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hi,
any opinion about using night splint for plantar fascitis.
we are treating with initial physiotherapy, like plantar fascia
stretching. SWD, foot intrinsic muscle strengthening exercise,
followed by hydrocortisone injections.
still few patient has short term relief
and have been tried with night splint .
i don't know how its works.
any defined protocol for treating this problem

suresh

:bang:

 

Hi Suresh:

I've given up on night splints, unless I have a really motivated patient or they happen to get results quickly, most find them very uncomfortable and hard to comply. Many of the PT and general Pods I know that use the night splints do it mostly for the high reimbursement rates! Not a good enough reason.

I get very good results with simple achilles stretching.

Steve

 

Hi Suresh

my experience with them is the same as Steve's really, on the whole patients find them uncomfortable & compliance is an issue (they tend to get fed up with them)

 

Best contraceptive I know of.

 

THAT is funny!
I have an image of a woman lying there...................................................

Steve

 

Simon, wished you'd enlightened me earlier :rolleyes:

 

Steve and Colleagues:

After feeling the same as you, that most patients found night splints to be cumbersome and difficult to wear, I now have found a night splint that most patients seem to tolerate well and will wear on a regular basis. I purchase it from Universal Footcare Products . I tell patients to wear it at night while sleeping as much as possible and to also wear it when they are sitting down at night while on the computer or watching television. Overall, my compliance is now about 80% with this splint versus less than 50% I had with the four other night splint designs I had tried for my patients. My guess is that the "soft padded" design is probably the reason for the better compliance with this night splint. In some patients it is a miracle cure and in others it does little. But it certainly is worth a try prior to proposing plantar fasciotomy since some patients make remarkable progress by using it regularly.

 

Now Kevin:
You didn't say whether you are using them for Soft tissue stretching or contraception.
Steve

 

May be used for mechanically induced soft tissue stretching or for preventing parasympathetic mediated soft tissue stretching.:rolleyes:

 

This clinical trial was recently registered:
Plantar Fasciitis Treated With Dynamic Splinting

 

Night splint treatment of plantar fasciitis pain

Both the traditional adjustable night splint and a dorsal night splint improved plantar fasciitis pain outcome scores in a retrospective study, with results trending in favor of the dorsal design: http://www.lowerextremityreview.com/article/night-splint-treatment-of-plantar-fasciitis-pain

 

i have had great results with the dorsal plantar fasciitis resting splint from Trulife not as bulky as some of the other resting splints you get, used in combination with a good stretching regime and foot orthosis if the patient has foot pathology

 

A comparison of two night ankle-foot orthoses used in the treatment of inferior heel pain: A preliminary investigation
J. Attard, D. Singh
Foot and Ankle Surgery Volume 18, Issue 2, June 2012, Pages 108–110

 

A comparison of two night ankle-foot orthoses used in the treatment of inferior heel pain: a preliminary investigation.
Attard J, Singh D.
Foot Ankle Surg. 2012 Jun;18(2):108-10.

 

Effectiveness of adjustable dorsiflexion night splint in combination with accommodative foot orthosis on plantar fasciitis
Winson C. C. Lee et al
JRRD; Volume 49, Number 10, 2012 ; Pages 1557–1564

 

I had a patient come in with a sock style device: a strap sewn to the end of the toe area of the sock looped back around the leg just below the knee, velcro adhered to pull the foot into the desired degree of dorsiflexion. He hated it; felt it was cutting his circulation.
Thoughts?

 

Strasbourg Sock? Helped my Achilles' tendon tightness/pain. Uncomfortable to sleep with as it dorsiflexes the hallux & (in my case) really irritated the distal aspect of my hallux. Even loosening it, it was not comfortable. BUT, I did have less tightness/stiffness arising in mornings.

 

Yep that's the one. I have to say, I completely understand patients being non-compliant with any kind of night splint, all of them seem vastly uncomfortable to sleep in.

 

Hi everyone

Although I regularly find the use of night splints a challenge for patient compliance. My colleagues and I tend to refer to them as resting splints now. We tend to advocate using the splint for when the patient is seated with the leg extended. Whether that is watching TV, on the computer or at work. When you show the patient the device you're hoping they will wear for bed. You can normally tell straight away that the compliance rate will be low.
I guess using it as a 'resting splint' reduces the number of hours the patient is standing for in some instances. Which I guess can only have a positive effect on the soft tissue loading.
Using as above we tend to get more positive results (sorry I can not give an exact figure).

 

I am not a big fan of night (or resting) posterior or dorsal splints and use them not very much at all. I use them mostly for chronic heel pain when several other options have not worked. I think 4-5 minutes of plantar fascia specific stretching before getting out of bed addresses the problem just as well for most patients. There are quite a few studies out there on night splints, Strassberg sock etc. but I think they all lack placebo controls.

Also, why not try osteopathic manipulation and the patient may get an instant increase in range of motion without anyone losing sleep or upsetting their television time?

Recently I have used dynasplint for a handful of patients with good results in terms of increased ankle dorsiflexion and decreased foot pain. See www.dynasplint.com I think is the website. However, I do not feel any comment much further on dynasplint or similar technology.

Furthermore, what about patients with plantar fasciitis that do not have equinus? Do you give them a night splint device? I don't. Hope that is helpful.

 

Hello Charlotte,

I agree. I tend to use them prior to and following surgery. Compliance prior to surgery is considerably lower than post-op in my experience. Personally, I would rather try a splint than have surgery and I tell my patients this. In the very few patients that end up heading towards the operating table I make them well aware that they are going to be wearing a splint at night in the weeks following surgery and this seems to help with compliance pre-op - a period of 'getting used to it' at least. If this resolves things everyone's happy.

I also advise patients that I had plantar fasciitis and it responded well to stretches and orthoses (and losing a bit of weight I think). A great motivator for me was avoiding injections in my heel, etc... as I am a big softy so I was a very compliant patient! I still remember Frank McCourt's lectures on it now.

Hope you're well,
Lee

 

Again, diet plays a major role whether your tendons are stiff or compliant.

It's incredible they load energy drinks with sugar. The stuff is known to make people stiff & damage joints.

 

Effectiveness of adjustable dorsiflexion night splint in combination with accommodative foot orthosis on plantar fasciitis.
Lee WC, Wong WY, Kung E, Leung AK.
J Rehabil Res Dev. 2012 Dec;49(10):1557-64.

 

Effectiveness of adjustable dorsiflexion night splint in combination with accommodative foot orthosis on plantar fasciitis.
Lee WC, Wong WY, Kung E, Leung AK.
J Rehabil Res Dev. 2012;49(10):1557-64.

 

The effectiveness and tolerability of tension night splints for the treatment of patients with chronic plantar fasciitis – A case-series study
Patrick C. Wheeler
International Musculoskeletal Medicine

 

Poster:
The effect of night splints in the treatment of plantar fasciitis:
a systematic literature review

 

The effectiveness of combined prescription of ankle–foot orthosis and stretching program for the treatment of recalcitrant plantar fasciitis
Rehab A.E. Sallam MD , Atif I El Ghaweet
Year : 2016 | Volume : 43 | Issue : 4 | Page : 172-177

 

The addition of a tension night splint to a structured home rehabilitation programme in patients with chronic plantar fasciitis does not lead to significant additional benefits in either pain, function or flexibility: a single-blinded randomised controlled trial
Patrick C Wheeler
BMJ Open Sport & Exercise Medicine 2017;3:e000234. doi: 10.1136/bmjsem-2017-000234

 

Impact of night orthotic managements on gastroc-soleus complex tightness in pediatric with flexible flatfoot: Systematic review
Sahar Payehdar et al
Prosthet Orthot Int. 2023 Feb 1;47(1):112-116