Is a night splint appropriate for a patient with persistent right foot pain, primarily in the mornings, who is currently taking over-the-counter (OTC) pain medications and has recently completed physical therapy?

Night Splint for Right Foot Pain: Appropriate Treatment for Morning Pain

A night splint is an appropriate and effective treatment for this 38-year-old male patient with right foot pain that is most pronounced in the mornings, especially after completing physical therapy without full resolution of symptoms.

Clinical Assessment and Diagnosis

Based on the patient's presentation of:

• Right foot pain, particularly in the mornings
• Incomplete resolution after physical therapy
• Current use of OTC pain medications

This clinical picture strongly suggests plantar fasciitis, which is characterized by:

• Pain that is typically worst with the first steps in the morning
• Pain that may improve with activity but returns after prolonged rest
• Incomplete response to initial conservative measures

Evidence-Based Treatment Approach

First-Line Treatments

The patient has already implemented several first-line treatments:

• Over-the-counter pain medications (likely NSAIDs)
• Physical therapy (which typically includes stretching exercises)

Night Splint Efficacy

Night splints are specifically indicated for patients with persistent plantar fasciitis with morning pain:

1. According to the American College of Foot and Ankle Surgeons guidelines, night splinting is recommended when initial treatments (NSAIDs, activity limitation, padding/strapping) do not provide sufficient relief 1.

2. Multiple studies demonstrate significant efficacy of night splints:

   • A randomized controlled trial showed that patients using night splints had 62% pain reduction at 52 weeks compared to 48% in other treatment groups 2.
   • Another study found that patients using dorsiflexion night splints showed significant improvement in foot pain with 88% of patients improving after treatment 3.

3. Night splints work by maintaining the ankle in a neutral or slightly dorsiflexed position during sleep, which:

   • Prevents the plantar fascia from contracting overnight
   • Provides a gentle, prolonged stretch to the fascia
   • Reduces the initial morning pain when taking first steps

Implementation Recommendations

1. Prescription specifics:

   • A custom-fitted posterior splint or adjustable dorsiflexion night splint
   • To be worn during sleep

2. Patient education:

   • Explain that the splint prevents overnight tightening of the plantar fascia
   • Advise that consistent nightly use is important for effectiveness
   • Inform that improvement may take several weeks (studies show 8-12 weeks is common) 4

3. Follow-up plan:

   • Schedule follow-up in 4-6 weeks to assess response
   • Consider additional interventions if inadequate improvement

Potential Pitfalls and Considerations

1. Compliance issues:

   • Night splints can be uncomfortable initially
   • Encourage consistent use despite initial discomfort
   • Consider an adjustable model that allows gradual increase in dorsiflexion

2. Contraindications:

   • Avoid in patients with peripheral vascular disease or neuropathy
   • Use with caution in patients with significant ankle or foot deformities

3. Complementary treatments:

   • Continue appropriate footwear during the day
   • Maintain stretching exercises from physical therapy
   • Consider orthotic insoles for daytime use if not already prescribed

Night splints have demonstrated effectiveness in multiple clinical trials specifically for patients with morning foot pain that persists despite initial conservative measures, making this an appropriate next step in this patient's treatment plan.