Elsevier

Gait & Posture

Volume 66, October 2018, Pages 118-123
Gait & Posture

Full length article
Effects of kinesiotaping and athletic taping on ankle kinematics during walking in individuals with chronic ankle instability: A pilot study

https://doi.org/10.1016/j.gaitpost.2018.08.034Get rights and content

Highlights

  • We tested how kinesiotaping and athletic taping affect ankle motion during walking.

  • Kinesiotaping reduced foot inversion during early stance phase.

  • Athletic taping increased tibial internal rotation during late stance phase.

Abstract

Background

Individuals with chronic ankle instability (CAI) tend to walk with an overly inverted foot, which increases the risk of ankle sprains during stance phase. Clinicians could perform ankle taping using kinesiotape (KT) or athletic tape (AT) to address this issue. Because KT is elastic while AT is not, the techniques and underlying mechanisms for applying these tapes are different, which may lead to different outcomes.

Research question

To compare the effects of KT and AT interventions on foot motion in the frontal plane and tibial motion in the transverse plane during stance phase of walking.

Methods

Twenty subjects with CAI were assigned to either KT or AT group, and walked on a treadmill in no tape and taped conditions. Their foot and tibial motions were captured by 3D motion analysis system. The main component of KT application was two pieces of tape applied from the medial aspect of the hindfoot to the lateral to generate a pulling tension towards eversion. AT was applied to the ankle using the closed basket weave approach. AT was not stretchable and not able to generate the same pulling tension as KT.

Results

KT increased foot eversion during early stance, but showed no effect during late stance. AT increased tibial internal rotation during late stance, but showed no effect during early stance.

Significance

Compared to AT, KT better provides a flexible pulling force that facilitates foot eversion during early stance, while not restricting normal inversion in late stance during walking. KT may be a useful clinical tool in correcting aberrant motion while not limiting natural movement in sports.

Introduction

Ankle sprains are one of the most common athletic injuries with a pooled cumulative incidence rate of 11.55 per 1000 exposures [1]. Inversion injuries account for 85% of all ankle sprains [2]. Many individuals who had an ankle sprain eventually develop chronic ankle instability (CAI), which is characterized by recurrent ankle giving way and/or sprains [3]. In high school and Division I athletes, approximately 23% were identified as having CAI [4]. Repeated injuries at the ankle due to CAI could cause irreversible degenerative changes, with 68–78% of individuals with CAI developing post-traumatic ankle osteoarthritis [5].

Alteration in gait kinematics may contribute to recurrent ankle sprains in individuals with CAI [[6], [7], [8], [9]]. Specifically, they tend to walk with an overly inverted ankle [7,8], which could increase the risk of inversion injuries following initial contact. Landing the foot on the floor with hyper-inversion moves the center of pressure further towards the lateral border of the heel [10]. This increases the moment arm for the ground reaction force to generate greater inversion torque during loading response [3]. Loading response is a gait period when the body weight is fully transferred onto the stance leg, and naturally the ankle moves into eversion for shock absorption [11]. If the eversion motion does not occur effectively, an inversion sprain can occur.

Decreasing ankle inversion during loading response may play a role in reducing the risk of ankle sprains. One approach to achieve this goal is using non-elastic athletic tape (AT) to restrict ankle inversion [12]. Two studies applied AT to the ankle using a traditional closed basket weave in individuals with CAI, and examined how the intervention affected gait [13,14]. One study showed that the intervention restricted ankle inversion during pre-swing (when the foot starts to push off the ground) but not during loading response [13]. However, restricting inversion during pre-swing may not be ideal, as this motion is required to lock the midfoot for creating a rigid lever for push off [15]. The other study examining tibia-rear foot coupling implied that the AT intervention restricted rear foot eversion in relation to tibial rotation during loading response [14]. However, ankle eversion is critical for shock absorption during loading response [15]. These results together showed that AT has the ability to “restrict” ankle motion, but has limited ability to “facilitate” a desired ankle motion at the right time during a gait cycle.

We asked if we can use Kinesiotape (KT) to achieve reduction of ankle inversion during loading response, while not affecting the same motion during pre-swing. Unlike AT, KT is elastic and can be stretched to 140% of its original length before being applied to the skin [16]. In principle, the elasticity of KT provides two advantages. First, KT can generate pulling force in the direction that the tape is stretched [16,17]. During loading response, this pulling force could be used to provide: (a) a sensory cue to guide active ankle movement towards eversion and (b) a mechanical assistance that passively moves the ankle towards eversion [18]. Second, people can overcome the tension generated by KT, and moves the ankle into inversion as it normally occurs during pre-swing.

The purpose of this pilot study was to compare effects of AT intervention (provide inversion restriction) and KT intervention (provide eversion facilitation through generating pulling tension) on foot motion in the frontal plane and tibial motion in the transverse plane during loading response and pre-swing. In closed chain, foot inversion drives the tibia into external rotation as the configuration of the subtalar joint is like a mitered hinged joint [15]. We hypothesized that KT has greater ability than AT to reduce foot inversion and increase tibial internal rotation during loading response, but AT has greater ability than KT to achieve the same during pre-swing.

Section snippets

Subject recruitment and assignment

Twenty subjects with CAI were conveniently recruited from a university campus. A sample size of 10–20 was previously suggested for a pilot study [19]. Subjects were included if they aged between 18 and 45, as ankle sprains often happen in the young population [20]. Subjects were determined to have CAI if they scored 24 or lower in the Cumberland Ankle Instability Tool (CAIT), had more than one event of ankle giving way in the past six months, and had an ankle sprain one year before enrollment [

Foot position

Subjects demonstrated a less inverted foot when walking with KT compared to walking without KT during the early stance phase (Fig. 3A). Such change only reached significance in zone 1 (without KT: 6.97 ± 3.1°; with KT: 5.28 ± 3.1°; p = 0.03; d = 0.82). The foot position change observed from zone 2 to zone 10 did not reach statistical significance.

Subjects showed minimal changes in foot position during each stance phase zone when walking with AT compared to walking without AT (Fig. 3B), and none

Discussion

This study had two major findings. First, KT reduced foot inversion (or increased foot eversion) right after initial contact during walking in individuals with CAI, but the same effect was not observed in AT. Second, AT increased tibial internal rotation (or reduced tibial external rotation) during late stance phase in walking in individuals with CAI, but the same effect was not shown in KT. Based on effect size estimates, all significant results had a medium to large effect [25].

The KT and AT

Conclusion

Compared to AT, KT better provides a flexible pulling force that facilitates foot eversion during early stance, while not restricting natural inversion during late stance in walking. The foot and ankle must move in different directions to achieve different functions in walking. The elasticity allows KT to facilitate motion in one direction, while not limiting motion in the opposite direction. This cannot be achieved by AT, which has a non-elastic property. The clinical significance of our

Conflict of interest statement

The authors affirm that there is no conflicts of interest that may have influenced the preparation of this manuscript.

Acknowledgements

We thank all students who assisted in subject preparation and data collection. We thankDr. Stephen Clark for his assistance in athletic taping.

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