Coverage Criteria:
(Patient must meet one of the following criteria)
Or all of the following:
- Plantar flexion contracture of the ankle with dorsiflexion on passive range of motion testing (using Goniometer) of at least 10 degrees.
- Reasonable expectation of the ability to correct the contracture
- Contracture is interfering/expected to interfere significantly with functional abilities
- Splint is used as part of therapy program including active stretching of the involved muscles/tendons