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Proper use of night splints

Posted by Ed Davis, DPM on 4/20/02 at 12:24 (080456)

There seem to be a number of questions about night splint use. This is a modality that must be used correctly in order to see results.

A tight gastosoleus-achilles complex (the big muscle in back of the calf that attaches to the achilles tendon), exerts more downward force or leverage on the forefoot when pushing off. This additional force pushes down on the midfoot area, that is attempts to flex the midfoot downward. Anything that pushes the midfoot area down is met by resistance or increased tension in the plantar fascia. If one pushes up on the arch or midfoot area with an arch support or orthotic, pain can occur. A tight gastrosoleus achilles complex will thus often defeat even a well made orthotic.

The achilles is made up of thousands of parallel fibers with a high tensile strength. A backward force applied to the foot causes the gastrocnemius muscle, the big muscle in back of the calf to contract. This happens via a spinal reflex, that is, an involuntary reflex.
Attempts to stretch the achilles tendon are met with muscular contraction of the gastrocnemius via the reflex arc. This is why stretching often fails.

The amount of backward force applied to the foot must be sufficient to create a light stretch of the achilles but insufficient to set of the reflex contraction of the gastrocnemius. Individuals who experience cramps or 'charley horses' when using a night splint are using too much backward force. If one's heel pops out of the nightsplint, that means that the reflex was activated too. No benefit is gained if the reflex is activated.

The beauty of the nightsplint is that it applies a very light backward force for extended periods of time. This allows the fibers of the achilles to gradually slide against each other and the tendon to elongate--the desired effect. The goal is to gain about 3 to 5 degrees of dorsiflexion (backward motion of the foot on the leg) per month. That does not sound like a lot but 3 to 4 months of faithful use has spared thousands of people the need to have their achilles tendons surgically lengthened.

The 'nightsplint' does not just have to be used at night. It is great when one is a good sleeper and can put the nightsplint on when going to bed and sleep for eight hours. Others may use it for 3 to 4 hours per night, a couple of hours when reading or watching TV, etc.

I prefer nightsplints which are adjustable such as the N'Ice and Stretch because the amount of tension that needs to be applied varies greatly among patients. I would encourage patients to let their doctor set the initial position. Patients usually use too much force. More is not better here.
Ed

Re: Proper use of night splints

paula on 4/20/02 at 12:39 (080458)

thank you dr ed, that was very helpful info.

Re: Well, I will probably end up buying a nightsplint...

Mahatmelissama on 4/20/02 at 16:13 (080485)

The cast that the assistant to my pod made is a rigid cast. Perhaps it is too much and an adjustable nightsplint is the answer.

I will definitly mull over and ponder this one. Thanks for explaining. I can't understand the medical terminology but i do understand that what you are saying is 'stetching will not undo tightness...nightsplint will'.

Re: pain in the ball

Sandy H. on 4/20/02 at 22:17 (080518)

I used night for a while and it helped loosen up my calfs, alleviate pain at medial side of heel a bit and get rid of morning pain but I ended up with pain around the ball of my foot and mid toe (perhaps because it was pressing there) Should I try the night splint again? The pain in the ball is particularly bad because it stops you pronating properly and using your big toe to push off. I got rid of that now and don't want to get that pain back. As an aside the New Balance 854s appear to deliberately flex around the ball/big toe which caused me lots of pain when I had that problem but they are OK now. Should I stick with 854s given they put pressure on big toe. Right now I'm using them to give my big toe a workout every now and again but not sure if that is the right thing to do.

Re: Proper use of night splints

CatherineL on 4/22/02 at 12:17 (080655)

good info and topic...

It reminds me that I should be wearing mine again. I have the n'ice splint and had worn it for about 4 months every night and it had helped a little, but as you had mentioned, my calf muscles are extrememly tight and inflexible, bo stretching had not been helping at all!

But, I am now on muscle relaxants (for something else), and this med has worked wonders on my PF (approx 40% improvement). I think the combo of the night splint and the med would do wonders for my feet... so this info you have summarized is a good push for me to start using the night splint again.

thanx
Catherine

Re: pain in the ball

Ed Davis, DPM on 4/22/02 at 14:18 (080677)

You are correct in that the night splint could have been puuting too much pressure on the ball of your foot. A pad placed just behind the ball of your foot on the nightsplint should effectively alleviate that problem.
Ed

Re: Proper use of night splints

paula on 4/22/02 at 19:57 (080746)

interesting post about muscle relaxers. hmmm. maybe i should try them. i was on cyclobenzaprene and had less trouble with pf at the time. i didnt put it together. duh

Re: Proper use of night splints

Janew on 4/25/02 at 10:55 (081082)

My roommate also has PF, although not nearly as bad as I do. Her doc didn't even know what it was, or how to treat it. As it turned out, one night she fell asleep with her shoes on, and when she woke up her foot didn't hurt. So now, whenever her PF flairs up she sleeps with her shoes on for a few nights and that keeps it in check for her - same theory as a night splint?

Re: Proper use of night splints

EricS on 4/25/02 at 14:08 (081104)

Dr. Ed,

What did you mean by 'If one's heel pops out of the nightsplint, that means that the reflex was activated too.'? This is in reference to you advising patients not to put too much force on the foot when adjusting the night splint. Does it mean the heel slipped out of the nightsplint sideways? Or does it mean the ball of the foot rests in the nightsplint but the heel is not resting in the nightsplint (popped up a little bit and pushing gainst the nightsplint strap). Thanks.

Re: Proper use of night splints

paula on 4/20/02 at 12:39 (080458)

thank you dr ed, that was very helpful info.

Re: Well, I will probably end up buying a nightsplint...

Mahatmelissama on 4/20/02 at 16:13 (080485)

The cast that the assistant to my pod made is a rigid cast. Perhaps it is too much and an adjustable nightsplint is the answer.

I will definitly mull over and ponder this one. Thanks for explaining. I can't understand the medical terminology but i do understand that what you are saying is 'stetching will not undo tightness...nightsplint will'.

Re: pain in the ball

Sandy H. on 4/20/02 at 22:17 (080518)

I used night for a while and it helped loosen up my calfs, alleviate pain at medial side of heel a bit and get rid of morning pain but I ended up with pain around the ball of my foot and mid toe (perhaps because it was pressing there) Should I try the night splint again? The pain in the ball is particularly bad because it stops you pronating properly and using your big toe to push off. I got rid of that now and don't want to get that pain back. As an aside the New Balance 854s appear to deliberately flex around the ball/big toe which caused me lots of pain when I had that problem but they are OK now. Should I stick with 854s given they put pressure on big toe. Right now I'm using them to give my big toe a workout every now and again but not sure if that is the right thing to do.

Re: Proper use of night splints

CatherineL on 4/22/02 at 12:17 (080655)

good info and topic...

It reminds me that I should be wearing mine again. I have the n'ice splint and had worn it for about 4 months every night and it had helped a little, but as you had mentioned, my calf muscles are extrememly tight and inflexible, bo stretching had not been helping at all!

But, I am now on muscle relaxants (for something else), and this med has worked wonders on my PF (approx 40% improvement). I think the combo of the night splint and the med would do wonders for my feet... so this info you have summarized is a good push for me to start using the night splint again.

thanx
Catherine

Re: pain in the ball

Ed Davis, DPM on 4/22/02 at 14:18 (080677)

You are correct in that the night splint could have been puuting too much pressure on the ball of your foot. A pad placed just behind the ball of your foot on the nightsplint should effectively alleviate that problem.
Ed

Re: Proper use of night splints

paula on 4/22/02 at 19:57 (080746)

interesting post about muscle relaxers. hmmm. maybe i should try them. i was on cyclobenzaprene and had less trouble with pf at the time. i didnt put it together. duh

Re: Proper use of night splints

Janew on 4/25/02 at 10:55 (081082)

My roommate also has PF, although not nearly as bad as I do. Her doc didn't even know what it was, or how to treat it. As it turned out, one night she fell asleep with her shoes on, and when she woke up her foot didn't hurt. So now, whenever her PF flairs up she sleeps with her shoes on for a few nights and that keeps it in check for her - same theory as a night splint?

Re: Proper use of night splints

EricS on 4/25/02 at 14:08 (081104)

Dr. Ed,

What did you mean by 'If one's heel pops out of the nightsplint, that means that the reflex was activated too.'? This is in reference to you advising patients not to put too much force on the foot when adjusting the night splint. Does it mean the heel slipped out of the nightsplint sideways? Or does it mean the ball of the foot rests in the nightsplint but the heel is not resting in the nightsplint (popped up a little bit and pushing gainst the nightsplint strap). Thanks.