Therapeutic Taping for the Foot and Ankle

1
Therapeutic Tapingfor the Foot and Ankle

• Dr. Dyanna Haley-Rezac, PT, DPT, OCS, CSCS, CKTP
• Dr. Scott Rezac, PT, DPT, OCS, CSCS, CKTP, CEAS

2
Plantar Fascia Unload Gastroc/Soleus/Achilles
Complex UnloadAthletic Training Modified
Kinesio Technique(also achilles tendonosis,
gastroc strain)

• Step 1 With foot in dorsiflexion, begin tape at
  transverse arch on plantar aspect of foot. Apply
  maximal stretch to calcaneus. Can also fan
  and/or direct to 1st ray for improved 1st
  distribution.

Step 2 Split tape and apply to medial and
lateral aspects of the gastroc/soleus complex
with moderate stretch. Very effective when
combined with navicular lift
3
Low Dye Tape on Medial Longitudinal ArchControls
Pronation During Stance, Running, Walking

• Vicenzion B et al. Initial effects of
  anti-pronation tape on the medial longitudinal
  arch during walking and running. British Journal
  of Sports Med. 2005 Dec39(12)939-43
• 17 subjects who were asymptomatic and exhibited a
  navicular drop greater than 10 mm.
• The augmented LowDye tape was effective in
  controlling pronation during both static and
  dynamic activity. Tape induced changes in static
  foot posture paralleled those during walking and
  jogging.

4
Low Dye Tape Increased Lateral Midfoot Plantar
Pressures

• Vicenzino B et al. Plantar foot pressures after
  the augmented low dye taping technique. J Athl
  Train. 2007 Jul-Sep42(3)374-80.
• Within-subjects, repeated-measures randomized
  control trial utilizing 15 women and 7 men who
  were asymptomatic.
• The ALD predominantly increased plantar pressures
  in the lateral midfoot during walking and
  jogging. In addition, tape reduced mean maximum
  pressure at the medial forefoot and at the medial
  rearfoot during walking.

5
Calcaneal tape vs sham, stretching, and no
treatment on Plantar Fascia PainCalcaneal Tape
More Effective

• Hyland MR Webber-Gaffney A Cohen L Lichtman PT
  J Orthop Sports Phys Ther 2006 Jun Vol. 36 (6),
  pp. 364-71.
• Randomized controlled trial of 41 subjects with
  plantar heel pain 1)calcaneal taping , 2)sham
  taping, 3) plantar fascia stretching and 4)
  control for the short-term management of plantar
  heel pain.
• Calcaneal taping was shown to be a more effective
  tool for the relief of plantar heel pain than
  stretching, sham taping, or no treatment but no
  change on PSFS.

6
Navicular LiftMcConnell Technique

• Stability and deceleration of pronation moment
  during stance
• Similar to a chopat for the foot
• Step 1 No stretch from lateral dorsum to
  navicular tubercle
• Step2 Maximal stretch from tubercle to
  anteriolateral tibia

7
Distal Fibular GlideMulligan Technique

• Improve DF
• Tension ATFL to prevent lateral ankle sprain
• Step 1 Tape from slightly anterior and distal to
  distal fibula
• Step2 maximal stretch in a posterior and
  proximal direction around the posterior calf
  while applying a posterosuperior glide
• Same technique can be used for superior tib-fib

8
Mulligan Fibular Glide TapingDecreased Ankle
Injury

• Moiler K, Hall T, Robinson K. The role of fibular
  tape in the prevention of ankle injury in
  basketball A pilot study. J Orthop Sports Phys
  Ther. 2006 Sep36(9)661-8.
• 443 measured basketball exposures resulted in 11
  ankle injuries. All injuries occurred in subjects
  with a history of previous ankle sprain.
  Significantly less ankle injuries were sustained
  by members of the FRT condition
• This study provides preliminary data regarding
  the prophylactic effects of FRT on ankle injury
  in male basketball players.

9
Athletic Ankle Taping Postural Sway Improved
Faster

• Matsusaka N et al. Effect of ankle disk
  training combined with tactile stimulation to the
  leg and foot on functional instability of the
  ankle. Am J Sports Med 2001 Jan-Feb Vol. 29
  (1), pp. 25-30.
• Twenty-two university students with unilateral
  functional instability of the ankle. 2 Groups
  1) Tape 2) No tape
• In group 1, postural sway values decreased
  significantly after 4 weeks and WNL after not
  more than 6 weeks. In group 2, the values did
  not improve significantly until after 6 weeks and
  WNL until 8 weeks. The findings suggest that this
  was due to an increased afferent input from skin
  receptors that were stimulated by the traction of
  the adhesive tape

10
Achilles Space CorrectionKinesio Tape utilizing
McConnell/Mulligan Concepts

• Step 1 Cut a 3-square piece of tape and remove
  backing from middle 1/3 of tape.

Step 2 With foot in DF, stretch maximally
horizontally across the Achilles tendon.
Step 3 Lie down two ends without stretch. Very
effective when combined with gastroc/soleus/planta
r fascia unload.
11
Transverse Arch Support

• Metatarsalgia
• Enhance transverse arch support
• Step 1 Stretch maximally across plantar
  transverse arch (metatarsal heads).
• Step2 Lie down end without stretch on dorsal
  aspect of foot.

12
Mortons Neuroma

• Space correction to relieve pain from Mortons
  neuroma / Metatarsalgia
• Step 1 Place with maximal stretch across site of
  most pain (usually between 2nd 3rd or 3rd
  4th MTP on plantar surface, but can be used on
  dorsal surface if neuroma is on the superior
  aspect)
• Step2 Lie down ends without stretch

13
Kinesio Neuroma Case StudyEliminated Pain

• Stahl, A. Clinicians Overview Case Study
  Post Operative Neuroma and RSD.  15th Annual
  Kinesio Taping International Symposium Review.
  (pp. 99-102) Tokyo, Japan Kinesio Taping
  Association. 1999.      
• Pt. s/p neuroma resection subsequently developed
  RSD
• Failed to manage pain with scar tissue
  mobilization, joint mobilization, e-stim, US,
  nerve blocks, walking boot, ther ex.
• Pt was pain free within 24 hours

14
Peroneal FacilitationKinesio Technique

• Lateral Ankle Sprain
• Peroneal Strain
• Mod to max stretch from lateral fibula to 1st MET
  (longus) or 5th MET (brevis)
• Tape with ankle in IV DF
• For active control of peroneals for lateral
  stability to correct over-pronation
• Great for ATF sprains with navicular lift and/or
  EV stirrup

15
Eversion Stirrup Biomechanical CorrectionAthletic
Taping Technique

• Lateral ankle sprain
• Can be used with peroneal facilitation and/or
  navicular lift
• Step 1 begin at the medial calcanceus and lie
  tape down on plantar aspect of the calcaneus
• Step2 stretch maximally up the lateral aspect of
  the calf to apply an EV force to the ankle.

16
Posterior TibialisKinesio Technique

• Medial ankle sprain
• Tarsal Tunnel Syndrome
• Tape with moderate stretch (facilitation) or
  minimal stretch (inhibition) in EV and DF

17
Tibialis AnteriorKinesio Technique

• Facilitate DF
• Inhibit with space correction for shin splints
• With foot in EV and PF, mod to max for
  facilitation and minimal to no stretch for
  inhibition

18
Tarsal Tunnel Space Correction

• Space correction of tarsal tunnel
• Can be used with posterior tibialis facilitation
  and/or navicular lift.
• Step 1 Stretch maximmally over tarsal tunnel, no
  stretch on ends
• Step2 Can repeat 2-4 times in different
  directions

19
Hammertoe, Mallet Toe Claw Toe Correction

• Toe Deformities
• Step 1 Start at the dorsum of the foot and apply
  a mod to max stretch across the joints in
  excessive flexion (facilitation) and minima
  stretch across the joint in excessive extension
  (inhibition). Can be done as a single 1 strip
  for each toe or fan for several toes.
• Step2 Cap around toes.

20
Hallux ValgusCorrection

• Can be augmented with navicular lift
• Valgus or Varus can be used on any toe.
• Step 1 Begin medial on the 1st ray, stretch
  moderately to maximally along medal foot to
  calcaneus (avoid positioning 1st MTP at end-range
  of available motion).
• Step2 Continue around posterior calcaneus
  laterally and back to medial foot on the dorsum
  ending at the medial 1st ray (starting point).
• Step3 A small strip can be used around the toe
  to secure ends without any stretch.

21
Taping Toes

• As with fingers, tape for what you want to
  accomplish
• Extension of DIP maximal stretch dorsal joint
• Normal motion of PIP no stretch
• Flexion of DIP maximal stretch volar joint
• Collateral ligament protection / Unload one joint
  X strips on either side of joint, anchor the
  ends
• Decrease strain on flexor tendon tape with
  moderate stretch on volar surface of digit up
  muscle to origin
• Immobilize a digit Buddy Tape two fingers
  together with two 1 strips
• Space correction over entrapment site

22
Edema / LymphedemaKinesio Technique

• Edema Reduction
• For acute ankle sprains or post-surgical
  foot/ankle.
• Anchor distally and lie strips without stretch
  around
• edema area without stretch.

23
Clinical Evidence Based

• Objective Assessments
• Gait
• Gait mechanics (at IC, MS, TS, etc)
• Heel Strike
• DF, 1st ray extension
• Decreased toe clawing
• Calcaneal, midfoot, forefoot position
• Stride Length
• Stance Time
• Distance
• Speed
• Assistive Device

24
Clinical Evidence Based

• Objective Assessment (cont).
• Pain
• at rest
• with AROM
• previously aggravating positions / activities
• VAS (Visual Analog Scale)
• Neurological Symptoms
• Outcome Measures
• LEFS (Lower Extremity Functional Scale)
• AROM
• MMT

25
Clinical Evidence Based

• Objective Assessment (cont).
• Functional Tests (Asterisk Signs)
• Step up, step down, SLS, jumping, running
• Less pain, more reps, improved range / height?
• Cutting, cross-overs, uneven surface
• ADLs
• Stair negotiation

26
Questions, Comments, Discussion
dyanna.rezac_at_rezacpt.com scott.rezac_at_rezacpt.co
m www.rezacpt.com