BACKGROUND: Talocrural joint manipulation has been shown to enhance proprioception, potentially improving static balance. OBJECTIVE: This study investigated the immediate effects of talocrural joint manipulation on postural stability and ankle mobility in patients with chronic stroke. METHODS: A randomized crossover study included 32 patients with chronic stroke. Each participant received a single session of both placebo and actual talocrural joint manipulation, alongside a conventional treatment program, with order randomized. Manipulation was applied in a high-velocity, low-amplitude manner, whereas the placebo involved 20 seconds of passive contact. Postural stability and ankle mobility assessed using a Biodex R Balance System and a smartphone's spirit level before and after interventions. Safety was monitored by recording adverse events. RESULTS: In the placebo group, improvements in ankle mobility (r 0.35 to 0.51; p = 0.004 to 0.046) and overall postural stability (d 0.38; p = 0.039) were observed, although these changes were small and not supported by confidence intervals. In contrast, talocrural joint manipulation produced significant gains across all outcomes (d 0.78 to 0.87; p < 0.001). Intergroup analyses confirmed greater benefits with manipulation, particularly for overall postural stability (r 0.45 to 0.52; p < 0.001, d 0.78; p = 0.002), including the primary outcome of overall postural stability (r 0.47; p < 0.001; CI 3.00 to 9.00 points). No significant carryover effects were detected (f 0.26 to 2.80; p = 0.10 to 0.61). Participants with audible cavitation showed greater improvements in both outcomes (r 0.411 to 0.720; p < 0.001 to 0.034). CONCLUSION: These preliminary findings suggest that talocrural joint manipulation may induce immediate improvements in postural stability and ankle mobility in patients with chronic stroke, without any adverse events.

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