Heel Pain Study: Night Splints In, Stretching Out?

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By Brian McCurdy, Associate Editor

While plantar fasciitis is the most common cause of heel pain, there’s not exactly a universal approach when it comes to conservative treatment for this condition. Now a recent study suggests that prefabricated night splints may offer better results than the oft-recommended standing stretching in relieving symptoms of plantar fasciitis.
The open retrospective study, which was published in the July/August edition of The Journal of Foot And Ankle Surgery, revolved around 160 patients who had unilateral or bilateral plantar fasciitis. In addition to a standard treatment regimen, the researchers had 71 patients perform standing gastrocnemius-soleus stretching while the remaining 89 patients were given a prefabricated night splint.
What were the results? Those receiving night splint treatment had a mean time to recovery of 18.5 days with 1.78 follow-up visits and 1.83 additional treatments, according to Lance D. Barry, DPM, the lead author of the study. Those who underwent standing stretching had a mean time to recovery of 58.6 days, 3.07 follow-up visits and 2.14 additional interventions.
In other words, patients in the adjunctive night splint group experienced a resolution of symptoms in one-third the time of those in the adjunctive standing stretching group. Dr. Barry and his co-authors, Anna N. Barry, MS, and Yinpu Chen, PhD, also note in the study that the night splint group required fewer visits and treatment interventions.

Dr. Barry, a Fellow of the American College of Foot and Ankle Surgeons, believes the study supports a common sense approach to plantar fasciitis. He points out the traditional treatment of stretching “never made sense to me” because with a cut or broken bone, doctors would join the broken tissues together and not move them around.
“This is the only body tissue that when it was damaged, we were stretching like a maniac,” says Dr. Barry.
Night splints, on the other hand, can help address nighttime contracted position of the foot and keep the ankle in the anatomical position. Dr. Barry says wearing these splints can help patients reduce contracture of the gastrocnemius-soleus complex while they sleep and prevent further tension from the complex.
Harry F. Hlavac, DPM, praised the study for scientifically documenting an effective four-tier treatment plan prior to surgery and noted that it has changed his perception of treating plantar fasciitis.
“Prior to reading this article, I favored stretching,” says Dr. Hlavac, the Past President of the American Academy of Podiatric Sports Medicine. “Now I will include night splints in addition to stretching so I do not need to explain why the patient doesn’t need to stretch and the patient feels that he or she is part of the rehab process.”

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