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Hallux Valgus Night Splints...

Discussion in 'Biomechanics, Sports and Foot orthoses' started by fatboy, Oct 18, 2006.

  1. fatboy

    fatboy Active Member


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    I would appreciate any opinions on Night Splints for Bunions...




    Do they work?

    If so, is there a specific age range they work best for?

    Is there any current research into effectivness?

    Why do they only appear to come in S, M & L sizes and not specific shoe sizes?

    Any experience using splints, or providing patients with splints would be gratefully recieved.
     
  2. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    Think about it intuitively - they apply a force of value x at night to attempt to straighten the deviated first MPJ. How many steps the next morning do you think it takes to match the value x and undo any benefit that might have been gained ---- let alone the concept of the ability to remold bone as you get older ...

    The only evidence available for its use is in children where body weight (ie the day time deforming forces are lower than adults) and bone remodelling is more possible:
    Having said that I have occasionally used them in patients with a chronic sort of "ache"/pain in the first MPJ ....
     
  3. ANDREWRYALS

    ANDREWRYALS Member

    Didnt Tim Kilmartin publish an article on this some years ago in the old SOCAP journal basically saying that Night Splints did virtually nothing?
     
  4. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    Tim did not do a study on night splints as far as I know. In his orthoses study in JBJS he referenced the above Groiso study. If he did write that they did nothing, I am not surprised for the reasons I said above.
     
  5. Cameron

    Cameron Well-Known Member

    Well back in the archives, Which (the consumer magazine) in the UK did a feature on "bunion straighteners" and reported comsumers found them of no practical worth. What was interesting was the pollees rarerly complained and subsequently (according to Which) the product kept selling.

    What was implied was the consumers were too embarrassed (at making the purchase in the first place) and were more comfortable with forgetting the matter (to the extent of not even asking for their money back)

    The origins of night splints came when toe traction (orthodigita) was very popular in the nineteen thirties (during the Depression) when surgery was less available and physical culture prevailed. There was greater emphasis on therapeutic exercise (both passive and active). Pull and set approach of stretching and holding was supported by Wolf and Davis's observations on soft tissues and bone molding and so they were really trendy. Public Health promoted health for all and body culture determined idealised feet ( high arch, straight toes and no bunions). Much empahsis was placed on preparing the next generation to be ready for war.

    Budin and co., recommended regimes of intrinsic foot muscle exercises (later promulgated in the UK by Lambrinudie) for children and this was the Genesis for foot health exercises. However as far as I am aware there is no independent evidence to support with predictable outcomes, no matter what interim benefits might acrue, such as inferred increased micro-circulation. Sensible shoes for children are introduced at this time and of course this was the era of the arch support. Heat treatments were also a vogue at this time.

    All good ideas but little real significant evidence to support use other than anecdotal evidience.

    Cameron
     
  6. British Journal of Podiatry November 2004 ; 7 (4): 101-105
    Conservative treatment of juvenile hallux
    valgus - A seven-year prospective study
    Andrew J H Macfarlane, T E Kilmartin

    Conclusion:
    This study has demonstrated that night splints can, over an average of 3
    years treatment, prevent the deterioration of juvenile hallux valgus and
    subsequent development of associated deformities of the other digits. There
    is clear justification for deferral of surgical reconstruction until
    skeletal maturity when the outcomes of surgery are likely to be more
    predictable. Further, night splint therapy should be considered as a first
    line treatment for hallux valgus.


    This pretty much supports and explains my clinical use and observations.
     
  7. LuckyLisfranc

    LuckyLisfranc Well-Known Member

     
    Last edited: Oct 19, 2006
  8. ANDREWRYALS

    ANDREWRYALS Member

    Firstly, thanks Simon for the update! Secondly, I have worked in Podiatric Surgery departments and tried night splints, the vast majority of people find them extremely uncomfortable to wear and usually end up taking them off. :)
     
  9.  
  10. LuckyLisfranc

    LuckyLisfranc Well-Known Member

    Simon

    As you know, at the end of the day, the choice of surgical procedure to correct a hallux valgus will depend on the a variety of factors, and IM angle will be the main one most people cite. So if a night splint can decrease the amount of detrioration of the IM angle (was this looked at in the study?), then you might argue that a distal Austin/Chevron style procedure with soft tissue balance might be more likely, rather than more proximal procedures, which theoretically are slightly more technically difficult. I doubt the night splints have any effect of secondary lesser toe changes, which would be more likley to be affected by day time use of foot orthoses (I hope).

    That being said, the operation time, postoperative recovery, costs and rehabilitation are all very similar, and the choice of procedure will be of little relevance in the grand scheme (even if the degree of deformity is greater).

    Each to their own, but I would just let the thing take its course, and fix it when pain/deformity and age indicate the need for intervention.

    Cheers,

    LL
     
  11. "This study has demonstrated that night splints can, over an average of 3
    years treatment, prevent the deterioration of juvenile hallux valgus and
    subsequent development of associated deformities of the other digits."

    Interested in your use of foot orthoses. Could you point to where these have been shown to reduce secondary digital deformites in HV?

    Don't have the study in front of me so can't answer your question re: IM angle. Not my study, me just a message carrier.
     
  12. LuckyLisfranc

    LuckyLisfranc Well-Known Member

    Simon,

    You would know better than most that there is no evidence (that I know of) that foot orthoses can help lesser toe deformity in HV. Hence the post script "(I hope)", considering the lack of any other great options in these typically flexible, hypermobile feet. Despite Kilmartin's other paper, I still live in the vain hope that they do something to affect weight-bearing forces during the day...just look at the navicular-cuneiform faulting on most of them! An orthotic has to do something to help that medial column instablity? I hope some cleverpants like yourself can prove that one day.

    Didn't read the comment on lesser digits. I wonder if the night splints only helped the transverse plane drift of the 2nd or lesser toes, or if there was any effect in the sagittal plane and less hammertoe development?

    LL
     
  13. night splint

    Slight divergance,

    Has anyone had any experiance of using hallufix Day and night splints? They're a polyprop splint with an articulation (saggital only) which claim to be wearable in shoes. Website at www.hallufix.de.

    Regards
    Robert Isaacs
     
  14. Jill4Feet

    Jill4Feet Welcome New Poster

    Hallux Valgus Night Splints

    I have used the Gel & Leather Bunion Night Splint from Dr. Jill's Foot Pads with great success. It has a very comfortable silicone gel section on the area that gets placed right next to the foot and a metal section covered with leather to hold the Hallux straight. Patient compliance was great and even some of my patients felt it was so comfortable they wore it in their shoes during the day as well as the night.
    Jill Scheur,DPM
    Williamsville, NY
    Jill4feet@aol.com
     
  15. Surely it's not just me thinking what I'm thinking right now? Personally I have used the FOS onion night splint.... You get it.
     
  16. Jill:

    In addition to the glowing endorsement you give above for the bunion splint, you are also the owner of the company http://www.drjillsfootpads.com/page5.html
    and you just thought that a little free advertising would be in order?? Congratulations, you have now joined the company of Ed Glaser and Brian Rothbart on Podiatry Arena.
     
  17. Peter

    Peter Well-Known Member

    Dr Jill,

    How about giving us your unbiased opinion on a product that you don't sell?

    You would then be contributing something of credible value to the members of this popular forum, rather than giving a cheap plug! :mad:
     
  18. Obviously not.

    I've really taken to the opportunistic product plugging on this site and think we are missing a trick here. Perhaps, we could get Noel Edmonds in and do a multicoloured swap shop thing (not only does this statement age me, it also shows just how parochial I am- those of you not familiar can google it I'm sure)

    I've got a pair of used AOL's that I'd like to swap for a Jensen Interceptor. Any takers?

    :p
     

    Attached Files:

    Last edited: Oct 31, 2006
  19. product plugging.

    What scares me is that if you ARE going to do a shameless plug for your own product, Dr Jills foot pads, and pretend to be a satisfied customer, why would you use an avater which says Dr Jills foot pads and give yourself the profile title of DR JILL!?!?!? Did'nt really think this one through did she?

    DUH!!!! :eek:

    Robert
     
  20. Simon:

    About time you got some real hair, mate! :p
     

    Attached Files:

  21. robcox

    robcox Active Member

    I am a little dubious of Kilmartins paper on juvenile HAV treatment by orthoses. He did not allow the first ray to plantarflex. This would likely cause jamming and subluxation of the 1st MTPJ. As a plantar or dorsiflexed first ray would seem to contribute to the pathology (as indeed mentined by Kilmartin in an earlier paper), surley an orthoses with a first ray cut out would benefit this condition.

    Rob
     
  22. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    We don't know if that was the case or not. Its widely suggested that is the case, but we just do not know. Those who do not like the outcomes of the Kilmartin et al study like to claim that, but I would like to know how they know it is the case. Kilmartin never published any work on how the foot orthoses he used affected first ray function (that does not mean they didn't).
    We don't know if that is the case or not. Theoretically it could be the case, but no one has actually done any outcome work to show it.
     
  23. admin

    admin Administrator Staff Member

    I have copied the last two messages to the thread on Juvenile HAV, lets keep the discussion in this thread to HAV night splints.
     
  24. musmed

    musmed Active Member

    Dear All

    Nobody with Hallux Valgus can activate their abductor hallucis.

    Does this matter?

    musmed
     
  25. CraigT

    CraigT Well-Known Member

    Paul,
    I agree with this observation...
    The question is whether this is the cause or effect?
     
  26. musmed

    musmed Active Member

    Craig et al

    In my study of 1...
    A 13 year old patient girl who is 6 feet 2 has a bunion on her left foot like her mother.

    Her bunion is in the early stages as yet.

    For the past 8 months I have been getting her to perform an eccentric loading exercise to her abductor hallucis muscle 200 times a day.

    Every 6weeks she has taken a photo of her foot and guess what...the bunion is disappearing unlike her mothers.

    Unfortunately She will not let me publish her photos. I am working on it.

    Yes the answer is...

    musmed
    ps only a series of 1. maybe others can get others to do the same..
     
  27. moe

    moe Active Member

    Hi Paul
    Could you please describe in a little more detail how the exercise is performed. Are there any joints you mobilise prior to this exercise program.
    Thanks in advance
    Iona
     
  28. musmed

    musmed Active Member

    Dear Iona

    I get the patient to stand on a phone book with both feet while standing at the sink

    2. stand the affected foot as in standing on tip toes
    3. get them to move to the affected side and lift the non affected leg off the phone book, now taking body weight on the toes
    4.slowly let the foot relax over 4 seconds. At 4 seconds the heel should be on the ground.
    5. start all over again.

    Basically you are performing an isokinetic eccentric lengthening exercise.

    Hope this is clear

    Good luck

    Paul C
     
  29. robcox

    robcox Active Member

    does this mean stand on tip toes (both feet), then take the unaffected side off?


    thanks

    Rob
     
    Last edited by a moderator: Nov 20, 2007
  30. musmed

    musmed Active Member

    Dear Rob

    Both feet flat on phone book. take affected foot off the phone book, get them to plantar flex and then take their weight on this foot when it is on the floor.

    Hope this solves it.

    Paul C
     
  31. lcp

    lcp Active Member

    I have HAV's on both feet, as does my mum and nan did too. I also have no trouble activating the abductor hallucis muscle, in fact it is quite defined!! only a sample size of 1, me, but just thought you might be interested in this.
    As for the night splints, I find some patients love them and wear them religiously, yet others simply cannot bear to wear them for longer than a few minutes. i have also found that for the harder plastic splints, sometimes a small otoform pad between the splint and the 2nd digit can alleviate some of the discomfort. I have also just given a patient one of the softer splints used for post-surgical alignment which appreared to have decent traction/support and be a lot more comfortable for the patient to wear. There is no research/evidence behind any of my thoughts, just my 2c. I also must stress that I always explain to the patient that the night splint is not a cure, it just may help with pain/aches associated with the HAV.
    Paul
     
  32. musmed

    musmed Active Member

    Dear All

    Great to see someone doing some research and challenging what is written. Good on you!

    I suggest that you try activation when they are tired. May I ask how many activations to muscle failure did it take?

    Paul C

    have a look at www,musmed.com.au and look at "Have a look at this" and let me know of yuor thoughts. Much to come
     
  33. lcp

    lcp Active Member

    ha ha mate, its not really that I challenge what is written, Im just too busy to read that which is written, so if I want to know if something works, I generally try it (within reason of course). That and the fact that there is a lot of research that "sits on the fence" so to speak, with no real outcomes either way, which I find really frustrating sometimes. As for the activation, I cant actually say that they are endurance muscles, my experience usually involved thinking hmm wonder if I can work this muscle?? I have noticed however, that direct pressure with my finger up near the muscle belly will abduct the hallux like a muscle contraction. Not sure of the relevance, but pretty interesting to see the hallux "straighten" when I do it...
    Paul
     
  34. musmed

    musmed Active Member

    Dear Paul

    They are endurance muscles. They are involved with 50% 0f every stride.
    They work like the adductors of the hip.

    If palpation of the Abd Hall muscle belly activates it, I can assure you it is a sick muscle.

    Hmm I wonder if I can work this muscle? Could you please explain this statement.

    Paul to Paul
    Ps had a look at www.musmed.com.au yet?
     
  35. lcp

    lcp Active Member

    what i meant mate, was I was just looking at my feet one day and wondered if I could contract the muscle. Like trying to move single toes etc. This was way back in high school biology class, not final year Podiatry or anything. And by saying it wasnt exactly an endurance muscle, I meant after five or so contractons, you can feel it getting tired is all. By palpation, the muscle wasnt contracting, it was relaxed and the palpation produced the same results as a contraction. Interesting about you saying how actively involved the muscle is during walking too. During uni life, I used to walk approx 8k a day and the muscle was actually quite big and solid.
    Sorry for the confusion mate
     
  36. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    A patent has just been granted for this hallux valgus splint:
    Orthopaedic device for correcting abnormal positions of the toes
    Link to patent
     
  37. Zac

    Zac Active Member

    Im in Australia. Has anyone found one night splint better than another for HAV ie. more comfortable, better patient compliance?
     
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