Today, I wanted to dive into a topic that’s been on my mind lately: nighttime stretching braces.
In the past, we’ve typically used static progressive braces, which have adjustable straps that can be shortened over time to increase range of motion. While the concept is solid, compliance has been a challenge for many families. Despite our efforts to make it easy (marking straps, giving clear instructions, offering guidance), the feedback from many has been that they are tricky, subjective, and confusing. If things are not just right, then the patient wakes up in the middle of the night which can be very frustrating to them and the parents. All in all, too many things could go wrong and as a result, they just weren’t getting used as much as we’d like. And in some cases, after a few rough nights, not at all!
The Experiment
Last year, we decided to try something different. Instead of focusing on progressive range of motion, we honed in on the main goal: preventing excessive plantar flexion during sleep. So, we experimented with holding the foot in a more neutral position, using a static brace.
Our new approach has been to use a solid ankle AFO (ankle-foot orthosis) made from soft plastic for added comfort and flexibility. It's also lined with foam in key areas to increase comfort. And the feedback has been fantastic!
Why It’s Working
The big win here has been compliance. With this brace, there’s no need for frequent adjustments—it’s set at one angle, and an angle the patient can tolerate, keeping kids out of excessive plantar flexion all night. This simplicity means that when they wake up, they have the range they need to comfortably get into their day brace and start heel-toe walking, helping to gain range throughout the day.
We’ve been using this approach for about a year now, and I’m happy to say it’s been extremely successful. Families report that it is much easier to put on, they receive far less complaints from their kiddos, and as a result, gains are being made!
Well that’s it for today—just something to think about if you’ve been facing similar challenges.
Thanks for reading!
Dave
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