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Night Splints

Discussion in 'Introductions' started by MicW, Jun 8, 2010.

  1. MicW

    MicW Active Member


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    Help needed for chronic plantar Fasciitis.

    I have a patient (male in his late 30's) who has very tight plantar fascia and is suffering greatly. I have employed all the usual options with no result. I intend now introducing a night splint to address equinus but am not sure which device to use. Can anyone advise the best and most affordable night splint available easily in NSW.

    Thanks
     
  2. drsarbes

    drsarbes Well-Known Member

    "I have employed all the usual options with no result."

    What were those?

    IMHO simple stretching exercises for the achilles work well (when actually done by the patient). I have not had much luck with night splints ON RECALCITRANT CASES. If night splints work then stretching exercises most likely would have worked as well.

    I assume by the heading of the post that your patient has heel pain.

    What is your routine for treating these? What's the duration of symptoms? Bilateral? Besides his "tight plantar fascia" any underlying etiologies? Activity level?

    Steve
     
  3. MicW

    MicW Active Member

    Thus far have employed gastrocs/achilles stretches, ice packs, low dye taping, orthoses, and bottle rolls.

    Yes, the patient does have heel pain (unilateral). Duration some 3 months, worse after non weightbearing. Now almost constant.

    His plantar fascia are incredibly tight and prominent. Patient precisely pinpoints the pain at fascial origin and into proximal one third of the fascia.

    On weightbearing he displays moderate collapse of his medial longitudinal arch. Rearfoot pronation minimal. Early heel lift and adductory heel twist at propulsion.

    Of concern is his occupation working in a factory/showroom which involves much lifting and ladder work. We have discussed a change but not possible.

    On top of this he is IDDM and reduced activity level due to his pain is resulting in weight gain.

    I take you point that if night splints work then gastrocs/achilles stretching should also BUT at night, whilst sleeping, are our feet not always plantarflexed (especially under heavy winter blankets) and does this not tend to encourage shortening of the gastrocs/ achilles.
     
  4. drsarbes

    drsarbes Well-Known Member

    MicW:

    I'm not sure why you are treating "night splints" as some type of major decision. If you feel they might help then get him one.

    I'm also not sure where you practice, but the treatments you have tried all fall into the Physical Therapy/Biomechanical categories.
    As you are aware, all Tx for PF/Heel spurs fall into one of 4 categories; Medical, Biomechanical, Physical therapy modalities, surgery. All but the surgery are basically attempting to decrease inflammation. If inflammation is not causing the pain then none will help.

    I have found it helpful to try not to repeat failed treatments within the same category (generally speaking).

    It appears that you have tried no medical therapies; i.e., NSAI's, cortisone, etc......
    You might also be more specific with his biomechanics to assure that whatever orthotic you prescribed is correct.

    You might also delve into his work station; any repetitive motions, pivoting, etc....that may be effecting one foot and not the other.

    If he has an anatomic predisposition to fasciitis/fasciosis ("tight") and your orthotics/stretching regime is not working, he most likely will be a surgical candidate.

    Steve
     
  5. MicW

    MicW Active Member

    Well actually Steve, my initial note was to try and find which type of splint to get so the decision had been made.

    I practice on the south coast of New South Wales, Australia. I bit like Gods country we feel here. I work with 5 other podiatrists who are all interested in your comments.

    NSAID's or cortisone may well be the way to go. I generally avoid surgery as much as possible for obvious reasons - but if ones life is being drastically impacted then surgery may be indicated.

    I have spoken today to the patient in regard to investigating any repetitive motions etc as you mentioned.

    We thank you for your help which we gratefully accept. I appreciate your thoughts and the time you've given us.

    Michael
     
  6. RobinP

    RobinP Well-Known Member

    Hi Steve,

    Although it is common sense, I've never really thought about this before.

    It's a good way of formulating and carrying out a treatment plan - Thanks

    Robin
     
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