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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
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
__________________
DrSArbes
Fellow American College of Foot & Ankle Surgeons
Board Certified Foot & Ankle Surgery, ABPS
Adjunct Professor OCPM
Green Bay, Wisconsin, USA
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)
THAT is funny!
I have an image of a woman lying there............................................. ......
Steve
__________________
DrSArbes
Fellow American College of Foot & Ankle Surgeons
Board Certified Foot & Ankle Surgery, ABPS
Adjunct Professor OCPM
Green Bay, Wisconsin, USA
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
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.
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
Now Kevin:
You didn't say whether you are using them for Soft tissue stretching or contraception.
Steve
__________________
DrSArbes
Fellow American College of Foot & Ankle Surgeons
Board Certified Foot & Ankle Surgery, ABPS
Adjunct Professor OCPM
Green Bay, Wisconsin, USA
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.
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
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/...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
Background
Non-operative treatment for plantar fasciitis varies widely and includes the use of night ankle-foot orthoses (AFOs). This study compares the effectiveness of a posterior AFO, which dorsiflexes the foot, with an anterior AFO, which maintains the foot in a plantigrade position.
Method
Each participant was given a questionnaire to fill in to evaluate how satisfied the participants were with the orthosis with regards to comfort, ease of use and appearance, and whether the pain in the foot was reduced and at what stage was the pain decreased.
Results
Two-thirds of all participants confirmed that morning pain and stiffness was less after wearing the AFO; both types were relatively easy to don and doff, but the posterior orthosis was more uncomfortable and disrupted sleep. On average, the anterior AFO reduced heel pain more significantly than the posterior orthosis.
Conclusion
Plantar fasciitis night AFOs are poorly tolerated orthoses but their use can be justified in that the pain levels are reduced. The anterior AFOs are more comfortable and more effective than posterior AFOs.
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.
Quote:
BACKGROUND:
Non-operative treatment for plantar fasciitis varies widely and includes the use of night ankle-foot orthoses (AFOs). This study compares the effectiveness of a posterior AFO, which dorsiflexes the foot, with an anterior AFO, which maintains the foot in a plantigrade position.
METHOD:
Each participant was given a questionnaire to fill in to evaluate how satisfied the participants were with the orthosis with regards to comfort, ease of use and appearance, and whether the pain in the foot was reduced and at what stage was the pain decreased.
RESULTS:
Two-thirds of all participants confirmed that morning pain and stiffness was less after wearing the AFO; both types were relatively easy to don and doff, but the posterior orthosis was more uncomfortable and disrupted sleep. On average, the anterior AFO reduced heel pain more significantly than the posterior orthosis.
CONCLUSION:
Plantar fasciitis night AFOs are poorly tolerated orthoses but their use can be justified in that the pain levels are reduced. The anterior AFOs are more comfortable and more effective than posterior AFOs.
Foot orthoses and night splints have been used separately to treat patients with plantar fasciitis, but were not always successful. Combined use of both orthoses might give
better outcomes. This study evaluated the effectiveness of a soft and self-adjustable dorsiflexion night splint in combination with an accommodative foot orthosis for patients with plantar fasciitis. Twenty-eight patients were assigned to group A (foot orthosis only) and group B (combination of foot orthosis and dorsiflexion night splints). A Foot Function Index (FFI) questionnaire was used to evaluate the pain and functions of feet just before, 2 weeks after, and 8 weeks after the treatments. Results showed that subjects in group B had significantly reduced pain scores at week 2 (p< 0.001) and week 8 (p<0.001). In group A, no statistical differences were noted in the pain (p= 0.15), disability (p= 0.56), activity limitation (p=0.75), and total FFI (p= 0.35) scores for the three time periods. The application of foot orthoses with adjustable dorsiflexion night splints was found to be more effective than the application of foot orthoses alone in relieving foot pain in patients with plantar fasciitis
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.
The Following User Says Thank You to thekwie For This Useful Post:
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).
The Following User Says Thank You to Charlotte Darbyshire For This Useful Post:
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.
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).
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.
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.
Quote:
Foot orthoses and night splints have been used separately to treat patients with plantar fasciitis, but were not always successful. Combined use of both orthoses might give better outcomes. This study evaluated the effectiveness of a soft and self-adjustable dorsiflexion night splint in combination with an accommodative foot orthosis for patients with plantar fasciitis. Twenty-eight patients were assigned to group A (foot orthosis only) and group B (combination of foot orthosis and dorsiflexion night splints). A Foot Function Index (FFI) questionnaire was used to evaluate the pain and functions of feet just before, 2 weeks after, and 8 weeks after the treatments. Results showed that subjects in group B had significantly reduced pain scores at week 2 (p < 0.001) and week 8 (p < 0.001). In group A, no statistical differences were noted in the pain (p = 0.15), disability (p = 0.56), activity limitation (p = 0.75), and total FFI (p = 0.35) scores for the three time periods. The application of foot orthoses with adjustable dorsiflexion night splints was found to be more effective than the application of foot orthoses alone in relieving foot pain in patients with plantar fasciitis.
Night splint for plantar fascitis
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