Night splints are non-invasive orthopedic devices worn on the lower leg and foot during sleep or rest. They provide a sustained, gentle stretch to the soft tissues of the foot and ankle, promoting healing and reducing chronic pain. By maintaining the foot in a specific position overnight, the splint counters the natural tendency of tissues to shorten while inactive. This conservative treatment helps alleviate the intense discomfort often experienced with the first steps in the morning.
Conditions Night Splints Address
The primary condition for which night splints are prescribed is Plantar Fasciitis, characterized by inflammation of the plantar fascia ligament. This thick band of tissue runs along the bottom of the foot, connecting the heel bone to the toes. Repetitive strain or overuse causes micro-tears and irritation, leading to sharp, stabbing pain, particularly near the heel bone.
Another frequent diagnosis benefiting from night splint therapy is Achilles Tendinopathy (Achilles Tendinitis). This condition involves pain and stiffness in the Achilles tendon, which connects the calf muscles to the heel bone. Tight calf muscles place excessive strain on the tendon, making a prolonged stretch beneficial for recovery.
Night splints may also be used for tight calf muscles, which contribute to various foot and ankle problems by limiting range of motion. They are also incorporated into post-surgical recovery plans, especially after procedures aimed at lengthening tendons. The splint stabilizes the area and maintains the desired tissue length achieved during the operation.
How Night Splints Achieve Healing
The fundamental principle behind the splint’s effectiveness is sustained passive stretching—a gentle stretch held over an extended period. During sleep, the foot naturally relaxes into a plantarflexed position (toes point downward), allowing the plantar fascia and calf muscles to contract and shorten. This nocturnal shortening causes the intense heel pain felt with the first morning steps, as the shortened tissues are suddenly pulled taut upon weight-bearing.
The night splint holds the foot and ankle in a neutral position, or often in slight dorsiflexion (toes point slightly upward toward the shin). This position prevents the overnight contracture of the plantar fascia and the gastrocnemius-soleus complex (the main calf muscles). Maintaining this gentle, prolonged tension encourages the lengthening of the soft tissues over time.
This sustained stretch helps to break the cycle of inflammation and micro-tearing that occurs when shortened tissues are abruptly stretched in the morning. By keeping the tissues elongated, the splint promotes better circulation to the area, which is necessary for tissue repair and healing. Essentially, the device ensures that the first step of the day does not involve a sudden, painful stretch of a contracted ligament.
Different Designs and Proper Use
Night splints are available in a few distinct designs, each offering a different balance of stability and comfort. The popular rigid boot, or posterior shell splint, fully encases the calf and foot, providing a high degree of stability and the strongest stretch. This design is often adjustable, allowing the user to set the degree of dorsiflexion, which can range from a neutral 90 degrees up to 10 or more degrees of stretch. However, its bulkiness can sometimes interfere with comfortable sleep, potentially reducing patient adherence.
The dorsal night splint is a lighter, less bulky alternative that secures the foot from the front, holding the toes and forefoot up. This design is generally more comfortable for those who toss and turn, but it provides a less aggressive stretch, typically ranging from neutral to about 5 degrees of dorsiflexion. A third option is the sock-style splint, a soft fabric sleeve with a strap that pulls the toes back, which is the least restrictive but may be best suited for milder symptoms.
Proper use begins with correct fitting, which should ensure the splint is snug but not so tight as to cause numbness or tingling, especially in the toes. Users should start by wearing the splint for short periods, such as 30 to 60 minutes in the evening, gradually increasing the duration as tolerance improves. The goal is often to wear it for several hours nightly, or for the entire sleep cycle, for a period of weeks or months, depending on the treatment plan.
If the splint has adjustable straps, tension should be increased slowly over several nights to allow the tissues to adapt without causing pain. It is common to experience initial discomfort or a noticeable stretching sensation, but sharp pain or restricted circulation indicates the splint is too tight and requires immediate adjustment. The splint should always be removed before standing or walking, as it is not designed to support full weight-bearing activity.