Plantar Fasciitis Night Splint Controversy

In analyzing your treatment options for plantar fasciitis, you have probably heard at least one mention of night splints. Generally speaking the reviews on popular products such as the Strassburg sock tend to vary from, “works like magic” to “couldn’t sleep with it on.”

Ironically, that night splints that are hard to sleep in 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. Hopefully we can answer the question, “do night splints really work?”

Experiment- Splints vs. Stretching

Foot Rolling On A BallDr. 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 splints 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 days.

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.” The reason that night splints are considered effective,

Now one study is certainly not conclusive, but the reason that there is thought to be such difference between the two groups lies in how night splints work. The splint, brace, or sock is designed to keep your foot in a slightly active position. When you are in a relaxed position, your calf muscle begins to contract and place greater tension on your plantar fascia. So both the calf stretches and the night splints attempt to prevent your calf muscle from contracting. The night splints, according to this study, are simply better at keeping tension off of the plantar fascia.

“Uncomfortable and Ineffective”

41ljp3Aw3aLMost night splint wearers tend to have a love-hate relationship with their device. On one hand the science suggests night splints deliver results. And on the other hand, it’s impossible to sleep with it on. Many wearers find themselves fumbling for the splint straps after only a few hours of restless sleep. One reviewer writes, ” …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. Another reviewer wrote “When I did see a podiatrist, he said night splints don’t work.” This appears to be a common sentiment among podiatrists. 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 he 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 consults on over-the-counter inserts like the Polysorb (Spenco). And if worst comes to worst then Dr. Davidson will prescribe physical therapy. After that, if a patient still only has minimal improvement, he will prescribe physical therapy and custom orthotics.

So there you have it, if you are dubious about night splints try:

  1. calf stretches
  2. over the counter insoles
  3. arch strengthening exercises
  4. custom orthotics

If you Must…

Night SplintsComfortPriceRating
OssurB $18 3.8/5
Cramer B+ $25 3.9/5
Alpha Brace B $20 3.9/5
United SurgicalA- $20 3.9/5
Orthotronix B $22 4.0/5
Bird & Cronin B $20 3.9/5
Strassburg Sock B-$403.6/5

Here are a few night splints that have received rave reviews from users. But before you buy, I definitely recommend reading a few of the negative reviews. Also your splint is not a substitute for more trusted treatment options such as, stretching or the modification of current arch support.

The bulkiness of a night splint might take some adjusting to. 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.

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.

When the plantar fasciitis is relaxed, it begins to tighten up making you more prone to tearing the new tissue with those first few steps in the morning. Calf stretching is aimed at loosening your feet slowly, but with the night splint on, you can prevent your legs from tightening by allowing them to rest in a slightly active position.

If that’s confusing, don’t worry. The basic premise of a night splint is preventing the tightening of your calf muscle during the night and decreasing the likelihood that you will re-injure your plantar fascia after resting for a long period.

Woman Runner Tying Sport Shoes

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! For the most part however, 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 not recommended.

If you are feeling bold, you can try to incorporate night splints into your course of treatment. Just make sure this isn’t your only treatment.  Your primary focus should be on stretching, strengthening exercises and arch support (plantar fasciitis insoles or shoes).

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