Heel Pain Study: Night Splints In, Stretching Out?

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Remembering A Pioneering DPM

The end of September marked the passing of Merton Root, DPM, who died from complications from pneumonia. Dr. Root was a biomechanical pioneer and one of the most influential educators in the podiatric profession. Over 40 years ago, he posed theories that laid the groundwork for the modern orthotic industry which have helped to advance sports medicine and general orthotics.

While Dr. Root will be missed in the podiatric community, his contributions remain timeless, as evidenced by the warm remembrances from his colleagues.

“His contributions to the podiatric field have been enormous and extraordinary,” offers Douglas Richie, Jr., DPM, who co-authored Dr. Root’s last original paper on range of motion of the first ray. “Dr. Root’s greatest contribution has been his emphasis of clinical observations to justify diagnosis and treatment decisions. He taught that biomechanical examination and gait analysis required a level of skill that could only be attained after years of experience and diligence. He was committed to following sound scientific methodology with a painstaking commitment to detail and accuracy.”

Howard Dananberg, DPM, concurs, noting that he has been inspired by Dr. Root’s work ethic almost as much as his volume of biomechanical literature.

“Dr. Root brought objectivity to podiatric biomechanics and brought podiatry into the 20th century,” notes Dr. Dananberg. “I have learned from Dr. Root the importance of persistence. His dedication to excellence and the drive to get his message across is as significant as the incredible body of work he produced. His was an amazing contribution that can never be underestimated.”

Robert Phillips, DPM, also drew considerable inspiration from the work of Dr. Root and cites the pioneer’s pervasive influence.

“Just about everything he taught can be found in the literature in bits and pieces,” says Dr. Phillips, the Director of Podiatric Residency at the Coatesville Veterans Affairs Medical Center in Coatesville, Pa.

“I have found Dr. Root to be a dynamic person in constantly trying to continue to develop his ideas and listen to new ideas. He had a type of continuous learning attitude that was very influential on me and caused me to constantly review and rethink even the most basic concepts. His vision of combining the knowledge of physiology and anatomy with the knowledge of mechanics and engineering was also very influential in my practice.”

Dr. Phillips says Dr. Root’s innovations have fueled modern orthotic technology.

“In the field of orthotics, he popularized the use of a non-weighbearing casting technique and the use of thermoplastic in making orthotics,” points out Dr. Phillips. “Almost all orthotic laboratories today use various forms of his techniques for making orthotics.”

Dr. Richie concurs and emphasizes that “Dr. Root ensured the integrity of the technology (of orthotic fabrication and biomechanics) and provided the impetus for the widening of knowledge embraced by the podiatric profession in the last half of the 20th century.”

www.hospitalpodiatrists.org

Looking for an ally in your attempt to get staff privileges at a local hospital? If so, you may want to check out www.hospitalpodiatrists.org. It’s the official site of the American Association of Hospital and Healthcare Podia
Dr. Barry says wearing night splints can help patients reduce contracture of the gastrocnemius-soleus complex during sleep and prevent further tension.
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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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