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

Scott & Dyanna Rezac - Taping Foot & Ankle 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 Scott & Dyanna Rezac - Taping Foot & Ankle

Scott & Dyanna Rezac - Taping Foot & Ankle Low Dye Tape on Medial Longitudinal Arch Controls 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 Dec;39(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. Scott & Dyanna Rezac - Taping Foot & Ankle

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. Scott & Dyanna Rezac - Taping Foot & Ankle

Scott & Dyanna Rezac - Taping Foot & Ankle 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. Scott & Dyanna Rezac - Taping Foot & Ankle

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 Scott & Dyanna Rezac - Taping Foot & Ankle

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 Scott & Dyanna Rezac - Taping Foot & Ankle

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. Scott & Dyanna Rezac - Taping Foot & Ankle

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 Scott & Dyanna Rezac - Taping Foot & Ankle

Scott & Dyanna Rezac - Taping Foot & Ankle 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. Scott & Dyanna Rezac - Taping Foot & Ankle

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. Scott & Dyanna Rezac - Taping Foot & Ankle

Scott & Dyanna Rezac - Taping Foot & Ankle 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 Scott & Dyanna Rezac - Taping Foot & Ankle

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, e-stim, US, nerve blocks, walking boot, ther ex. Pt was pain free within 24 hours Scott & Dyanna Rezac - Taping Foot & Ankle

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 over-pronation Great for ATF sprains with navicular lift and/or EV stirrup Scott & Dyanna Rezac - Taping Foot & Ankle

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. Scott & Dyanna Rezac - Taping Foot & Ankle

Posterior Tibialis Kinesio® Technique Medial ankle sprain Tarsal Tunnel Syndrome Tape with moderate stretch (facilitation) or minimal stretch (inhibition) in EV and DF Scott & Dyanna Rezac - Taping Foot & Ankle

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 Scott & Dyanna Rezac - Taping Foot & Ankle

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 Scott & Dyanna Rezac - Taping Foot & Ankle

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. Scott & Dyanna Rezac - Taping Foot & Ankle

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 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. Scott & Dyanna Rezac - Taping Foot & Ankle

Scott & Dyanna Rezac - Taping Foot & Ankle 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 Scott & Dyanna Rezac - Taping Foot & Ankle

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. Scott & Dyanna Rezac - Taping Foot & Ankle

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 Scott & Dyanna Rezac - Taping Foot & Ankle

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 Scott & Dyanna Rezac - Taping Foot & Ankle

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 Scott & Dyanna Rezac - Taping Foot & Ankle

Questions, Comments, Discussion dyanna.rezac@rezacpt.com scott.rezac@rezacpt.com www.rezacpt.com Scott & Dyanna Rezac - Taping Foot & Ankle