Basics of Taping and Orthotics

Plantar Fascia/Arch Taping

Plantar fasciitis or fasciosis is estimated to affect more than 10% of the general population. The most common causes of this pathology relate to a high body mass index, and increased pronation of the midfoot with subsequent flattening of the medial longitudinal arch. Pain persisting along the midfoot extending to the insertion of the plantar fascia at the calcaneus, especially with the first few steps after a period of non-weight-bearing, may benefit from added support to the midfoot. Low-dye and other forms of arch support taping techniques are intended to supplement the structural support of the medial longitudinal arch and the plantar fascia that creates a windlass mechanism needed for normal ambulation.

These taping techniques involve strips of tape that initiate over the insertion of the plantar fascia at the calcaneus or encircle the heel and then extend to the base of each metatarsal head. Elastic or nonelastic tape can be used, with inch widths typically employed. The strips will slightly overlap each other, with a strip that secures the tape under the metatarsal heads. Versions of low-dye taping typically involve continuing a strip of tape under the medial longitudinal arch, and pulling up toward the lateral surface of the shank, effectively pulling the foot out of a pronated position ( Fig. 33.1 ). Additional strips of elastic tape may be wrapped around the midfoot to support the fan shaped collection of strips supporting the arch of the foot.

In a systematic review, van de Water and Speksnijder examined the short-term effects of taping techniques on treating pain and disability associated with plantar fasciosis. The limited evidence reviewed showed a positive short-term effect (<1 week) on pain reduction with taping techniques compared with control conditions and other interventions, but the evidence was inconclusive on the impact on patient disability. Similar positive short-term effects of taping on stiffness were observed by in combination with iontophoresis, with continued benefits observed after 4 weeks of continued treatment. Relief of pain and symptoms through external support of the foot beyond a week may require additional interventions, such as orthotics, which is discussed later in this chapter.

Toe Taping

Sprains to the first metatarsophalangeal (MTP) joint are common in field sports and can be quite debilitating. “Turf toe,” as it is commonly called, can result from a hyperextension or hyperflexion mechanism to the great toe (first MTP joint), which limits dorsiflexion of the great toe and restricts the ability of the patient to push off during ambulation. A taping technique may be employed to resist the painful motion of the MTP joint by looping inch strips of tape to pull the toe into flexion or extension. Additional strips are wrapped around the midfoot to anchor the strips and complete the technique.

Ankle Taping Techniques

The most common anatomical injury among the physically active is to the ankle. Subsequently, taping of the ankle for preventive and immediate treatment purposes is the most common technique used in clinical practice. Due to anatomical and biomechanical principles, the lateral ligaments are the most commonly affected structures of the ankle complex. The purpose of a typical ankle taping technique is to limit plantar flexion and inversion of the ankle complex, which are injurious movements associated with a lateral ankle sprain.

The most common technique for providing support to the lateral ankle complex is called the “closed basket weave.” Typically performed with 1.5 inch nonelastic tape, the strips of tape are applied as “anchors,” “stirrups,” and “heel-locks,” which will cover the ankle complex from the midshank distally to the tarsals ( Fig. 33.2 ). The combination of strips will position the ankle complex into a dorsiflexed and slightly inverted position. The strips of nonelastic tape may be applied either to skin that has been shaved or over a layer prewrap. In addition, thin square foam pads with petroleum jelly may be placed over the insertion of the Achilles tendon on the calcaneus and over the talus, to reduce friction over these skin areas that may suffer irritation from the crossing of the applied strips of tape.

To provide mild stability and compression to an acutely injured ankle, a clinician may utilize an “open basket weave” taping technique. The sequence of application of the anchor and stirrup strips of nonelastic tape is similar to the closed basket weave technique, but the crisscrossing heel locks are not applied with nonelastic tape, leaving the dorsum of the foot exposed ( Fig. 33.3 ). The heel locks are applied with elastic tape under small amounts of tension, or with an elastic bandage. This technique allows some support to ankle complex with the primary purpose to provide comfortable compression to help minimize the early stages of the inflammatory process.

Knee Taping Techniques

Knee Stability

There are many forms of external prophylactic support for the knee, with rigid braces being the choice most clinicians use for long-term wear and prevention. However, there are taping techniques that can be applied to provide stability to the knee joint during physical activity. Most available knee braces are designed to supplement the cruciate and/or collateral ligaments of the knee. Taping techniques can be applied to mimic or supplement the limitations to knee movement these rigid braces are intended to create.

Protection against excessive valgus or varus forces that may threaten the medial and lateral collateral ligaments can be achieved by crisscrossing strips of tape over the medial or lateral surfaces of the knee joint and securing them proximally and distally to the thigh and shank ( Fig. 33.4 ). Additional support can be provided to the cruciate ligaments with this technique by wrapping these crisscrossed strips around the anterior and posterior aspects of the thigh and shank ( Fig. 33.5 ). The angle of each strip is varied in order to comprehensively support the knee joint complex.

Patellofemoral Pain

Patellofemoral pain syndrome (PFPS) is a classification of pathology that presents with anterior knee pain or retropatellar pain. The etiology of PFPS has multiple origins, with many attributed to malalignment and poor tracking of the patella in relation to the femoral groove, resulting in pain. One of the many treatments proposed to alleviate the symptoms of PFPS are taping techniques to reposition the patella statically and dynamically. A systematic review by Aminaka and Gribble concluded that patellar corrective taping techniques have positive outcomes for alleviating pain and improving function, but the explanatory mechanisms are not well established by the existing literature. This is likely a result of the complexity and variability of the pathology, which also helps explain why there are so many variations on patellar taping techniques.

A basic tenet of patellar taping techniques is to determine what form of malalignment and maltracking the patient is suffering from (i.e., patella alta, medial rotation, etc.), and then attempt to pull and reposition the patella, using specialized tape, into the opposite direction or combination of directions. The specialized tape is then used to maintain the corrected position, in order to alleviate excessive pressures between the posterior surface of the patella and the trochlear groove of the femur. One popular collection of these techniques was developed by McConnell, but many variations on these techniques exist and may be successful for individual patient needs. In general, these applications are intended to be worn for longer periods of time (days or weeks; see the section below), as the symptoms may persist beyond physical activity into activities of daily living. Subsequently, specialized, and often more expensive, taping materials are utilized. A common technique is to draw the patella medially, using the tape to hold the position statically, and encourage a new movement pattern during dynamic positioning that prevents lateral patellar displacement during a strong contraction of the quadriceps muscle group ( Fig. 33.6 ). Additional adjustments in the tilt, rotation, and vertical placement of the patella can be made with the taping technique.

Length of Wear/Length of Effectiveness

The materials used for most athletic taping techniques are not designed for long-term wear. These materials provide a significant amount of stability and movement limitation immediately after application, with most of the published evidence focused on ankle taping techniques. However, because they are cloth-based products, exposure to moisture, heat, and tension will quickly reduce the biomechanical stiffness properties of the materials, in as little as 10 minutes after application. One study suggests that while both elastic and nonelastic cloth-based tapes will lose tensile strength after 30 minutes of exercise, elastic tape may not lose as much tension as nonelastic tape, and may be more comfortable. Limited investigation on the amount of joint restriction after application and participation in exercise on the newer category of self-adherent tape materials suggests these newer materials may provide more sustainable stability to the ankle, specifically in restricting inversion movement, compared with nonelastic cloth tape. More research is needed to determine how to improve the restrictive properties of taping materials to maximize their effectiveness.

Evidence on the optimal time period of lasting strength of taping materials used in treating foot and knee conditions discussed in this chapter is quite limited. One can only project that the properties of taping materials that have been studied related to ankle taping would apply to the materials if they are used on other joints of the lower extremity and are subjected to similar demands of physical activity. In most cases, taping techniques are designed for short-term wear (a few hours) before being removed. While a taping technique may be applied every day for many weeks or months (i.e., the length of a sport competition season), some techniques, like the Low-Dye and arch support techniques for plantar fasciitis, are typically applied as an intermediary until a more permanent orthotic can be obtained for the patient.

The exception to this are the materials used for patellofemoral corrective taping. These are applied with the intent of the patient wearing the material on the skin potentially for several days in order to receive a benefit of the repositioned patella during all forms of physical and daily living activities. These materials are constructed of more robust material that resists moisture and maintains its mechanical stiffness. The cost of these materials, such as Leukotape (Beiersdorf, Inc., Wilton, CT), is much higher per roll than cloth-based elastic and nonelastic tapes, and would severely limit joint movement, which explains why clinicians may choose not to use these materials in the daily application of most of the taping techniques that have been described in this chapter.

Injury Prevention

There is an ongoing debate in the literature and in clinical practice as to what is the most effective and cost-efficient prophylactic support for reducing injury in the lower extremity. Typically the comparisons are between taping and bracing of the joints of the lower extremity. While taping is a staple among sports medicine clinicians, there is a relatively limited amount of investigation into the efficacy of taping techniques for the prevention of injury, with the majority of this literature focused on ankle injuries.