Plantar Fasciitis – Need Both Orthotics and Calf Stretching Night Splint To Make a Difference

Recent article did not find orthotics by self made a difference, but when combined with dorsiflexion calf stretching night splint reduced pain by 50% in 8 weeks.

J Rehabil Res Dev. 2012 Dec;49(10):1557-64.
Effectiveness of adjustable dorsiflexion night splint in combination with accommodative foot orthosis on plantar fasciitis.
Lee WC, Wong WY, Kung E, Leung AK.  free article here

  • 14 cases in each group
  • Orthotics were designed to reduced shock absorption and balance foot – the latter often from flat feet – ie pes planus combined with a 6 mm heal lift
  • Dorsiflexion splint involved:
    “(1) a 3 mm-thick polypropylene footplate;
    (2) a tailor-made low-profile soft ankle-foot sleeve made of perforated neoprene sheets with appropriate sewing that allowed the footplate to be attached, and
    (3) an adjustable Velcro strap with a buckle”

Results:

Comment: – Explains why results are hard to obtain with just arthrtis pills and a Tuli’s heel cups combined with moleskin raise

I believe the foot nerves are irritated in plantar fasciitis and try to knock them out some with 5% lidocaine in 5% Dextrose injections into them (I use a bent needle and stay fairly close to skin – using < 1.5 mls total . Afterwards, I then try to tear the plantar fascia by pushing on it transversely and knuckling it after. No steroid (or maybe trivial 5 mg kenalog) is used.

Here is an anatomy pic of it:

Medial calcaneal nerve entrapment was written about here:

Physiotherapy Theory and Practice, 24(4):291–298, 2008
Medial calcaneal nerve entrapment as a cause for chronic heel pain
David J Diers
http://www.ncbi.nlm.nih.gov/pubmed/18574754

The tip off that was an issue was “moderate to severe tenderness on the medial side of the calcaneus and on the anterior border of the calcaneus. This palpation also reproduced pain in the plantar surface of the heel near the area of the heel spur.”

It is intersting how night splint hyperextends toes to get more plantar stretch. One source of polypropylene would be alimed Carboplast 4″ by 12″ sheets available Here

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