Essential Insights On Athletic Taping For Common Sports Injuries

Coming from an athletic training background, I was introduced to the benefits of taping and padding early in my career. Much of the principles and techniques that I have used are from core principles in athletic training, which we incorporate into our biomechanical skills course at the California School of Podiatric Medicine.

Taping and padding should be an integral part of every podiatrist’s practice. Taping is both an art and science that offers the patient and doctor many benefits: reduced pain, increased function and a predictor for orthotic therapy based on a patient’s response to taping and padding. Many of the additions that we add to our orthotic prescription are based on the different pads that we have used to reduce pressure and offload. If the patient does not respond positively to taping and padding, you should be very cautious in prescribing a custom functional orthotic for treatment.

I have found that the two main reasons podiatrists do not tape in their practice are that they do not think they can get reimbursement for taping or that they do not know how to tape.   

Why Use Taping And Padding?
Athletic taping has the following advantages and caveats.

• Athletic taping requires practice, creativity and adaptability.
• It can be therapeutic as well as diagnostic.
• Athletic taping can be a predictor of orthotic treatment success.
• It is not a substitute for a comprehensive rehabilitation program.
• Athletic taping does allow for an earlier return to activity and offers protection from further injury.

The functions of taping and padding are for support, control of excessive motion (flexible splint), proprioception and protection (reduced end range of motion stress). Patients often can leave taping on for several days as long as it is comfortable and supportive. I allow patients to shower with the tape on as long as it is not for an extended period. They can use a hair dryer on warm or cool to help dry the taped area. Athletes usually remove the tape after the activity.  

The most common taping procedures are: low Dye strapping, turf toe strapping, ankle strapping and Achilles tendon strapping. The most common pads I use are metatarsal pads, sesamoid pads, cobra pads, the medial longitudinal arch pad and heel lifts. Note that one should put padding on top of the tape job in order to ensure that the tape has even contact and pressure. This also allows the patient to remove the pad when showering and subsequently reapply the tape. I usually start with a thinner pad (1/8 inch) to see how the patient responds before going to a thicker pad.  

Prior to taping a patient or athlete, always inquire about any reactions or allergic reactions to taping. If the patient has had a negative reaction, find out what type of tape it was from. Also, if patients have fair skin or freckles, be cautious and monitor the tape job closely. Frequently, you can use pre-wrap or underwrap for sensitive patients. A pre-tape spray is also very helpful as it preps the skin and provides for better adhesion of the tape. Frequently, we have the patient shave the area to provide better contact and less discomfort when removing tape. Make sure the patient has not applied lotion to the area as it will affect the contact of the tape. It is best that the patient does not wear flip-flops or sandals after taping the foot.

Using Tape For Medial Versus Lateral Column Overload
It is helpful to divide common injuries and pathologies into medial or lateral column overload injuries. Common medial column overload injuries would be plantar fasciitis, medial tibial stress syndrome, posterior tibial tendinopathy or dysfunction, patellofemoral pain syndrome, sesamoiditis and hallux abducto valgus to name a few. Lateral column overload would be iliotibial band tendonitis or syndrome, peroneal tendonitis or lateral ankle instability.

In my practice, the medial column overload is the most common injury and I routinely use a low Dye strapping and pad (cobra, etc.) as treatment options. For lateral column overload, reverse the low Dye arch straps with tension going in a medial to lateral direction (pronating foot).

Troubleshooting Common Problems With Taping
The following are solutions for common taping problems I have experienced over the years in practice.

Tape is too tight. Have the patient walk in the office for a few minutes to confirm that the tape is on too tight. Usually, it will feel fine after a few minutes of walking as the tape loosens up a bit. Also, the retention strap may be on too tight. Try not to take the tape off right away and reapply the tape job as it may not be necessary.

Tape comes off. Usually this happens because one has not applied the retention strap correctly to hold it on. Make sure the patient has not applied lotion recently. Also, it is best to have patients put on their socks and shoes after applying the tape.

Tape losing strength. This can result from tape staying on too long, getting too wet or not having enough reinforcement of tape straps (depending on the activity and weight of the patient).

Skin is irritated or itchy. This is because athletes have left the tape on too long, got the tape too wet, have sensitivity to tape or did not use underwrap under the tape job. The patient may need to take a tape vacation or go on to a brace or support such as an over-the-counter arch support or wrap.

What You Should Know About The Common Principles Of Taping
Learn to tear tape with your hands instead of depending on bandage scissors. Do this simply by holding the tape with your thumb and index finger, and rapidly tearing with one hand while holding the other hand still.

For skin preparation, using a spray tape adherent protects the skin and allows the tape to adhere to skin better. You can apply petroleum jelly and pads on pressure areas. Make sure to cover any open skin areas. Have the patient shave the area of hair if needed as tape removal can be painful.

When applying underwrap, apply it in a single layer with gentle tension, overlapping about a half from the forefoot to the rearfoot. Do the tearing by a rapid pull on the underwrap. Remember, the underwrap will retain moisture and heat, but is useful when athletes tape on a daily basis or have skin sensitivity issues.

Using tape cutters or scissors, one can gently remove tape, lifting it away from the skin and following contours. Avoid rapid removal as this can cause tape cuts or “skin burns.” It is usually best to remove the tape job following athletic activity.

As for types of tape, I prefer porous cloth athletic tape, which allows moisture and heat to pass through, helping to keep the skin dry and cool. Nonporous tape increases the potential for skin damage and can be occlusive. Very few patients will have reactions to cloth athletic tape. Some areas adhere better to adhesive elastic type tape (such as Elastikon (Johnson and Johnson) or Elastoplast (Beiersdorf)), which allows muscles to contract without restricting circulation or nerve function. Some doctors like to apply paraffin wax over the tape job to secure the tape but I find it defeats the purpose of using porous tape. One can use flesh-colored tape for those athletes such as dancers, martial artists and gymnasts who compete barefoot.

Always instruct your athletes to monitor the tape job for any tingling, numbness, impairment of circulation, skin reaction or loss of mobility to affected areas. If any problems occur, they should gently remove the tape, soak their foot, apply lotion to the area and contact you for follow-up.

Here are a few key pointers for taping.

1) Place the foot and ankle in the position you want it to be stabilized in as movement can cause wrinkles and uneven application to tape.
2) Select the proper type of tape for the area and overlap by half.
3) Avoid continuous taping whenever possible to prevent constriction of the area.
4) Keep a roll of tape in hand while taping.
5) Smooth and mold tape to the skin when applying.
6) Apply tape firmly and with a purpose. Fit the contour of the skin and pull the tape in the desired direction to control motion.
7) Begin taping with an anchor piece to attach strips to and finish with a lock strap.
8) Tape directly to the skin whenever possible for maximum support and protection.
9) Always be in a comfortable position to tape the patient and apply pressure for straps.

Pertinent Principles On Low Dye Strapping
The following is my basic low Dye taping technique, which consists of anchors, transverse straps and a retention strap, which are basic taping techniques. Please remember there are many variations to taping the arch.  

1) Apply an anchor strap for arch strapping just proximal to the first and fifth metatarsal heads, looping behind the rearfoot. Take care not to be too plantar (pulls on heel fat pad) or too high (irritates the Achilles).
2) Apply transverse straps with pressure lateral to medial (for medial column overload), overlapping a half for added strength and preventing gaps, leaving the heel area open and going distally to just proximal to the first and fifth metatarsal heads. Typically, this is three or four straps for the average adult foot.
3) Repeat the anchor strap and apply the second set of transverse straps and anchor this.
4) Apply a retention strap on top of the foot to secure the low Dye strapping.
5) One can apply a cobra or medial longitudinal arch pad for additional control for medial column overload.  

Comparing Bracing And Taping
There are pros and cons to taping versus bracing for the ankle. Bracing is usually more cost-effective for the entire athletic season, is easier on the skin, maintains support and athletes or patients can usually apply braces.

However, fit is the key as a brace only comes in basic sizes. Braces are also more bulky or high profile than taping. Although tape is inexpensive, a professional does need to apply it for the best benefit.

In Summary
Athletic taping and padding can play an integral role in your treatment of athletes and patients in your practice with common athletic injuries and biomechanical overload issues. If you currently do not incorporate taping and padding for the treatment of foot and ankle injuries in your practice, it may be of benefit to develop your skills in taping and padding. It provides support, control and proprioceptive benefits as well as immediate relief or reduction of pain. Taping is an essential prelude to considering functional orthotics and what pads and additions you would consider for your orthotic prescription. From an evidence-based medicine perspective, we need studies that demonstrate the effectiveness of taping as we know empirically that it is an essential part of our podiatric treatment plan for a variety of injuries.

Dr. Dutra is a Past President of the American Academy of Podiatric Sports Medicine. He is a Fellow of the American Academy of Podiatric Sports Medicine, the American College of Sports Medicine, the American College of Foot and Ankle Orthopedics and Medicine, and the National Academies of Practice. Dr. Dutra is an Assistant Professor in the Department of Applied Biomechanics at the California School of Podiatric Medicine at Samuel Merritt University. He is affiliated with Kaiser Permanente in Oakland, Calif., and is a podiatric consultant for intercollegiate athletics at the University of California at Berkeley. Dr. Dutra is also a member of the Board of Directors of the Joint Commission on Sports Medicine & Science.