What Does Science Say About Night Splints and Plantar Fasciitis?
Night Splints for Plantar Fasciitis
Plantar fasciitis is one of the leading causes of the painful heel. In this condition, a person has difficulty stepping on the foot. Thus it reduces mobility. Quite often pain is sharper in the morning when a person wakes up after a prolonged rest. The pain would lessen during the day.
It is not a rare condition; statistics show that 10% of the population may have a problem of plantar fasciitis at least once in a lifetime. Obesity, standing or walking for long durations are often the cause of plantar fasciitis. However, over-exertion is just one explanation. In the most cases, the cause of plantar fasciitis is not understood.
Plantar fasciitis is a chronic disorder. It causes tenderness in the heel, that is over medial calcaneal tuberosity. Researchers think that stress and inflammation cause shrinking of the plantar fascia, which pains on physical exertion.
It is essential to understand that in plantar fasciitis there is minimal pain or discomfort when lying down in a bed. The pain only occurs when putting body weight on heels. If pain continues during the rest, the cause would be probably different. Continual night time pain may be due to tumor, infection, other systemic inflammatory diseases.
Treatment Options in Plantar Fasciitis
There are numerous treatment options, though none seem to work in all the cases. Quite often a person with plantar fasciitis may be referred to a foot specialist (podiatrist). Anti-inflammatory drugs (like ibuprofen) remain the mainstay of non-surgical treatment. However, they only provide temporary relief in pain; they are not a remedy. Quite often anti-inflammatory drugs are taken for months, thus increasing the risk of side effects.
No treatment of plantar fasciitis is complete without non-pharmacological methods. Thus physiotherapy has a role in reducing pain and improving blood flow. Even a few minutes of self-massage of heels would significantly reduce pain, though only for a short time. Applying ice packs may help with severe pain.
For better outcomes over the time, it is vital that plantar fascia must be stretched frequently. Thus gentle stretching exercises done regularly may do wonders. It is a slow method, but a safe and effective way to treat the condition.
Role of Night Splints in Plantar Fasciitis
Stretched plantar fasciitis re-shrinks during the night, when a person is resting. It is the reason why there is so much pain in the morning when a person first steps on the heel. Thus logically keeping plantar fascia stretched during the night may help. But how can one keep it stretched while sleeping? It is where night splints have a role to play. Although they are bulky and not entirely comfortable for use, science says that they do help over the time.
Some individuals may complain that night splints did not help them. However, in most such cases the failure of treatment is due to a lack of adherence. A night splint is not a magic bullet. It takes time to help, to work, to relieve pain.
Research indicates that most people would benefit from them if they stick to them long enough. Although, adherence is one of the most significant problems. Many individuals would stop using them when they feel some relief, only to see pain returning. Many others may merely neglect or forget to put on while sleeping.
Scientific Evidence of the Usefulness of Night Splints in Plantar Fasciitis
In science RCTs (random clinical trials) are considered to be golden standard, when it comes to proving the efficacy of some treatment. There are hundreds of clinical studies that demonstrated that splints work. They are useful when used along with other treatment options. They are rarely used alone. Interestingly, research also shows that splints are more beneficial in moderate to severe cases. They are highly useful in people in their 40ies or above.
In one of the clinical trials, several exciting facts were demonstrated about the use of night splint. In one study 44 patients took part. These were patients living with pain for more than two months at least. In the research, doctors gave them the usual drug therapy and also recommended using night splint for two months. However, 25 patients refused to use night splint. When patients were analyzed after a month, there was not much difference between those who used night splint and those who did not. However, things were entirely different after two months. At the end of two months, those who agreed to use night splints reported much better outcomes than those who did not.
The study mentioned above can have many implications. Firstly, it demonstrated that adherence is an issue with night splints, and many simply do not like using them. Secondly, it showed that night splints do work; they help reduce pain. Thirdly, it demonstrated that beneficial effect from night splints is not felt immediately, rather after prolonged use.
Although, there are some contradictory reports too. Some studies failed to show expected benefits with night splints. But then nobody said that they are magical or would help everyone.
The most significant proof of their effectiveness is the treatment guidelines by Academy of Orthopedic Physical Therapy. These guidelines strongly recommend the use of night splints. They classify the evidence in support of night splints as strong (category A). Full treatment guidelines can be assessed here.