Night Splints Research Articles

Can we use nerve gliding exercises in women with carpal tunnel syndrome?

This study investigated the effectiveness of nerve gliding exercises used in combination with conservative treatment approaches in patients with carpal tunnel syndrome. A total of 35 hands of 26 patients with carpal tunnel syndrome were divided into 2 groups. Static volar wrist splints were applied to 16 hands in the control group, and these patients were trained to modify their functional activities in accordance with conservative treatment. In the experimental group, nerve gliding exercises were applied to 19 hands that were also treated conservatively. A day-and-night splint, together with the conservative training program, was applied for 6 weeks to both groups. Subsequently, a night splint only was used in both groups, and nerve gliding exercises were continued in the experimental group for the remaining 4 weeks. Pretreatment and posttreatment assessments of pain, sensation, muscle strength, and grip and pinch strength, along with Tinel and Phalen tests, were performed in all cases; electrophysiologic measurements were recorded. Significant progress was detected in both control and experimental groups during the posttreatment phase compared with the initial phase (P < .05). However, when the 2 groups were compared, the experimental group in which nerve gliding exercises were added to conservative therapy approaches demonstrated more rapid pain reduction; these patients also showed greater functional improvement, especially in grip strength (P < .05).

Éducation thérapeutique du patient : vers une démarche raisonnée

Heel pain is a very common foot disease. Varieties of names such as plantar fasciitis, jogger's heel, tennis heal, policeman's heel are used to describe it. Mechanical factors are the most common etiology of heel pain. Common causes of hell pain includes: Plantar Fasciitis, Heel Spur, Sever's Disease, Heel bump, Achilles Tendinopathy, Heel neuritis, Heel bursitis. The diagnosis is mostly based on clinical examination. Normally, the location of the pain and the absence of associated symptoms indicating a systemic disease strongly suggest the diagnosis. Several therapies exist including rest, physical therapy, stretching, and change in footwear, arch supports, orthotics, night splints, anti-inflammatory agents, and surgery. Almost all patients respond to conservative nonsurgical therapy. Surgery is the last treatment option if all other treatments had failed. Rest, ice, massage, the use of correct exercise and complying with a doctor's advice all play important part in helping to recover from this hell pain condition, but getting good quality, suitable shoes with the appropriate amount of support for the whole foot is the most important.

Gait Improvement Surgery in Diplegic Children

Gait improvement surgery in ambulatory children with cerebral palsy performed as single-event multilevel surgery is today a well-established modality of treatment, but follow-up studies are lacking. Preoperative and follow-up gait analysis data of 32 diplegic children who underwent single-event multilevel surgery for gait improvement between 1995 and 1998 were evaluated retrospectively. Relevant sagittal plane kinematic parameters of the hip, knee, and ankle joint and time-distance parameters were considered for outcome measures in this study. Postoperative gait analysis was performed three times in all the cases: after discontinuation of the dynamic AFOs (mean 1.0 +/- 0.3 years), after discontinuation of the night splints (mean 2.3 +/- 0.7 years), and at least 1.5 years after discontinuation of physiotherapy and splints (mean 4.4 +/- 1.1 years). The aim of the study was to ascertain whether the improvements in gait function were maintained over these examinations. The authors found that gait function continued to change over 1, 2, and 3 years of follow-up. A general decrease in gait function was measurable in this collective between the first postoperative and the second postoperative evaluations. The results indicate that evaluation of gait improvement surgery in cerebral palsy performed at a minimum of 3 years after surgery would give the most predictive outcome of treatment.

Interventions for treating hallux valgus (abductovalgus) and bunions.

Hallux valgus is classified as an abnormal deviation of the great toe (hallux) towards the midline of the foot. To identify and evaluate the evidence from randomised trials of interventions used to correct hallux valgus. We searched the Cochrane Musculoskeletal Injuries Group trials register (2003/1), the Cochrane Central Register of Controlled Trials (The Cochrane Library issue 1, 2003), MEDLINE (January 1966 to March 2003) and EMBASE (1980 to January 2003). No language restrictions were applied. Hand searching of specific foot journals was also undertaken. Date of the most recent search: 31st March 2003. Randomised or quasi-randomised trials of both conservative and surgical treatments of hallux valgus. Excluded were studies comparing areas of surgery not specific to the control of the deformity such as use of anaesthetics or tourniquet placement. Methodological quality of trials which met the inclusion criteria was independently assessed by two reviewers. Data extraction was undertaken by two reviewers. The trials were grouped according to the interventions being compared, but the dissimilarity in the comparisons prevented pooling of results. The methodological quality of the 21 included trials was generally poor and trial sizes were small. Three trials involving 332 participants evaluated conservative treatments versus no treatment. There was no evidence of a difference in outcomes between treatment and no treatment. One good quality trial involving 140 participants compared surgery to conservative treatment. Evidence was shown of an improvement in all outcomes in patients receiving chevron osteotomy compared with those receiving orthoses. The same trial also compared surgery to no treatment in 140 participants. Evidence was shown of an improvement in all outcomes in patients receiving chevron osteotomy compared with those receiving no treatment. Two trials involving 133 people with hallux valgus compared Keller's arthroplasty with other surgical techniques. In general, there was no advantage or disadvantage using Keller's over the other techniques. When the distal osteotomy was compared to Keller's arthroplasty, the osteotomy showed evidence of improving the intermetatarsal angle and preserving joint range of motion. The arthroplasty was found to have less of an impact on walking ability compared to the arthrodesis. Six trials involving 309 participants compared chevron (and chevron-type) osteotomy with other techniques. The chevron osteotomy offered no advantages in these trials. For some outcomes, other techniques gave better results. Two of these trials (94 participants) compared a type of proximal osteotomy to a proximal chevron osteotomy and found no evidence of a difference in outcomes between techniques. Three trials involving 157 participants compared outcomes between original operations and surgeon's adaptations. There was no advantage found for any of the adaptations. Three trials involving 71 people with hallux valgus compared new methods of fixation to traditional methods. There was no evidence that the new methods of fixation were detrimental to the outcome of the patients. Four trials involving 162 participants evaluated methods of post-operative rehabilitation. The use of continuous passive motion appeared to give an improved range of motion and earlier recovery following surgery. Early weightbearing or the use of a crepe bandage were not found to be detrimental to final outcome. Only a few studies had considered conservative treatments. The evidence from these suggested that orthoses and night splints did not appear to be any more beneficial in improving outcomes than no treatment. Surgery (chevron osteotomy) was shown to be beneficial compared to orthoses or no treatment, but when compared to other osteotomies, no technique was shown to be superior to any other. Only one trial had compared an osteotomy to an arthroplasty. There was limited evidence to suggest that the osteotomy gat the osteotomy gave the better outcomes. It was notable that the numbers of participants in some trials remaining dissatisfied at follow-up were consistently high (25 to 33%), even when the hallux valgus angle and pain had improved. A few of the more recent trials used assessment scores that combine several aspects of the patients outcomes. These scoring systems are useful to the clinician when comparing techniques but are of dubious relevance to the patient if they do not address their main concern and such scoring systems are frequently unvalidated. Only one study simply asked the patient if they were better than before the treatment. Final outcomes were most frequently measured at one year, with a few trials maintaining follow-up for 3 years. Such time-scales are minimal given that the patients will be on their feet for at least another 20-30 years after treatment. Future research should include patient-focused outcomes, standardised assessment criteria and longer surveillance periods, more usefully in the region of 5-10 years.

Interventions for treating plantar heel pain.

Ten percent of people may experience pain under the heel (plantar heel pain) at some time. Injections, insoles, heel pads, strapping and surgery have been common forms of treatment offered. The absolute and relative effectiveness of these interventions are poorly understood. The objective of this review was to identify and evaluate the evidence for effectiveness of treatment in treating plantar heel pain. MEDLINE (from 1966 to December 1997), EMBASE and the Cochrane Library were searched. Three podiatry journals (The Foot, The Chiropodist (later The Journal of British Podiatric Medicine), and The British Journal of Podiatric Medicine) were handsearched. We contacted known investigators in the field to identify unpublished data or research in progress. Non English language reports were excluded from the review. Randomised and quasi randomised trials of interventions for plantar heel pain in adults. Two reviewers independently evaluated studies for inclusion, extracted data and assessed study quality. Additional information was obtained by direct contact with investigators. No poolable data were identified. Where measures of variance were available we have calculated the weighted mean differences based on visual analogue scale (VAS) scores. Eleven randomised trials involving 465 participants were included. Study quality was generally poor, and pooling of data was not possible. All studies measured a reduction in heel pain as the primary outcome. Seven trials evaluated interventions against placebo/dummy or no treatment. There was limited evidence for the effectiveness of topical corticosteroid, administered by iontophoresis in reducing pain. There was no evidence for the effectiveness of injected corticosteroid. There was limited evidence for the effectiveness of low energy extracorporeal shock wave therapy in reducing night pain, resting pain and pressure pain in the short term (12 weeks). In individuals with chronic pain (longer than six months), there was limited evidence for the effectiveness of dorsiflexion night splints in reducing pain. There was no evidence to support the effectiveness of therapeutic ultrasound, low-intensity laser therapy, exposure to an electron generating device or insoles with magnetic foil. No randomised trials evaluating orthotic devices, surgery, or radiotherapy against a control population were identified. There was limited evidence for the superiority of corticosteroid injections over orthotic devices. Although there is limited evidence for the effectiveness of local corticosteroid therapy, the effectiveness of other frequently employed treatments in altering the clinical course of plantar heel pain has not been established in comparative studies. Well designed and conducted randomised studies are required.

CHRONIC HEEL PAIN IN A COLLEGIATE BASKETBALL PLAYER

HISTORY An 18-year-old female Division I collegiate basketball player developed severe right heel pain during preseason training, experiencing episodes of mild morning dyskinesia and mild to moderate pain after workouts. Despite introduction of gel heel cups and physical therapy, training which included box jumps, rebounding and repetitive landing on the heels aggravated the heel pain. Medical treatment through the basketball season included oral NSAIDS, steroid injection, orthoses, night splinting and physical therapy. Training load was modified to eliminate impact. Although she was able to continue playing her pain escalated; morning dyskinesia became moderate to severe, mid-day pain became persistent and severe post exercise pain was experienced. Her injury persisted into the off-season, 8 months after onset and she was referred for follow-up in her home town. PHYSICAL EXAMINATION Examination identified pain to palpation at the medial calcaneal tubercle and along the proximal one-third medial band plantar fascia. Thickening and enlargement of the proximal one-third medial band plantar fascia was noted. Full and pain free range of motion was noted to the ankle and foot. Standing caused moderate pain. Walking gait was antalgic with rearfoot and midfoot pronation progressing through midstance and into the propulsive phase of gait. DIFFERENTIAL DIAGNOSIS Plantar fasciitis. Calcaneal spur syndrone. Calcaneal stress fracture. TEST AND RESULTS Foot anterior-posterior, oblique and lateral radiographs: - linear radiodensities adjacent to the cuboid without obvious signs of avulsion fracture - small plantar-medial spurring of the calcaneus Foot calcaneal axial radiograph: - small posterior-lateral erosion of the calcaneus Foot magnetic resonance: - increased signal intensity seen to plantar fascia and musculature adjacent to calcaneus - mild bone marrow edema of the calcaneus. FINAL/WORKING DIAGNOSIS Chronic plantar fasciitis Calcaneal spur syndrome. TREATMENT AND OUTCOMES High energy extracorporeal shock wave therapy (ESWT) procedure. Prescription foot orthoses introduced immediatly. A progressive program of lower extremity specific range of motion exercises began immediately post ESWT. Endurance maintained with cross training during the first 6 weeks post ESWT. Transition to low load drills began 6 weeks post ESWT. Supervised return to running activities and high load drills which emphasized eccentric tissue conditioning began 8 weeks post ESWT. Returned to basketball 12 weeks after ESWT when the athlete demonstrated pain free range of motion, normal strength and tolerated the demands of basketball.

SHOCK WAVES DO MORE THAN JUST CRUSH STONES: EXTRACORPOREAL SHOCK WAVE THERAPY IN PLANTAR FASCIITIS

SUMMARYHeel pain is a common orthopaedic problem, The cause of this clinical entity remains an enigma. The overall prognosis is good, however, and the symptoms generally settle well with time. There appears to be little evidence of the effectiveness of local steroid injections and dorsiflexion night splints. Extracorporeal shock wave therapy (ECSW) has been used in orthopaedics since the 1980s. With this, a new tool has become available for the treatment of plantar fasciitis, achillis tendinitis, shoulder pain and tendinosis of the elbow. In our pilot study we found good results with the use of ECSW therapy in resistant plantar fasciitis. Additional controlled studies are required to define the precise role of this new modality in the treatment of chronic plantar fasciitis.

A retrospective study of standing gastrocnemius-soleus stretching versus night splinting in the treatment of plantar fasciitis

Plantar fasciitis is the most common cause of heel pain, yet the conservative treatment of plantar fasciitis is not standardized. This open retrospective study compared the effects of standing gastrocnemius-soleus stretching to a prefabricated night splint. One hundred and sixty patients with unilateral or bilateral plantar fasciitis were evaluated and treated according to the standard regimen in addition to either night splints or stretching. Seventy-one patients performed standing stretching of the gastrocnemius-soleus complex. Eighty-nine patients utilized the prefabricated night splint without standing stretching. The night splint treatment group had a significantly shorter recovery time (p < .001), fewer follow-up visits to recovery (p < .001), and fewer total additional interventions (p = .034) compared to the stretching group. Absolute body weight, body mass index, and age did not have a statistically significant effect on the time to recovery or additional interventions needed. The duration of pain prior to this treatment was a predictive factor and was associated with increased time to recovery and increased number of treatment interventions. Its was concluded that early treatment in a standardized four-tiered treatment approach, including the night splint without standing stretching of the gastrocnemius-soleus complex, speeds time to recovery.

COMPARISON OF FOOT ORTHOSIS, PHYSIOTHERAPY AND NIGHT SPLINTS IN THE TREATMENT OF PLANTAR FASCIITIS

PURPOSE: To determine the effectiveness of physiotherapy, foot orthosis prescription and night splint treatment for previously untreated plantar fasciitis. METHODS: This single blinded, randomized clinical trial recruited 50 females (mean ± SD, age: 43.1 ± 10.5y; height: 165.3 ± 7.3cm; weight: 80.2 ± 17.7kg) and 47 males (mean ± SD, age: 46.2 ± 9.6y; height: 179.8 ± 7.2cm; weight: 88.9 ± 16.3kg) who were diagnosed with plantar fasciitis (rheumatologic conditions excluded) and had no previous treatment for their heel pain, except for the use of NSAID's. Patients were randomized to one of the following treatment groups: (Group 1) 10 physiotherapy sessions (n = 31 with 43 limbs); (Group 2) foot orthosis prescription (n = 22 with 41 limbs); (Group 3) night splint use (n = 33 with 42 limbs). All subjects were taught home soleus and gastrocnemius stretching exercises. Pain was assessed using visual analog scales (VAS) for morning, walking, sitting and physical activity pain. RESULTS: The VAS scores (mean and SD) for baseline and 12 weeks follow-up are presented in the Table below. CONCLUSION: Each treatment appears equally efficacious in treating previously untreated plantar fasciitis. This project was funded by Alberta Heritage Foundation for Medical Research-Health Research Fund and Colman Prosthetics & Orthotics.Table: No Caption Available

The diagnosis and treatment of heel pain

Mechanical heel pain is one of the most frequent conditions presented to foot and ankle specialists. Plantar heel pain is responsible for the majority of mechanical heel pain cases. Plantar heel pain is defined as insertional heel pain of the plantar fascia with or without a heel spur (Fig. 1). The most common cause cited for plantar heel pain is biomechanical abnormalities that lead to pathologic stress to the plantar soft tissues (1–7). Localized nerve entrapment of the medial calcaneal or muscular branch off the lateral plantar nerve may be a contributing factor (8–11). Patients usually present with isolated plantar heel pain upon initiation of weightbearing, either in the morning upon arising or after sitting for a period of rest. The pain tends to decrease after a few minutes, then returns as the day proceeds and time on the feet increases. Associated significant findings may include high body mass index, tightness of the Achilles tendon, pain upon palpation of the inferior heel, and inappropriate shoe wear (12–14). Many patients will have attempted self-remedies before seeking medical advice. A careful history is important, including time(s) of day when pain occurs, current shoe wear, activity level both at work and at leisure, and history of trauma. An appropriate physical examination of the lower extremity includes range of motion of the ankle with special attention to decreased range of motion of dorsiflexion of the ankle, palpation of the inferior medial aspect of the heel, palpation of the medial aspect of the heel, the occurrence of bilateral symptoms, and angle and base of gait evaluation. Following physical evaluation, appropriate radiographs may be considered. Radiographic identification of a plantar heel spur indicates that the condition has been present for at least 6–12 months, whether having been symptomatic or not (Fig. 2). As a rule, the longer the duration of heel pain symptoms, the longer the period to final resolution of the condition. Initial treatment options may include nonsteroidal antiinflammatory drugs (NSAIDs), padding and strapping of the foot, and corticosteroid injections for appropriate patients. Patient-directed treatments seem to be as important in resolving symptoms. They include regular stretching of the calf muscles, avoidance of flat shoes and barefoot walking, use of cryotherapy directly to the affected part, over-the-counter arch supports and heel cushions, and limitation of extended physical activities. Patients usually have a clinical response within 6 weeks of initiation of treatment. If improvement is noted, the initial therapy program is continued until symptoms are resolved. If no improvement is noted, the patient should be referred to a podiatric foot and ankle surgeon. The second phase of treatment for the referred patient includes continuation of the initial treatment options with considerations for additional therapy: the use of custom orthotic devices, especially in the biomechanically malaligned patient, the use of night splints to

An Inexpensive Tension Night Splint

An Inexpensive Tension Night Splint

Arthroscopic Release of the Stiff Elbow

Arthroscopic Release of the Stiff Elbow

Is 20 years of immobilization, not sufficient to render metacarpophalangeal joints completely useless? — Correction of a 20-year old post-burn palmar contracture: a case report

This report presents a case of post-burn palmar contracture with flexion contracture of thumb of 20-year duration. The contracture was released and the raw area was covered with split thickness skin graft. Only one ‘K’ wire in soft tissue was needed to keep all the fingers straight and immobilized, suggestive of intermetacarpal ligamentous contracture. A static night splint was given to maintain the correction. Complete range of movement was achieved in a month with the combination of dynamic splinting and physiotherapy. It was interesting to note that even 20 years of contracted position did not render the metacarpophalangeal joints completely stiff and useless. Probable reasons are discussed.

Early mobilization after sliding achilles tendon lengthening in children with spastic cerebral palsy.

Equinus deformity is a common finding in children with cerebral palsy and may be treated by Achilles tendon lengthening. To prevent recurrence, some authors recommend immobilizing the operated leg with an above-knee cast for six weeks, followed by use of a night splint or orthosis. Nevertheless, there are recurrence rates of up to 20.5%. The aim of this study was to evaluate the long-term result of postoperative immobilization for two weeks in a below-knee cast and early weight bearing, without the use of a splint or orthosis. Thirty-six children (52 feet) with spastic cerebral palsy underwent sliding Achilles tendon lengthening. Follow-up of five to ten years showed a comparable recurrence rate (19.2%) to that reported with the standard, more stringent management approach. Most of the recurrences were in children operated on before five years of age. We believe earlier motion helps to sustain the tendon length achieved at surgery and allows for earlier independent gait.

Effectiveness of Tension Night Splints in Treating Plantar Fasciitis: A Review

The purpose of this review was to investigate the effectiveness of tension night splints for treating plantar fasciitis. A computerized literature search (Medline 1966–2000; CINAHL 1982–2000) using the key words plantar fasciitis, tension night splints and treatment yielded nine studies on the use of tension night splints as either primary or adjunct treatments for plantar fasciitis. Most of the research was descriptive in nature. Six studies, including one randomized clinical trial, suggested that tension night splints, in conjunction with other techniques, will resolve symptoms in patients who have failed other courses of treatment. A randomized clinical trial has also shown that tension night splints are effective as a solo treatment. Tension night splints have been shown to be effective in overweight and chronic patients, however, more research is needed to determine the effectiveness in patients with acute plantar fasciitis.

Sports and other soft tissue injuries, tendinitis, bursitis, and occupation-related syndromes.

This review highlights three areas: plantar fasciitis, Achilles tendinitis, and carpal tunnel syndrome. The diagnosis and treatment of plantar fasciitis are reviewed; nonsurgical treatments remain the mainstay of management. Several recent articles support the use of night splints. Some novel treatments recently investigated, including low intensity laser irradiation and extracorporeal shock wave lithotripsy, are reviewed, as well as the effectiveness of steroid injection. Novel treatments for Achilles tendinitis are also reviewed, including the use of injection therapy and the treatment approach of one author for the management of Achilles tendon rupture. Nonsurgical techniques in the treatment of carpal tunnel syndrome, such as yoga, ultrasound, noninvasive laser neurolysis, manipulation, nerve and tendon gliding exercises, and medications, are reviewed. Prednisolone was shown to be effective in the treatment of mild to moderate disease and nonsteroidal anti-inflammatory drugs were found to be ineffective.

Night Splint Treatment for Plantar Fasciitis A Prospective Randomized Study

A prospective randomized study of 116 patients with plantar fasciitis was performed to determine the effectiveness of adjuvant night splint therapy in relieving the acute symptoms of plantar fasciitis. Patients were randomized into one of two groups. Patients in Group 1 were treated with 1 month of oral antiinflammatory medication, Achilles stretching exercises, and shoe recommendations. Patients in Group 2 received identical treatment but also used a dorsiflexion night splint for 3 months. Blinded clinical review of patients was performed at 4, 6, and 12 weeks. Health status data Short Form 36 also was collected at these times and again at an average 19 months of followup. Overall, 68% of patients reported improvement with this nonoperative protocol for a 12-week period. No statistical difference was seen with the presence or absence of a night splint. In addition, no differences in improvement rates were observed with gender, duration of antecedent symptoms, the presence of bilateral symptoms, or the presence of a heel spur. Age older than 45 years did prove to be a statistically significant poor prognostic factor for improvement at the 12-week follow-up. Short Form 36 data obtained at baseline showed significantly lowered perception of health when compared with age matched controls. Patients in both treatment groups had significant improvement in Short Form 36 scores with 12 weeks of conservative care.

Plantar Fascia Injection

Plantar fasciitis is a major cause of heel pain in athletes and active people. The pain can usually be controlled with conservative measures, such as stretching, the use of arch supports, night splinting, and short-term activity modification, which allow the injured tissue to heal. However, persistent cases sometimes require an injection of a corticosteroid and local anesthetic into the calcaneal origin of the plantar fascia to relieve pain and promote healing.

Orthoses in the treatment of rearfoot problems.

Orthotic management is helpful in the treatment of most orthopedic conditions involving the rearfoot, including plantar fasciitis, Achilles tendon disorders, posterior tibial tendon dysfunction, flatfoot, ankle sprains, and problems associated with diabetes, arthritis, and equinus disorders. A review of the effectiveness of orthoses in the treatment of these conditions is presented here. An in-depth analysis of the orthotic management of plantar fasciitis and a critical review of foot orthoses for the pronated foot are presented. Also discussed are the rationale and effectiveness of the tension night splint in the treatment of plantar fasciitis, orthotic devices for the different stages of posterior tibial tendon dysfunction, and the various categories of orthoses for off-loading the diabetic foot. The modern ankle brace, the effectiveness of prefabricated versus prescription foot orthoses, and recent developments in the ankle-foot orthosis are also reviewed.

Stabilization of the Chevron procedure for hallux valgus deformity with a capsuloperiostal flap

This article reports on the use of a Chevron procedure in the treatment of hallux valgus for better stabilization of the osteotomy. This procedure was performed on 31 feet of 24 patients, Twenty-two of the patients were female and two were male. The average age was 41 and average follow-up time was 14 months. The average correction of the 1-2 intermetatarsal angle was 3.8 degrees and average correction of the hallux valgus angle was 15.3 degrees. On the follow-up, 93.5% of the feet were pain free and 81% did not have any discomfort with shoewear. There were two cases of superficial infection, and two patients complained of dysesthesia or hypoesthesia after the operation. Results revealed less correction loss, shorter union time, less metatarsophalangeal stiffness, and more postoperative patient tolerance. The authors attached the distally based "V"-shaped medial capsuloperiostal flap to the metatarsal shaft and, because of obtained stability, used no internal fixation or postoperative cast but only night splint, allowed weightbearing on the heel as soon as the patient tolerated it, and encountered no displacement of fragments, malunion, or recurrence of the deformity.