, and primarily to fig. 1, a joint loosening apparatus 10 includes a frame 12 and spaced apart double struts 14, 15. The first leg 14 and the second leg 15 of the frame 12 define a front opening 16 therebetween. The first and second struts 14, 15 are coupled to first and second hinges 18, 19. The hinges 18, 19 are coupled to a first bracket 20 and a second bracket 21. The brackets 20, 21 are coupled to the base plate 51. The illustrative examples of the frame 12 and struts 14, 15, hinges 18, 19, and brackets 20, 21 are not intended to exclude embodiments incorporating similar or equivalent single or multiple support members and structures for carrying and supporting orthopedic devices and orthoses that are currently or intended to be available.

In non-limiting embodiments of the frame 12 of the articulating instrument 10, and in accordance with the principles of the present disclosure, the frame 12 and components of the frame 12 including the base plate 51 may be, but are not necessarily, formed or constructed or fabricated from a metallic material (such as, but not limited to, steel, aluminum, or titanium-based materials) or a plastic or other rigid polymeric material, carbon fiber, or other carbon-based material.

In another non-limiting embodiment, the frame 12 including the base plate 51 may be formed or constructed or manufactured from a semi-rigid elastomeric material, but not necessarily using additive manufacturing. Suitable elastomeric materials may include, but are not limited to, thermoplastic elastomers, acrylonitrile-butadiene-styrene, poly (styrene-butadiene-styrene), polybutadiene, polyamides, epoxy resins, silicone resins, olefinic materials, and other thermoplastics impregnated with antimicrobial metals.

With continued reference to fig. 1, the talar band 22 of the joint loosening device 10 may include a hollow first portion 24 and a second portion 25 such that the second portion 25 of the talar band 22 is coupled to the second bracket 21 at a second end of the second portion 25. The talar band 22 may extend through the medial-lateral plane between the first leg 14 and the second leg 15 of the frame 12. A buckle with guides or similar suitable elements may, but need not, be used to tighten the talar band 22 around the talus T (see fig. 2-3). The example of a buckle that is typically used with a strap is not intended to preclude embodiments incorporating similar or equivalent tightening elements or mechanisms (such as clips, straps, clamps, and loops) that are currently or intended to be available.

Still referring to fig. 1, the joint loosening device 10 may also include a tensioner 26 as a rotational tensioning mechanism coupled to the talar strap 22. Tensioner 26 may, but need not, include a dial 27, a push release 29 (see fig. 2) for disabling tensioner 26, and a spool assembly 28, which may, but need not, be made of a system of laces, ropes, wires or cables, and guides. As the dial tensioner 26 rotates in the first direction, the hollow first portion 24 of the talar band 22 gradually surrounds the second portion 25 of the talar band 22, resulting in stabilization of the talar T (see fig. 2-3). A commercially available example of a rotary tensioning mechanism is the BOA by BOA technology ^® And (5) a fitting system. The illustrative example of tensioner 26 is not intended to exclude embodiments incorporating similar or equivalent rotary tensioning mechanisms or rotary ratchets that are currently or intended to be available.

Referring now to fig. 2-4 and with continued reference to fig. 1, in operation of the dial tensioner 26, the talar strap 22 is forcibly pulled against the talus T of the subject S. The resultant force is a stable force that simulates the force applied by a physical therapist when performing joint loosening of the ankle. Talar band 22 may be made of materials suitable for locating, securing, and stabilizing a person's bones, including hook and loop, latex-free materials, nylon/foam, polyethylene/nylon, soft foam, and soft/strong nonwovens or wovens covered in softer materials (e.g., foam) so that the band material does not dig into the soft tissue.

The use of talar straps 22 and tensioners 26 as incorporated into embodiments of the joint loosening fixture 10 may help avoid the lack of repeatability from one physical therapy practitioner to the next. Although the technique of joint loosening by the physical therapy practitioner is not necessary when using the joint loosening instrument 10, one or more physical therapy practitioners may instead design a treatment regimen for the use of the subject S of the joint loosening instrument 10. In addition, a regimen may be developed to direct the primary force exerted by the talar strap 22 at any desired location to treat other ankle A and foot F disorders.

With continued reference to fig. 1-4 and with reference now to fig. 5, the dual posts 14, 15 of the frame 12 define a front opening 16 between the posts 14, 15 to substantially receive at least one of the calf L, ankle a, and foot F of the subject S. The double struts 14, 15 are arranged parallel to each other opposite each other, wherein the first strut 14 and the second strut 15 are each pivotally hinged to a first bracket 20 and a second bracket 21. A cable pulley system 30 comprising a cable 31 and at least one pulley body 32 with an axle 33 is fixed to the frame 12 and the talar belt 22. The cable 31 includes a first end coupled to a first end of the talar strap 22, and a second end of the cable 31 is coupled to the first strut 14 of the frame 12 along a longitudinal length of the first strut 14. The pulley body 32 is mounted along the horizontal length of the rearwardly extending first bracket 20 and is adjustably selectable along the horizontal length of the first bracket 20 by a pulley body adjuster 36. The guide 34 may, but need not, be mounted to the first strut 14 along the longitudinal length of the first strut 14 to accommodate the tension created by adjusting the pulley wheel 32 forward along the pulley wheel adjuster 36. The illustrative examples of cable pulley system 30 and cable 31 are not intended to exclude embodiments incorporating similar or equivalent straps, brackets, hook-and-loop fastener systems or ratchet devices (such as linear, ladder or buckle ratchet) or combinations thereof that allow for adjustment of tension against the distal lower limb of subject S, as currently or contemplated to be available.

With continued reference to fig. 1-5, cable 31 is routed at low friction from a first end 41 coupled to talar strap 22 to a second end 42 coupled to first strut 14 via pulley wheel body 32, guide 34, and cable sleeve 47. The cable manager 35 may, but need not, include a guide 34 attached to the pulley wheel body 32. The pulley body adjuster 34 includes a pull knob 37 and a mounting member 38 with a linear extension 39 and a locking member 40. The frame 12 is longitudinally adjustable using button slots 45 and buttons 46 provided in the cuffs 44. The frame 12 may also be adjusted around the calf L using a contoured wrap 48, a clasp 49, a strap 50 (which may, but need not be, a hook and loop fastener). The frame 12 may be repositioned and biased back to the rest or return position, but not necessarily by a hinged spring-loaded return means attached against hinges 18, 19.

Referring to fig. 6-7, foot orthosis 52 can be removably coupled to base plate 51. The base plate is coupled to a first bracket 20 and a second bracket 21 of the frame 12. Foot orthotic 52 includes a first side 53 with hook and loop fasteners 54 for easy positioning and repositioning of arch support 55. Wedges 57A, 57B, 57C and 58A, 58B, 58C with varying inclinations may be positioned and repositioned on top of or anterior-posterior/medial-lateral adjacent foot orthosis 52 to modify ankle positioning. Alternatively, the second side 56 of the foot orthotic 52 may be used, for example, when the subject S wears the shoe C (see fig. 8 showing an anti-slip shoe).

In one non-limiting embodiment, the foot orthotic 52 and wedges 57A, 57B, 57C and 58A, 58B, 58C may be formed or constructed or manufactured from, but not necessarily, semi-rigid materials (e.g., foam, silicone, and thermoplastics) and may be impregnated with an antimicrobial material.

Referring to fig. 1-5 and 8, heel support 60 includes a cradle 61 and a back support 62 for securely positioning and supporting heel H of subject S. The back support 62 is adjustable by a wing drive 63.

Referring to fig. 2-4, in use and operation, subject S begins by slowly pushing the knee of subject S forward toward the distal end of foot F, resulting in pivotal actuation of dual struts 14, 15, which in turn, tensions cable pulley system 30. The foot F (including the talus T) remains stationary while the tibia and fibula slide anteriorly. The movement of the knee forward by subject S toward the distal end of foot F may, but need not, occur beyond the sagittal plane, i.e., the movement may also occur in the transverse plane and the frontal plane. The goniometer 64 may be used to estimate the degree of ankle dorsiflexion. The physical therapist may model the joint loosening fixture 10 and its settings, features, and use for the next session to enable the subject S to perform ankle dorsiflexion unassisted. In addition to assisting in use under the treatment of a physical therapist, the joint loosening apparatus 10 may also be used unassisted on the field at home, or in a gym, and prior to and during play.

The description of the embodiments has been presented for purposes of illustration and description. It is not intended to be exhaustive or to limit the disclosure. Individual elements or features of a particular embodiment are generally not limited to that particular embodiment, but rather are interchangeable and can be used in alternative embodiments where applicable, even if not specifically shown or described. It can also be varied in many ways. Such variations are not to be regarded as a departure from the disclosure, and all such modifications are intended to be included within the scope of the disclosure.

The exemplary embodiments are provided so that this disclosure will be thorough, and will fully convey the scope to those skilled in the art. Numerous specific details are set forth, such as examples of specific components, devices, and methods, in order to provide a thorough understanding of embodiments of the present disclosure. It will be apparent to one skilled in the art that specific details need not be employed, that example embodiments may be embodied in many different forms and that neither should be construed to limit the scope of the disclosure. In some exemplary embodiments, well-known processes, well-known device structures, and well-known techniques have not been described in detail.

The terminology used is for the purpose of describing particular example embodiments only and is not intended to be limiting. The singular forms "a," "an," and "the" are intended to include the plural forms as well, unless the context clearly indicates otherwise. The terms "comprises," "comprising," "including," and "having" are inclusive and therefore specify the presence of stated features, integers, steps, operations, elements, and/or components, but do not preclude the presence or addition of one or more other features, integers, steps, operations, elements, components, and/or groups thereof. The method steps, processes, and operations described herein should not be construed as necessarily requiring their performance in the particular order discussed or illustrated, unless specifically identified as an order of performance. It will also be appreciated that additional or alternative steps may be employed.

When an element or layer is referred to as being "on," "engaged to" or "connected to" another element or layer, it can be directly on, engaged with, connected to, or coupled to the other element or layer, or intervening elements or layers may be present. In contrast, when an element is referred to as being "directly on" or "directly engaged to" or "directly connected to" another element or layer, there may be no intervening elements or layers present. Other words used to describe the relationship between elements should be understood in a similar fashion (e.g., "between" pairs "directly between," "adjacent" pairs "directly adjacent," etc.). As used herein, the term "and/or" includes any and all combinations of one or more of the associated listed items.

Although the terms first, second, third, etc. may be used herein to describe various elements, components, regions, layers and/or sections, these elements, components, regions, layers and/or sections should not be limited by these terms. These terms may be only used to distinguish one element, component, region, layer or section from another region, layer or section. Unless clearly indicated by the context, terms such as "first," "second," and other numerical terms do not imply a sequence or order. Thus, a first element, component, region, layer or section could be termed a second element, component, region, layer or section without departing from the teachings of the example embodiments.

Spatially relative terms, such as "inner," "outer," "below," "under," "lower," "above," "upper," and the like, may be used for ease of description to describe one element or feature's relationship to another element or feature as illustrated in the figures. In addition to the orientations depicted in the drawings, spatially relative terms may be intended to encompass different orientations of the device in use or operation. For example, if the device in the figures is turned over, elements described as "below" or "beneath" other elements or features would then be oriented "above" the other elements or features. Thus, the exemplary term "below" can encompass both an orientation of above and below. The device may be otherwise oriented (rotated 90 degrees or at other orientations) and the spatially relative descriptors used herein interpreted accordingly.

With respect to the use of substantially any plural and/or singular terms herein, those having skill in the art can translate from the plural to the singular and/or from the singular to the plural as is appropriate to the context and/or application. For clarity, various singular/plural permutations may be explicitly set forth herein.

It will be understood by those within the art that, in general, terms used herein and especially in the appended claims (e.g., bodies of the appended claims) are generally intended as "open" terms (e.g., the term "comprising" should be understood as "including but not limited to," the term "having" should be understood as "having at least," the term "comprising" should be understood as "including but not limited to," etc.). Those skilled in the art will further understand that if a specific number of an introduced claim recitation is intended, such an intent will be explicitly recited in the claim, and in the absence of such recitation no such intent is present. For example, as an aid to understanding, the following appended claims may contain usage of the introductory phrases "at least one" and "one or more" to introduce claim recitations. However, the use of such phrases should not be construed to imply that the introduction of a claim recitation by the indefinite articles "a" or "an" limits any particular claim containing such introduced claim recitation to embodiments containing only one such recitation, even when the same claim includes the introductory phrases "one or more" or "at least one" and indefinite articles such as "a" or "an" (e.g., "a" and/or "an" should be interpreted to mean "at least one" or "one or more"); the same holds true for the use of definite articles used to introduce claim recitations. In addition, even if a specific number of an introduced claim recitation is explicitly recited, those skilled in the art will recognize that such recitation should be interpreted to mean at least the recited number (e.g., the bare recitation of "two recitations," without other modifiers, means at least two recitations, or two or more recitations). Moreover, in those instances where a convention analogous to "at least one of A, B and C, etc." is used, such a construction in general is intended in the sense one having skill in the art would understand the convention (e.g., "a system having at least one of A, B and C" would include but not be limited to systems having only A, only B, only C, A and B together, A and C together, B and C together, and/or A, B and C together, etc.). In those instances where a convention analogous to "at least one of A, B or C, etc." is used, such construction in general is intended in the sense one having skill in the art would understand the convention (e.g., "a system having at least one of A, B or C" would include but not be limited to systems having only A, only B, only C, A and B together, A and C together, B and C together, and/or A, B and C together, etc.). Those skilled in the art will further appreciate that virtually any disjunctive word and/or phrase presenting two or more alternative terms, whether in the description, claims, or drawings, should be understood to contemplate the possibilities of including one of the terms, either of the terms, or both terms. For example, the phrase "a or B" will be understood to include the possibilities of "a" or "B" or "a and B".

As will be appreciated by those of skill in the art, for any and all purposes, as with respect to providing a written description, all ranges disclosed herein also encompass any and all possible sub-ranges and combinations of sub-ranges thereof. Any listed range can be readily identified as sufficiently descriptive and capable of decomposing the same range into at least equal halves, thirds, quarters, fifths, tenths, quadrants, thirds, etc. As a non-limiting example, the various ranges discussed herein can be readily broken down into the lower third, middle third, upper third, etc. As will also be understood by those skilled in the art, all language such as "up to", "at least", etc. include the recited numbers and refer to ranges that can be subsequently broken down into sub-ranges as discussed above.

From the foregoing, it will be appreciated that various embodiments of the disclosure have been described herein for purposes of illustration, and that various modifications may be made without deviating from the scope and spirit of the disclosure. Therefore, the various embodiments disclosed herein are not intended to be limiting, with the true scope and spirit being indicated by the following claims. All references cited herein are incorporated herein by reference in their entirety.

Claims (14)

1. A joint loosening instrument, comprising:

a frame including spaced apart double struts defining a front opening therebetween for substantially receiving a calf, ankle and foot of a human subject, the double struts being disposed parallel to each other opposite each other and each having an inwardly facing side, a first strut and a second strut of the double struts each pivotally hinged to a first bracket and a second bracket;

a talar band including a tensioner to stabilize a talus of the human subject;

a cable pulley system comprising a cable and at least one pulley wheel with an axle, the at least one pulley wheel mounted on the frame, the cable having a first end and a second end, the first end of the cable being coupled to the first end of the talar strap, the cable being threaded in a posterior direction from the first end of the talar strap to engage at least a portion of the at least one pulley wheel, the cable being threaded in a proximal direction from the at least one pulley wheel along an inward facing side of the first strut, the second end of the cable being coupled to the first strut toward a proximal end of the first strut;

a foot orthotic configured to at least partially receive a foot of the human subject, the foot orthotic removably coupled to a base plate coupled to a first brace and a second brace of the frame with the double brace substantially perpendicular to the frame; and

a heel cradle mounted to the base plate, the heel cradle including an adjustably repositionable heel support to substantially receive at least the human subject's heel,

wherein the subject pushes at least a portion of the subject's knee forward toward the distal end of the subject's foot, causing pivotal actuation of the dual strut to tension the cable pulley system.

2. The joint loosening instrument of claim 1, wherein the first post includes an extension of the first bracket in a posterior direction, the at least one pulley wheel being adjustably repositionable along a length of the extension to tension the cable pulley system.

3. The joint loosening instrument of claim 1, wherein the tensioner comprises a dial and a reel assembly, wherein rotation of the dial in a first direction causes a hollow first portion of the talar band to encompass a second portion of the talar band and forcibly pull the talar band substantially against the talus of the human subject, a second end of the second portion of the talar band being coupled to the second bracket.

4. The joint loosening instrument of claim 1, wherein the frame further comprises a cuff having a hook and loop fastener approximately contoured to correspond to at least a portion of the subject's lower leg, the cuff being adjustably repositionable along a longitudinal length of the dual post to adjust a height of the cuff.

5. The joint loosening instrument of claim 1, wherein the foot orthotic comprises a removably securable semi-rigid insert approximately shaped to support at least a portion of an arch of the subject's foot, and a set of removably securable and repositionable semi-rigid wedges having varying inclinations.

6. The joint loosening instrument of claim 1, wherein the frame comprises a goniometer.

7. A joint loosening instrument, comprising:

a frame including spaced apart double struts defining a front opening therebetween for substantially receiving a calf, ankle and foot of a human subject, the double struts being disposed parallel to each other opposite each other and each having an inwardly facing side, a first strut and a second strut of the double struts each pivotally hinged to a first bracket and a second bracket;

a talar band including a tensioner to stabilize a talus of the human subject;

a cable pulley system comprising a cable and at least one pulley wheel with an axle, the at least one pulley wheel mounted on the frame, the cable having a first end and a second end, the first end of the cable being coupled to the first end of the talar strap, the cable being threaded in a posterior direction from the first end of the talar strap to engage at least a portion of the at least one pulley wheel, the cable being threaded in a proximal direction from the at least one pulley wheel along an inward facing side of the first strut, the second end of the cable being coupled to the first strut toward a proximal end of the first strut; and

a heel cradle mounted to a base plate, said heel cradle including an adjustably repositionable back support to substantially receive at least a heel of said human subject, said base plate being coupled to a first bracket and a second bracket of said frame with said dual post substantially perpendicular to said frame,

wherein the subject pushes at least a portion of the subject's knee forward toward the distal end of the subject's foot, causing pivotal actuation of the dual strut to tension the cable pulley system.

8. The joint loosening instrument as defined in claim 7, wherein the first post includes a rearward extension of the first bracket, the at least one pulley wheel being adjustably repositionable along a length of the extension to tension the cable pulley system.

9. The apparatus of claim 7, wherein the tensioner comprises a dial and a spool assembly, wherein rotation of the dial in a first direction causes a hollow first portion of the talar band to surround a second portion of the talar band and forcibly pull the talar band substantially against the talus of the human subject, a second end of the second portion of the talar band being coupled to the second bracket.

10. The apparatus of claim 7, wherein the frame further comprises a cuff having a hook and loop fastener approximate contour corresponding to at least a portion of the subject's lower leg, the cuff being adjustably repositionable along a longitudinal length of the dual post to adjust a height of the cuff.

11. The apparatus of claim 7, further comprising:

a foot orthotic configured to at least partially receive a foot of the human subject, the foot orthotic removably coupled to the baseplate.

12. The apparatus of claim 11, wherein the foot orthotic comprises a removably securable semi-rigid insert approximately shaped to support at least a portion of an arch of the subject's foot, and a set of removably securable and repositionable semi-rigid wedges having varying inclinations.

13. The apparatus of claim 7, wherein the frame comprises a goniometer.

14. A device for dynamically treating a distal lower limb, the device having a frontal plane dividing the device along anterior and posterior sides, the device having an inner and outer plane dividing the device into medial and lateral sides and oriented generally perpendicular to the frontal plane, the device comprising:

a first hinge and a second hinge;

a frame having first and second struts spaced apart from each other as longitudinal extensions from the first and second hinges, the first and second struts connected to each other by cuffs;

a band extending between an inner side and an outer side of the frame;

a band tensioner coupled to the band, wherein tension of the band around the band by the band tensioner pulls the band against a talus of the distal lower limb;

a cable system engaged to at least one pulley with a first end of a cable coupled to the strap and a second end of the cable coupled to the first post, wherein articulation of the first hinge and the second hinge toward the frontal plane pulls the cuff away from the frontal plane by actuation of the at least one pulley;

wherein at least one goniometer is arranged in alignment with an outward face of at least one of the first hinge and the second hinge.