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Posterior Night Splint

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141. Tarsal Tunnel Syndrome (Treatment)

on the orthotic for both the hindfoot and forefoot. The use of night splints with the foot in plantar flexion and varus may be considered in patients with a valgus foot. This modality has not been shown to have long-term efficacy in well-controlled comparison studies with outcome measures, but it is commonly used in clinical practice. [ ] Previous Next: Surgical Therapy When conservative therapy fails to alleviate the patient's symptoms, surgical intervention may be warranted. Space-occupying masses require (...) , whereas six had very good results, four good, and two poor. Protective sensation recovered in all patients. Preparation for surgery The patient may be placed in either the supine or the lateral recumbent position to facilitate exposure of the medial aspect of the operative foot. Use of a pneumatic tourniquet is recommended. Operative details A curved incision should be made approximately 1 cm posterior to the distal tibia and carried in the plantar direction, paralleling the shaft and malleolus

2014 eMedicine Surgery

142. Plantar Heel Pain (Treatment)

the ankle in dorsiflexion can be worn. [ ] Patients who wear a posterior night splint should be warned to take it off before getting out of bed. As an anecdotal example, one patient walked to the toilet while wearing the splint, slipped, and sustained a humeral fracture. However, a dorsally applied splint, as opposed to a posterior splint, need not be taken off before the patient gets out of bed (see images below). A night splint applied on back of the leg and foot. A night splint applied on the front (...) of the leg. Attard et al compared the effectiveness of the posterior night splint, which dorsiflexes the foot, with that of the anterior night splint, which maintains the foot in a plantigrade position. [ ] In this study, two thirds of all participants confirmed that morning pain and stiffness was less after wearing the night splints; both types were relatively easy to don and doff, but the posterior orthosis was more uncomfortable and disrupted sleep. On average, the anterior night splint reduced heel

2014 eMedicine Surgery

143. Plantar Fasciitis (Treatment)

, NSAID therapy, strapping and taping, and over-the-counter (OTC) orthoses. Counseling as to activity modification, as well as choice of shoe gear, is important. After 6 weeks, recalcitrant cases should be treated additionally with a night splint and, possibly, an injection, along with the initial regimen for another 6 weeks. If pain persists, referral to a foot and ankle specialist should be considered. Injection therapy, immobilization in a cast or walker boot, physical therapy, and custom orthotics (...) in patients with chronic plantar fasciitis that does not respond to conservative management. IPST may be considered before surgery when ESWT devices are not available. A randomized, double-blind, prospective clinical pilot study showed that IPST is safe and effective; however, the exact mechanism is unknown and thus warrants further research. [ ] Previous Next: Splints and Orthoses Night splints Most people naturally sleep with their feet in a plantar-flexed position, which causes the plantar fascia

2014 eMedicine Surgery

144. Cubital Tunnel Syndrome (Treatment)

symptoms. The ulnar nerve should be protected from prolonged elbow flexion during sleep and protected during the day through avoidance of direct pressure or trauma. For initial conservative treatment of cubital tunnel syndrome, use of an elbow pad or night splinting for a 3-month trial period is recommended. [ , ] If symptoms do not improve with splinting, daytime immobilization for 3 weeks should be considered. Surgical release may be warranted if the symptoms do not improve with conservative (...) option is to apply a commercial soft elbow splint, with a thermoplastic insert, for persistent symptoms. For constant pain and paresthesia, one should consider using a rigid thermoplastic splint positioned in 45° of flexion to decrease pressure on the ulnar nerve. Initially, patients should wear this splint at all times; as symptoms subside, they can wear it only at night. Patient education and insight are important. Resting on elbows at work, using elbows to lift the body from bed, and resting

2014 eMedicine Surgery

145. Clubfoot (Treatment)

in the corrected position. Apply an above-the-knee plaster-of-Paris cast, which is changed at 3 weeks and maintained to 6 weeks. The foot is initially held in slight equinus if there is tension on the skin closure, which is corrected at the time of cast change. Splintage is continued for at least 4 months after surgery, and night splints are used for several years. The Ilizarov correction is used for recurrent clubfeet, especially in conditions such as arthrogryposis. [ , , , ] (See the image below (...) the deformity early and fully and to maintain the correction until growth stops. Traditionally, two categories of clubfeet are identified, as follows: Easy or correctable clubfeet - These are readily corrected with manipulation, casting, and splintage alone Resistant clubfeet - These respond poorly to splinting and relapse quickly after seemingly successful manipulative treatment; they require early operative management and are said to be associated with a thin calf and a small high heel. The Pirani scoring

2014 eMedicine Surgery

146. Mucopolysaccharidosis (Follow-up)

in these patients. Night splinting and occupational aids have also been helpful. Bone marrow transplantation (BMT) has been successful in the treatment of MPS conditions, especially Hurler syndrome. Children treated with BMT generally have an increased lifespan compared to untreated children. Untreated children commonly died of cardiorespiratory compromise in the first decade of life. However, the musculoskeletal condition (dysostosis multiplex) did not improve with BMT. Skeletal radiographs of children treated (...) growth" techniques. Severe deformities may also necessitate corrective osteotomy, usually of the proximal tibia. Ankle valgus can be also be treated with guided growth techniques. Kyphosis is progressive in many of these patients, especially at the thoracolumbar level and sometimes associated with thoracic scoliosis. [ ] Posterior spinal fusion is proved to prevent further progression. In the cervical spine, odontoid hypoplasia can be seen leading to atlantoaxial instability. Fusion from C1 to C3 can

2014 eMedicine Surgery

147. Supracondylar Humerus Fractures (Follow-up)

of the plates, it is clear that contoured locking plate designs perform far better than traditional nonlocking plates. The ultimate decision regarding plate orientations should be made by the surgeon after careful consideration of the specific requirements of the patient, the characteristics of the fracture, and the availability of equipment. Previous Next: Postoperative Care A posterior long-arm splint is applied with the elbow at 60-90° of flexion, depending on the amount of swelling. The arm is elevated (...) , and early motion, acceptable results can be achieved. Next: Surgical Therapy Optimally, surgery should be performed within the first 72 hours following the injury. Further delay may be necessary in patients with multiple traumatic injuries or in patients who are unable to undergo anesthesia for other medical reasons. In these cases, splint the limb in as nearly normal an anatomic position as possible and elevate it or keep it in sidearm olecranon traction. Generally, unless an open injury, vascular

2014 eMedicine Surgery

148. Swan-Neck Deformity (Follow-up)

after the procedure, the patient is fitted for a dynamic outrigger splint that maintains extension in an appropriate anatomic position of the fingers while the patient undergoes active flexion exercises. Night splints are manufactured to maintain the fingers in extension. Splinting is required for the next 4-8 weeks. Follow-up radiographs are obtained to confirm the appropriate positioning of the implants. Crossed intrinsic transfer of the extensor tendons from the ulnar side to the radial side (...) this problem should be considered. First, MP joint dislocation produces a fixed deformity with a flexed and ulnarly deviated finger. Second, volar and ulnar subluxation of the extensor tendons into the gutters between the phalanges limits extensor function as the extensors essentially become flexors in this position. In this condition, the patient can sometimes maintain MP extension actively after the finger is passively extended. Finally, paralysis due to posterior interosseous nerve compression can also

2014 eMedicine Surgery

149. Plantar Heel Pain (Follow-up)

the ankle in dorsiflexion can be worn. [ ] Patients who wear a posterior night splint should be warned to take it off before getting out of bed. As an anecdotal example, one patient walked to the toilet while wearing the splint, slipped, and sustained a humeral fracture. However, a dorsally applied splint, as opposed to a posterior splint, need not be taken off before the patient gets out of bed (see images below). A night splint applied on back of the leg and foot. A night splint applied on the front (...) of the leg. Attard et al compared the effectiveness of the posterior night splint, which dorsiflexes the foot, with that of the anterior night splint, which maintains the foot in a plantigrade position. [ ] In this study, two thirds of all participants confirmed that morning pain and stiffness was less after wearing the night splints; both types were relatively easy to don and doff, but the posterior orthosis was more uncomfortable and disrupted sleep. On average, the anterior night splint reduced heel

2014 eMedicine Surgery

150. Spinal Tumors (Follow-up)

. Osteoid osteoma usually present in children aged 10-20 years, with a male predominance. They involve the axial skeleton only 10% of the time. In the spine, 59% of osteoid osteomas are found in the lumbar region, 27% in the cervical region, 12% in the thoracic region, and 2% in the sacral region. [ , ] Osteoid osteomas are usually stage 2 lesions and are actively symptomatic. They can result in painful scoliosis, radicular pain, gait disturbances secondary to pain and splinting, and muscular atrophy (...) . Symptoms usually are relieved or ameliorated by administration of nonsteroidal anti-inflammatory drugs (NSAIDs) or salicylates. In the spine, osteoid osteomas occur 75% of the time in the posterior elements (pedicles, facets, or laminae). Osteoid osteomas occur 7% of the time in the vertebral body and 18% of the time in the transverse and spinous processes. On plain radiography, osteoid osteomas appear as a round or oval radiolucent nidus, with a surrounding rim of sclerotic bone. An area of central

2014 eMedicine Surgery

151. Obstructive Sleep Apnea Syndrome (Follow-up)

. CPAP acts as a pneumatic splint to maintain airway patency. By simultaneously increasing the functional residual capacity, this pressure also helps prevent oxygen desaturation even if airway obstruction breaks through. BiPAP or noninvasive ventilation is the preferred form of treatment over CPAP in children with OSA due to neuromuscular disease. [ ] Marcus et al demonstrated improvements in daytime sleepiness, ADHD symptoms, internalizing behaviors and overall quality of life in children with OSA (...) as early as 3 months following the initiation of CPAP therapy. The findings held true in a heterogeneous group of children with OSA and were present even with a mean use of 3 hours/night. These authors suggest that despite the challenges of adherence in young or developmentally delayed children with OSA, clinicians should encourage use of CPAP therapy in appropriate children. [ ] Various patient interfaces are available, including nasal masks, facemasks, gel masks, and nasal pillows to help facilitate

2014 eMedicine Pediatrics

152. Assistive Devices to Improve Independence (Treatment)

; and diabetic retinopathy (eg, microaneurysms, dot hemorrhages), which can be managed with glycemic control or laser surgery. The result of these various changes is a loss of visual acuity, decrease in peripheral vision, and a decline in dark adaptation ability. These visual impairments are related to a higher incidence of falls in the geriatric population, especially at night. Correction and management of visual impairment In the majority of the geriatric population, eyeglasses are sufficient to correct (...) thick carpet, repairing unstable furniture, and installing good lighting. A well-lit pathway to the bathroom that is clear of clutter must be emphasized. Large touch-lights or automatic sensory lights, which do not require dexterity, can be placed at the patient's bedside or in other areas to help decrease the risk of falls, especially at night. Motion-detector lights are helpful in providing illumination (eg, to the bathroom) at night. Falls in the shower and bathtub are the third leading cause

2014 eMedicine.com

153. CPG for the Management of Stroke Patients in Primary Health Care

or vertebrobasilar location, where either of the two criteria below are satis? ed: a) Atherosclerosis with stenosis: 50% stenosis of the luminal diameter or occlusion of the rela- tive extracranial artery or of the large-calibre intracranial artery (middle cerebral, posterior cerebral or troncobasilar), in absence of any other etiology. b) Atherosclerosis without stenosis: Presence of plaques or stenosis of 50 years, HBP, diabetes mellitus, nicotine addiction or hypercholesterolemia. Cardioembolic infarction

2009 GuiaSalud

154. Study of Low Level Laser Therapy to Treat Chronic Heel Pain Arising From Plantar Fasciitis

first arising in the morning, and after prolonged periods of rest. Progressive conservative treatment options for plantar fasciitis include rest, stretching, strengthening, massage, physical therapy, orthotics and shoe inserts, heel cups, night splints, plantar strapping, non-steroidal anti-inflammatories (NSAIDs), steroid and corticosteroid injections and iontophoresis. When conservative treatments are unsuccessful, surgical release or removal of the plantar fascia may occur. However, most (...) splinting, casting, physical therapy, or local corticosteroid injections Subject is willing and able to refrain from consuming non-study approved medications or partaking in other therapies for relief of heel pain throughout study participation Exclusion Criteria: Inability to definitively rule out any one or more of the following potential etiologies of chronic heel pain: mechanical posterior; neurologic; arthritic; and traumatic heel pain Bilateral heel pain Evidence of acute trauma to the heel Loss

2013 Clinical Trials

155. [Trial of device that is not approved or cleared by the U.S. FDA]

a minimum period of 2 weeks; and any two or more of the following conservative treatments: rest, taping, stretching, orthotics, shoe modifications, night splinting, casting, physical therapy, or local corticosteroid injections. Subject is willing and able to refrain from consuming over-the-counter and/or prescription medications for the indication of the relief of pain throughout the study. Subject is willing and able to refrain from partaking in other non-study treatments or therapies for the relief (...) of heel pain throughout the study. Exclusion Criteria: Subject does not have any one or more of the following etiologies of chronic heel pain: Mechanical Posterior Heel Pain; Neurologic Heel Pain; Arthritic Heel Pain; and Traumatic Heel Pain Evidence of acute trauma to the heel Loss of plantar foot sensation Foot deformity Previous surgery to the heel Foot trauma within the previous three months Skin ulceration - infection or wound - on the heel and surrounding treatment area Sciatica Benign

2013 Clinical Trials

156. Femoral Anteversion

rotation (60 to 90 degrees) Decreased external hip rotation (10 to 15 degrees) VII. Differential Diagnosis See Infants or other neuromuscular disorder Toddlers Teen and pre-teen VIII. Diagnosis Biplanar Radiography Used to Measure Femoral Anteversion IX. Management Watchful waiting until age 8 years Avoid non-helpful measures Shoe Modifications Night splints Dennis-Browne splint Twister cables Passive s Physical Therapy Femoral Rotational Osteotomy Indications Comorbid neuromuscular disease (e.g (...) Normal hip Femoral head slightly anterior to Femoral neck Retroverted hip Femoral head posterior to Femoral neck Associated with IV. Mechanism Excessive medial rotation of the femur Normal Femoral Neck Anteversion angles Adults: 15-25 degrees Children Age 3-12 months: 39 degrees Age 1-2 years: 31 degrees V. Symptoms Standing appearance: "Kissing e" Clumsy gait appearance: "Egg-Beater" feet (" ") Sitting position: "Inverted W" Sitting with hips flexed and internally rotated (feet at either side

2015 FP Notebook

157. Effectiveness of Manual Therapy Combined With Standard Treatment in the Management of Plantar Fasciitis

bearing. The pain intensity can be very high and this can cause functional limitations and reduce quality of life. Despite the high prevalence of the PF, treatment is controversial and not supported by extensive research. Review of the previous studies on various treatments, mentioned steroid injections, shock waves, night splint, orthotics, heel padding and stretching exercises. Limitation of ankle dorsi flexion is a common finding and thought to be a contributing factor to the development (...) therapy in frequency of 1 MHz, power of 1.5 watts per centimeter-squared, pulses of 50% for 5 minutes. The study group will receive the same treatment and a number of manual techniques that include antero-posterior (AP) mobilization for talocrural joint in two variations (weight baring and non-weight baring) to improve the range of dorsi flexion, subtalar joint mobilization to improve range of eversion and mid-tarsal mobilization to improve pronation / supination of the forefoot. Each technique

2011 Clinical Trials

158. Overview of Fractures, Dislocations, and Sprains

are immobilized initially with a splint until most of the swelling resolves. How to Apply Fiberglass Splints VIDEO How to Apply a Posterior Ankle Splint VIDEO How to Apply a Long Arm Splint VIDEO How to Apply a Sugar Tong Ankle Splint VIDEO How to Apply a Thumb Spica Splint VIDEO How to Apply an Ulnar Gutter Splint VIDEO How to Apply a Short Leg Cast VIDEO How to Apply a Shoulder Sling and Swathe and Shoulder Immobilizer VIDEO How to do a Short Arm Cast VIDEO How to Apply a Volar Arm Splint VIDEO Joint (...) in millimeters or bone width percentage. Angulation is the angle of the distal fragment measured from the proximal fragment. Displacement and angulation may occur in the ventral-dorsal plane, lateral-medial plane, or both. Treatment Treatment of associated injuries Reduction as indicated, splinting, and analgesia RICE (rest, ice, compression, and elevation) or PRICE (including protection with a splint or cast) as indicated Usually immobilization Sometimes surgery Initial treatment Serious associated problems

2013 Merck Manual (19th Edition)

159. Stroke Rehabilitation

, and aphasia require specific therapy. Hemiplegia For patients with hemiplegia, placing 1 or 2 pillows under the affected arm can prevent dislocation of the shoulder. If the arm is flaccid, a well-constructed sling can prevent the weight of the arm and hand from overstretching the deltoid muscle and subluxating the shoulder. A posterior foot splint applied with the ankle in a 90° position can prevent equinus deformity (talipes equinus) and footdrop. Resistive exercise for hemiplegic extremities may (...) , resulting in pain and difficulty maintaining personal hygiene. Patients and family members are taught to do these exercises, which are strongly encouraged. A hand or wrist splint may also be useful, particularly at night. One that is easy to apply and clean is best. Heat or cold therapy can temporarily decrease spasticity and allow the muscle to be stretched. Hemiplegic patients may be given benzodiazepines to minimize apprehension and anxiety, particularly during the initial stage of rehabilitation

2013 Merck Manual (19th Edition)

160. Achilles Tendon Enthesopathy

through their range of motion for about 1 min when rising after extended periods of rest. Night splints may also be prescribed to provide passive stretch during sleep and help prevent contractures. Standing Gastrocnemius Stretch VIDEO Heel lifts should be used temporarily to decrease tendon stress during weight bearing and relieve pain. Even if the pain is only in one heel, heel lifts should be used bilaterally to prevent gait disturbance and possible secondary (compensatory) hip and or low back pain (...) , DPM, Temple University School of Podiatric Medicine Click here for Patient Education NOTE: This is the Professional Version. CONSUMERS: Topic Resources Achilles tendon enthesopathy is pain at the insertion of the Achilles tendon at the posterosuperior aspect of the calcaneus. Diagnosis is clinical. Treatment is with stretching, splinting, and heel lifts. (See also .) The cause of Achilles tendon enthesopathy is chronic traction of the Achilles tendon on the calcaneus. Contracted or shortened calf

2013 Merck Manual (19th Edition)

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