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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:
Quote:
Juvenile hallux valgus. A conservative approach to treatment
JA Groiso The Journal of Bone and Joint Surgery, Vol 74, Issue 9 1367-1374
A conservative method consisting of use of a thermoplastic splint at night as well as passive and active exercises was used for the treatment of hallux valgus in fifty-six children and teen-agers who were between one month and sixteen years old. The splint was remodeled periodically. At the time of follow-up, which ranged from two to six years, the metatarsophalangeal joint angle or the intermetatarsal angle, or both, had improved in approximately half of the feet. No recurrences were detected among the patients who improved.
Having said that I have occasionally used them in patients with a chronic sort of "ache"/pain in the first MPJ ....
__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________ God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University This is where I am, where are you?
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.
__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________ God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University This is where I am, where are you?
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.
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.
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.
__________________ Science is the antidote to the poison of enthusiasm and superstition
[quote=Simon Spooner]... over an average of 3 years treatment... [quote]
Impressive, the study authors must have used Klingon mind tricks on these kids.
I am flat out getting someone to use any type of night splint for more than a few weeks...let alone three YEARS!
I think as a parent I would rather just let my child let their juvenile hallux valgus roll along until skeletal maturity, and then treat surgically. If it is likely you are going to do surgery anyway, why bother subjecting a family to this inconvenience?
LL
Last edited by LuckyLisfranc : 19th October 2006 at 03:34 AM.
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. :)
[quote=LuckyLisfranc][quote=Simon Spooner]... over an average of 3 years treatment...
Quote:
Impressive, the study authors must have used Klingon mind tricks on these kids.
I am flat out getting someone to use any type of night splint for more than a few weeks...let alone three YEARS!
I think as a parent I would rather just let my child let their juvenile hallux valgus roll along until skeletal maturity, and then treat surgically. If it is likely you are going to do surgery anyway, why bother subjecting a family to this inconvenience?
LL
Agreed compliance is an issue, however, I do have patients who have been wearing them for >2 years. Do you think the amount of pathological change in the forefoot as a whole and the degree of the deformity has influence upon the surgery required and the outcome? That is, if you can prevent deterioration and development of secondary pathology using the splints and then just correct the HV rather than having to deal with all the associated pathologies, don't you think this is worthwhile? Is a mild to moderate HV easier to correct than a severe one?
__________________ Science is the antidote to the poison of enthusiasm and superstition
Agreed compliance is an issue, however, I do have patients who have been wearing them for >2 years. Do you think the amount of pathological change in the forefoot as a whole and the degree of the deformity has influence upon the surgery required and the outcome? That is, if you can prevent deterioration and development of secondary pathology using the splints and then just correct the HV rather than having to deal with all the associated pathologies, don't you think this is worthwhile? Is a mild to moderate HV easier to correct than a severe one?
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.
I doubt the night splints have any effect of secondary lesser toe changes,
"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."
Quote:
Originally Posted by LuckyLisfranc
which would be more likley to be affected by day time use of foot orthoses (I hope)
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.
__________________ Science is the antidote to the poison of enthusiasm and superstition
Interested in your use of foot orthoses. Could you point to where these have been shown to reduce secondary digital deformites in HV?
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?
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.
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
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
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.
__________________ Science is the antidote to the poison of enthusiasm and superstition
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
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.
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
Surely it's not just me thinking what I'm thinking right now?
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
__________________ Science is the antidote to the poison of enthusiasm and superstition
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?
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
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.
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).
Quote:
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.
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.
__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________ God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University This is where I am, where are you?
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
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.
does this mean stand on tip toes (both feet), then take the unaffected side off?
thanks
Rob
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.
Hallux Valgus Night Splints...
Hallux Valgus Night Splints
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