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One out of 10 people in the United States will develop plantar fasciitis at some point, according to a report published in the December 1, 2005, issue of “American Family Physician.” Plantar fasciitis refers to pain on the sole of the foot at the medial or inner aspect of the heel that is at its worst during the first few steps in the morning or after inactivity. Night splints can relieve the symptoms of plantar fasciitis for some patients.
During sleep, feet normally point downward, which allows the plantar fascia to contract. Night splints are used to keep the ankle at 90 degrees during sleep instead of allowing the foot to rest in flexion. Abnormal foot structure increases the chance one will develop plantar fasciitis. People with high arches have greater gravitational force across the plantar fascia while feet with low arches roll inward more during with walking putting tension on plantar fasciitis. Night splints can prevent contracture of the calf muscles, control abnormal pronation or the tendency of foot to roll inward, and maintain the anatomical length of the plantar fascia without stretching.
Custom Molded Splints
To make a custom splint, a therapist, podiatrist or physician molds a hard plastic splint to each patient’s leg and foot. The splint covers the posterior part of the leg and the sole of the foot. It is fastened around the leg and foot by Velcro straps. The splints can be made to control abnormal foot motion since they are fit closely to the leg with minimal or no padding. Because each splint is unique, they can cost more than a commercial off-the-shelf splint. The splints are not designed for walking. The bottom of the splint is usually slippery and can cause falling if the patient tries to walk on it
Commercial or prefabricated splints resemble a boot. They have a hard shell and padded inner liner. Straps are used to close the front of the splint. The bottom of the splint is usually slightly curved and has treads to allow for minimal ambulation, but can still create a fall risk if the patient gets up during the night. Commercial splints are bulkier than custom or soft splints. Commercial splints are less effective than custom splints, according to a report published in the December 1, 2005, issue of “American Family Physician.”
Soft splints consist of a strap around the lower leg and a sock with a toe loop. There is an additional strap pulling the toe loop toward the lower leg. This keeps the ankle at 90 degrees and flexes the toes. Since there are no hard pieces bed partners may prefer this type of splint over the hard splints. These splints are not designed for walking and can cause falls at night if the patient gets out of bed. Dr. Lance Barry, writing in the “Journal of Foot and Ankle Surgery,” reported that patients treated with a soft splint had a shorter recovery of 18.5 days compared to 58.6 days recovery time for patients doing three times daily calf stretching.
Opinions differ on the effectiveness of using splints for plantar fasciitis. While Barry and other doctors advocate the use of night splints for plantar fasciitis, Dr. Robert Probe in “Clinical Orthopaedics & Related Research” cites studies showing that there was no significant difference between using night splints or stretching programs for treatment of plantar fasciitis. Patient’s pain improved by using either stretching or night splints.