When is it appropriate to use crutches and a night-time plantar‑fascia brace for plantar fasciitis?

Crutches and Night Braces for Plantar Fasciitis

Crutches are not indicated for plantar fasciitis; however, night splints should be added to conservative treatment after 6 weeks if initial measures fail, or combined with orthoses from the start for faster pain relief.

When to Use Night Splints

The American College of Foot and Ankle Surgeons guideline provides a clear algorithmic approach 1:

• Initial 6 weeks: Start with stretching, NSAIDs, activity modification, heel cushions, and arch supports—no night splints yet
• After 6 weeks without improvement: Add night splinting as part of escalated conservative care
• Continue for 2-3 months before considering more aggressive interventions

For faster results, consider combining night splints with foot orthoses from the outset rather than waiting 6 weeks. Research shows that combining adjustable dorsiflexion night splints with accommodative foot orthoses produces significantly better pain reduction at 2 weeks (p<0.001) and 8 weeks (p<0.001) compared to orthoses alone 2. Another study demonstrated significantly higher improvements in both AOFAS and VAS scores at 2 months when night splints were added to conservative treatment (p=0.01 and p=0.001 respectively) 3.

Night Splint Specifications

• Position: 5 degrees of dorsiflexion 3
• Duration: Wear nightly for 8 weeks minimum
• Type: Adjustable dorsiflexion splints are preferable 2

Crutches: Not Recommended

Crutches are not part of standard plantar fasciitis management. The guideline mentions "fixed-ankle walker-type devices" for refractory cases after 2-3 months 1, but this refers to walking boots, not crutches. Complete non-weight-bearing with crutches would be counterproductive—patients need controlled loading with activity modification, not complete immobilization.

Important Caveats

Night splints show mixed evidence for long-term benefit. One high-quality 2017 RCT found no significant differences between night splints plus home exercises versus home exercises alone for most outcome measures in chronic plantar fasciitis 4. However, there may be earlier benefit in the intervention group, making night splints worthwhile for patients seeking faster relief 4.

Recurrence rates remain similar whether or not night splints are used (13.6% with splints vs 29% without at 2+ years follow-up) 3. The primary benefit is accelerated short-term pain relief, not prevention of recurrence.

Clinical Algorithm

1. Weeks 0-6: Conservative treatment only (stretching, ice, NSAIDs, activity modification, heel cushions)
2. Week 6 without improvement: Add night splints + continue conservative measures
3. Weeks 6-12: Continue combined treatment
4. After 12 weeks without improvement: Consider casting, walking boot, injections, or referral to podiatric surgeon 1

Alternative accelerated approach: Start night splints combined with orthoses immediately for patients with severe pain or those requiring faster return to function 5, 2.