Night Splints

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What you should know about the classic night splint boot

Written by: Dr. Dina Elsalamony, MD, MScPH

When it comes to treating plantar fasciitis, more than 85% of people report significant improvement or complete relief of symptoms within 12 months of conservative treatment. In addition to icing, stretching, taking anti-inflammatories such as NSAIDs and lifestyle modification, mechanical interventions, including night splints and foot orthoses, have proven to be effective in reducing the symptoms associated with plantar fasciitis. 

Night splints are often recommended by doctors as they are considered to be one of the best available treatments used to prevent early morning plantar fasciitis pain. 

What are night splints?

A night splint is basically a boot that you wear at night to keep your foot in either a neutral or a slightly dorsiflexed position, providing the plantar fascia with a gentle stretch while sleeping. Most people naturally sleep at night with their feet in a plantarflexed position, additionally, the bedding resting on top of the back of the foot for many hours at night can further accentuate this position, hence, night splints were primarily designed to counteract that, maintaining the person’s ankle in either a neutral or slightly dorsiflexed position. 

There are a few different types of night splints, however, the most prescribed one is what is known as the original/posterior/tension night splint, this splint has been around for the longest, hence, it is the most tried and studied one. It consists of a prefabricated plastic brace that you can strap your foot into and is often adjustable to create various degrees of stretch.

It is important to note that the original/posterior night splint is not made for walking and that the person is advised to remove it before getting out of bed to avoid any harm.

Night splints for plantar fasciitis

Night splints have been used for decades as an effective treatment for plantar fasciitis, although they solely will not fully cure this condition, they are one of the best devices available that aid in reducing pain, particularly early morning/first step pain, and accelerate the healing process. Numerous studies have reported evidence of their effectiveness, especially when combined with other forms of conservative treatments. For example, a study has found that tension night splints are effective in treating plantar fasciitis when combined with anti-inflammatory drugs, a stretching program, and the use of a heel pad. (1)

Another study has concluded that in cases with no previous treatment for plantar fasciitis when incorporating the use of night splints into the conservative treatment, rapid regression of the symptoms was evident, particularly the pain experienced in the early morning or after a long period of rest. (2)

Additionally, two randomized clinical trials have reported that night splints are effective as either primary or adjunct plantar fasciitis treatment in chronic and overweight patients, with high levels of tolerance and compliance by most patients. (3)

How do night splints reduce morning heel pain?

To answer this question, we first need to understand what causes the early morning pain in people with plantar fasciitis! Often symptoms are reported to be a lot worse first thing in the morning or after a long period of rest, this is thought to happen as a result of one or multiple reasons;

1) When resting or sleeping at night, the ankle defaults to a plantarflexed position leading to the plantar fascia being flexed rather than stretched, over-night and after a long period of maintaining this position, the plantar fascia stiffens and shortens, particularly if the person is suffering from plantar fasciitis, which means there is degeneration of the collagen fibers of the plantar fascia, and consequently more noticeable stiffness is encountered by those who have this condition. In the morning when first start to walk, that ankle position will change to a more of an upright angle, which will require the fascia to elongate and stretch in order to adapt to the change in position, and since the fascia has been stiff and shortened for some time, this will cause pain varying from mild to severe in some cases.

2) The planter-flexed ankle position also worsens any tightness in the gastrocnemius-soleus muscle (calf muscle) or the Achilles tendon which connects the calf muscles to the heel. And since approximately 80% of people with plantar fasciitis also report having tightness in the Achilles tendon, (4) factors contributing to this or putting more pressure on the plantar fascia, could increase the early morning pain and negatively impact the plantar fascia healing. (5)

Night splints were made to prevent these issues from happening during sleep, as their main purpose is to place the foot at about 90 degrees to the ankle, while also applying mild dorsiflexion to the toes to provide a gentle stretch to the fascia overnight. The foot and ankle position achieved by wearing the night splint, is meant to resist the gravity force that places the fascia in a shortened position at night, as well as decreasing secondary night-time contraction of the calf muscles and the Achilles tendon. (6)

What are the benefits of wearing night splints?

1. Providing great stretch to the fascia overnight.
2. Resisting the tightness of the calf muscles and Achilles’ tendon.
3. Relieving morning pain and improving foot function.
4. Preventing further damage and assist in the healing process.

References:

1. Batt, M. E., Tanji, J. L., & Skattum, N. (1996). Plantar fasciitis: a prospective randomized clinical trial of the tension night splint. Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine, 6(3), 158–162.
   
2. Beyzadeoğlu, T., Gökçe, A., & Bekler, H. (2007). Plantar fasiitis için konservatif tedaviye eklenen dorsifleksiyon gece atelinin etkinliği [The effectiveness of dorsiflexion night splint added to conservative treatment for plantar fasciitis]. Acta orthopaedica et traumatologica turcica, 41(3), 220–224.
   
3. Ryan, John & Overend, Tom. (2000). Effectiveness of Tension Night Splints in Treating Plantar Fasciitis: A Review. Physical Therapy Reviews. 5. 147-154. 10.1179/108331900786166704.
   
4. https://my.clevelandclinic.org/health/diseases/14709-plantar-fasciitis
   
5. Wapner, K. L., & Sharkey, P. F. (1991). The use of night splints for treatment of recalcitrant plantar fasciitis. Foot & ankle, 12(3), 135–137. https://doi.org/10.1177/107110079101200301
   
6. https://lermagazine.com/article/night-splint-treatment-of-plantar-fasciitis-pain