Dorsal Night Splint

Suggested HCPCS Code: L4396/L4397

  • Soft, flexible brace
  • Easily fasten and adjust with Velcro closures
  • Gentle stretch provided through simple dorsiflexion strap
  • Fits either left or right foot
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.

Our Process is as follows: