Transcript Slide 1

Therapeutic Taping
for the
Foot and Ankle
Dr. Dyanna Haley-Rezac, PT, DPT, OCS, CSCS, CKTP
Dr. Scott Rezac, PT, DPT, OCS, CSCS, CKTP, CEAS
Plantar Fascia Unload
Gastroc/Soleus/Achilles Complex Unload
Athletic 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
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Low Dye Tape on Medial Longitudinal Arch
Controls Pronation During Stance, Running, Walking
Vicenzion B et al. Initial effects of antipronation tape on the medial longitudinal
arch during walking and running. British
Journal of Sports Med. 2005 Dec;39(12):93943
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.
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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-Sep;42(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.
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Calcaneal tape vs sham, stretching, and no
treatment on Plantar Fascia Pain
Calcaneal 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.
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Navicular Lift
McConnell 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
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Distal Fibular Glide
Mulligan 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
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Mulligan Fibular Glide Taping
Decreased 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 Sep;36(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.
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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. 2530.
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
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Achilles Space Correction
Kinesio® 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/plantar
fascia unload.
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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.
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Morton’s Neuroma
Space correction to relieve pain
from Morton’s 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
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Kinesio® Neuroma Case Study
Eliminated Pain
Stahl, A. Clinician’s 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, estim, US, nerve blocks, walking boot,
ther ex.
Pt was pain free within 24 hours
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Peroneal Facilitation
Kinesio® 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 overpronation
Great for ATF sprains with
navicular lift and/or EV
stirrup
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Eversion Stirrup
Biomechanical Correction
Athletic 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.
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Posterior Tibialis
Kinesio® Technique
Medial ankle sprain
Tarsal Tunnel Syndrome
Tape with moderate
stretch (facilitation) or
minimal stretch
(inhibition) in EV and DF
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Tibialis Anterior
Kinesio® 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
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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
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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.
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Hallux Valgus
Correction
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 endrange 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.
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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
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Edema / Lymphedema
Kinesio® Technique
Edema Reduction
For acute ankle sprains or post-surgical foot/ankle.
Anchor distally and lie strips without stretch around
edema area without stretch.
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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
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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
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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
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Questions, Comments, Discussion
[email protected] [email protected]
www.rezacpt.com
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