Night splints remain a key adjunct in the conservative management of plantar fasciitis and Achilles tendinopathy, particularly when early interventions fail to provide adequate relief. Though simple in concept, proper prescription, fitting, and patient education are critical to optimizing adherence and therapeutic outcomes.
Night splints may be prescribed across several disciplines involved in musculoskeletal care including Podiatrists, Orthopedic Surgeons, Sports Medicine Physicians, Physiatrists, and occasionally Physiotherapists. Night splints are most frequently prescribed when symptoms persist beyond several weeks of standard care, including rest, activity modification, orthotics, and stretching. Indications include:
- Chronic plantar fasciitis: Especially when morning heel pain and first-step stiffness are prominent, reflecting overnight shortening of the plantar fascia.
- Achilles tendinopathy: To maintain gentle, prolonged dorsiflexion and prevent contracture during sleep.
- Post-surgical or immobilization recovery: To preserve tissue length and reduce the risk of equinus deformity.
The therapeutic principle is low-load, prolonged stretch (LLPS). By maintaining the ankle in mild dorsiflexion overnight, the splint keeps the plantar fascia and gastrocnemius–soleus complex elongated, reducing repetitive microtrauma at tissue insertion sites.
While clinical evidence supports night splint efficacy, patient adherence remains the limiting factor. The most frequently reported issues include discomfort, pressure points, fit and slippage, over tightening, and sleep disruption resulting in non-compliance where early intolerance leads to premature discontinuation before clinical benefit is achieved
When properly prescribed and tolerated, night splints can yield meaningful functional improvements and reduce symptom recurrence. Documented benefits include:
- Reduction in morning pain and stiffness through maintained tissue elongation.
- Enhanced healing due to improved collagen remodeling and reduced overnight contracture.
- Decreased recurrence rates in chronic plantar fasciitis and Achilles tendinopathy.
- Non-invasive, cost-effective therapy compared to injections or surgical intervention
Night splints provide a clinically supported, low-risk intervention that complements other conservative modalities for plantar fasciitis and Achilles tendinopathy. The key to success lies not in prescription alone but in fit, comfort optimization, and patient adherence strategies. With appropriate education and gradual acclimation, night splints can significantly enhance rehabilitation outcomes and reduce the chronicity of these common overuse conditions.