In analyzing your treatment options for plantar fasciitis, you have probably heard at least one mention of night splints. Generally speaking, the feedback from wearers of popular products such as the Strassburg sock (not really a true night splint) tend to vary from, “works like magic” to “couldn’t sleep with it on.”
The gripe that night splints are uncomfortable appears to be a fairly common complaint. So let’s explore the effectiveness of night splints further with a few studies and opinions from well regarded podiatrists before incorporating it into the recovery strategy. Hopefully we can answer the question, “do night splints really work?” along the way.
Experiment- Splints vs. Stretching
Dr. Barry, a fellow of the American College of Foot and Ankle Surgeons, studied the recovery times of plantar fasciitis sufferers assigned to a calf stretching regimen versus those assigned to a night splint routine. He released his findings in the Journal of Foot and Ankle Surgery in 2002. The results were significant to say the least. Patients wearing the night splints recovered within around 18 days where as those with a calf stretching routine recovered in roughly 60 days. That’s a whopping 40 day difference.
Stretching “never made sense to me,” Dr. Barry mentions. Think broken bones or a cut, you wouldn’t want to stretch during the healing process. “This is the only body tissue that when it was damaged, we were stretching like a maniac.”
Now a single study is certainly not conclusive, however a number of other studies have replicated these findings (just do a google scholar search), as well as some that didn’t. In general the data does suggest they are effective provided, they are actually used consistently and in combination with other treatment options. Before diving into concerns of comfort, let’s quickly recap why they work.
Left foot is relaxed. Right foot is active.
The foot on the left is in the “relaxed position,” where there is less strain on the achilles and the plantar fascia. This our foot’s natural tendency when we sleep.
The foot on the right is in the “active position” where there is pressure on the plantar fascia. This is our foot’s natural tendency when we are walking or generally moving about.
Next time you’re in bed, notice how your feet naturally adopt the relaxed position on the left. Sleeping sans splint, the plantar fascia will heal in a more relaxed position. This is problematic given that the first steps of the day will stretch out the plantar fascia again and re-tear some of that newly healed tissue, slowing recovery.
The splint, much like a cast for a broken bone, sets the plantar fascia in the “active position.” With the splint, healing occurs in the active position, where you are less likely to tear the newly added tissue, leading to faster recovery times.
“Uncomfortable and Ineffective”
Most night splint wearers tend to have a love-hate relationship with their device. On one hand the science suggests that a night splint can deliver results. And on the other hand, it is quite difficult to sleep with it on. Many wearers find themselves fumbling for the splint straps after only a few hours of restless sleep.
One reviewer on Amazon summarizes the pros and cons of the splint nicely, ” …I must admit that my heel felt better in the mornings after wearing it, but I would sincerely like to know WHO CAN SLEEP WITH THIS THING ON? The hard outer shell would bang into my other leg, I couldn’t turn over with it, and I had to purchase knee-high socks to be able to tolerate it on my leg. Yes, it helps morning pain, but it does so at the expense of a decent night’s sleep. After several attempts (again, I was desperate), I couldn’t last more than two or three nights in a row due to sleep deprivation. I decided I needed my sleep more than I needed my heel to feel better.”
Perhaps most significantly, the controversy over night splints extends to podiatrists themselves. A podiatrist with the charming name of David Davidson is cited in an article on Podiatry Today as stating that he does not prescribe night splints, “They are uncomfortable to sleep in and only minimize the first step out of bed pain.”
Instead of prescribing a night splint, Dr. Davidson advises on a stretching regimen. At the two week check up, if the plantar fasciitis has not significantly improved he will adjust the regimen. Following another check up, Dr. Davidson typically advises on over-the-counter inserts like the Polysorb (Spenco). And if worst comes to worst then he will prescribe the more expensive yet effective combination of physical therapy and custom orthotics.
There you have it, if you are dubious about night splints try:
- light calf stretches (here’s a link to stretching routines)
- over the counter insoles (here’s a link to insoles)
- arch strengthening exercises
- custom orthotics
Adding Night Splints to the Mix.
Start with only a few hours at a time. Night splints may assist you in recovery, but their real cost is your comfort. The bulkiness of a night splint might take some adjustment. For at least the first week, some podiatrists discourage their patients from trying to sleep with it on. Instead, wear it during your spare relaxation time such as reading or watching TV. After you feel comfortable you can start wearing the splint at night. Having that first week or so as a grace period will limit the possibility of you losing sleep as a result of the splint.
Two Types of Splints
In general, all splints do pretty much the same thing. They keep your foot stretched while sleeping. And to be honest, there isn’t that much differentiating the available products online. There are however two different types of boots.
For early stage plantar fasciitis, a dorsal night splint may be more practical than a boot. The differences between these two styles lie in the design of the splint as well as the muscular support that is provided. This style provides support to the foot and runs along the top surface of the foot. A strap pulls the wearer’s toes upright so that the fascia can stay stretched out throughout the night.
A boot splint, on the other hand, is the type of splint that is most notorious for providing wearers with the “awkward” feeling that many people report. This feeling is to be expected since the design is much heavier and bulkier, often providing support to the wearer’s entire leg under the calf.
Which Splint Style is Best ?
If keeping your entire leg protected throughout the night is crucial for the comfort of your affected leg, you may benefit from a boot splint. If your condition is mild and you prefer a less bulky object around your leg while you sleep, you may prefer a dorsal design. The best night splints for plantar fasciitis will vary depending on the severity of the condition as well as personal preferences in terms of comfort.
How Does it Work Again?
When you fall asleep, your foot naturally goes into a position where the calf muscle, achilles tendon, and plantar fascia are relaxed. Sounds great right? After all, we have been talking about the plantar fasciitis as a condition where too much tension is placed on those leg components.
However after a night of healing in the relaxed position, the new tissue within your plantar fascia may be more prone to tearing with those first few steps in the morning. The night splint allows your plantar fascia to heal in the active position that you use it in during the day.
The Bottom Line
Night splints may be effective if you can actually wear them. They are clunky, rather pricey, and patients tend to have difficulty keeping them on. If you are truly determined and can find a comfortable splint, then you might try to boost your recovery time by as much as 40 days! However, only give night splints a shot after incorporating more comfortable treatment options like insoles, shoes, and slippers.
Night splints are really more of a last resort among podiatrists. Lawrence Huppin DPM will prescribe night splints only following use of otc insoles, footwear adjustments, stretches, pain killers, and eliminating high-stress activities. Splints should be thought of as an alternative to third course treatments, like physical therapy. Cortisone injections are definitely not recommended.
If you are feeling bold and willing to advance your recovery time at the cost of some discomfort, incorporate night splints into your course of treatment. Just make sure this isn’t your only treatment strategy.
A final note on the effectiveness of any treatment. Plantar Fasciitis is a tendon overuse injury, meaning it’s going to take time to heal, much longer in fact than a muscle based strain. Tendons don’t have the same access to blood flow as muscles, as such they are much much slower to heal. Given the nature of the overuse origins of the injury, we are also often reluctant to stop the repetitive activity that induced the initial strain ie. running or wearing your favorite pair of flip flops.
Rather than think in terms of day or weeks, consider that tendons and in all likelihood, your plantar fasciitis will take several months (3-7) to fully recover. So try out a splint without the expectation of overnight results, remember to ease into wearing it, and utilize it in combination with other means of arch support.