
Dorsal Night Splint
- Soft, flexible brace
- Easily fasten and adjust with Velcro closures
- Gentle stretch provided through simple dorsiflexion strap
- Fits either left or right foot
Suggested HCPCS Code: L4396/L4397
Product Number | Size | Shoe Size |
17-0400 | Small/Medium | W: 7-10 M: 7.5-9.5 |
18-0101 | Large/X-Large | W: 10.5-11.5 M: 10-12.5 |
Underlying Conditions:
- Plantar Fascial Fibromatosis
- Contracture of Ankle
- Contracture of Foot
- Cervical Disc Disorder with Radiculopathy/Myelopathy
Coverage Criteria:
(Patient must meet one of the following criteria)
- Plantar Fasciitis
Or all of the following:
- Plantar flexion contracture of the ankle with dorsiflexion on passive range of motion testing (using Goniometer) of at least 10 degrees.
- Reasonable expectation of the ability to correct the contracture
- Contracture is interfering/expected to interfere significantly with functional abilities
- Splint is used as part of therapy program including active stretching of the involved muscles/tendons
For Product Instructions click HERE.