Randomized Controlled Trial of Calcaneal Taping, Sham Taping, and Plantar Fascia

Journal of Orthopaedic & Sports Physical Therapy
Official Publication of the Orthopaedic and Sports Physical Therapy Sections of the American Physical Therapy Association
Randomized Controlled Trial of Calcaneal
Taping, Sham Taping, and Plantar Fascia
Stretching for the Short-Term Management
of Plantar Heel Pain
Matthew R. Hyland, PT, MPA, CSCS 1
Alisa Webber-Gaffney, PT, OTR/L 2
Lior Cohen, PT 3
Steven W. Lichtman, EdD, FAACVPR 4
Study Design: Prospective, experimental, randomized, single-factor, pretest/posttest design.
Objectives: To examine the effects of a calcaneal and Achilles-tendon–taping technique, utilizing
only 4 pieces of tape and not involving the medial arch, on the symptoms of plantar heel pain.
Background: Plantar fasciitis is one of the most common causes of heel and foot pain. Physical
therapists have applied many techniques in an attempt to relieve the symptoms of plantar heel
pain, including various taping methods for which there is little existing evidence.
Methods and Measures: Subjects (n = 41) were randomly assigned into 4 groups: (1) stretching of
the plantar fascia, (2) calcaneal taping, (3) control (no treatment), and (4) sham taping. A visual
analog scale (VAS) for pain and a patient-specific functional scale (PSFS) for functional activities
were measured pretreatment and after 1 week of treatment (posttreatment).
Results: A significant difference was found posttreatment among the groups for the VAS (P , .001).
Specifically, significant differences were found between stretching and calcaneal taping (mean ±
SD, 4.6 ± 0.7 versus 2.7 ± 1.8; P = .006), stretching and control (mean ± SD, 4.6 ± 0.7 versus 6.2
± 1.0; P = .026), calcaneal taping and control (mean ± SD, 2.7 ± 1.8 versus 6.2 ± 1.0; P , .001),
and calcaneal taping and sham taping (mean ± SD, 2.7 ± 1.8 versus 6.0 ± 0.9; P , .001). No
significant difference among groups was found for posttreatment PSFS (P = .078).
Conclusions: Calcaneal taping was shown to be a more effective tool for the relief of plantar heel
pain than stretching, sham taping, or no treatment. J Orthop Sports Phys Ther 2006;36(6):364-371.
doi:10.2519/jospt.2006.2078
Key Words: ambulation, biomechanics, gait, orthotics, pain
1
Instructor, Department of Physical Therapy, Mercy College, Dobbs Ferry, NY; President, Rye Physical
Therapy & Rehabilitation, Rye, NY.
2
Staff Therapist, Hasbro Children’s Hospital & RI Hospital Sports Rehab Center, New York, NY; Student
(at time of study), Mercy College, Dobbs Ferry, NY.
3
Director, Metro Physical Therapy and Sports Rehabilitation, New York, NY; Student (at time of study),
Mercy College, Dobbs Ferry, NY.
4
Assistant Professor, Department of Physical Therapy, Mercy College, Dobbs Ferry, NY; Director,
Cardiopulmonary Outpatient Services, Helen Hayes Hospital, West Haverstraw, NY.
The protocol for this study was approved by The Institutional Review Board of Mercy College, Dobbs
Ferry, NY. The authors have no financial affiliation (including research funding) or involvement with any
commercial organization that has a direct financial interest in any matter included in this manuscript.
Address correspondence to Matthew R. Hyland, 266 Purchase Street, Rye, NY 10580. E-mail:
mhylandpt@aol.com
364
P
lantar fasciitis is one of
the
most
common
causes of heel and foot
pain, affecting up to 2
million Americans each
year and accounting for 15% of all
foot pathologies.31,34 This inflammatory response has been classified as an overuse syndrome
resulting in microtears of the
plantar fascia at its origin.5,10
Waugh40 has suggested that accepted inflammatory conditions,
such as epicondylitis, may be more
accurately referred to as chronic
pain syndromes. Therefore, individuals suffering from what has
traditionally been referred to as
plantar fasciitis may be more accurately described as suffering from
plantar heel pain. Patients initially
presenting with plantar heel pain
typically complain of pain during
the first few steps they take in the
morning and/or their first few
steps after prolonged rest.5,10,31 Individuals most prone to plantar
heel pain are middle-aged women,
obese individuals, athletes, and
male runners.10,31,34 The 2 most
common underlying causes of
plantar heel pain, degenerative
and mechanical, are believed to
result from years of overuse and
trauma.5
Journal of Orthopaedic & Sports Physical Therapy
11,13,18,22,23,28,31,33,36,38,39,41,42
J Orthop Sports Phys Ther • Volume 36 • Number 6 • June 2006
365
REPORT
Numerous nonsurgical treatments have been used
to relieve the symptoms associated with heel pain.
These include rest,6,10 exercise (stretching and
strengthening),6,32,28,38 external support (orthotics,
night splints, and taping),9,10,11,16,21-23,33,39,41 and modalities (cryotherapy, ultrasound with and without
phonophoresis, electrical stimulation, whirlpool, and
administration of nonsteroidal anti-inflammatory medications through iontophoresis or injections).4-6,10,13,18 Davis et al6 determined that 89% of
patients had some pain relief after 12 months of
nonsurgical treatment. To date, stretching appears to
be the easiest, most useful technique to alleviate the
symptoms associated with plantar heel pain.7,32,26,28,38
Stretching of the Achilles tendon and plantar fascia,
performed 3 to 5 times daily, has been shown to be
effective in decreasing the pain at the plantar fascia.32,28,38 However, although alleviating symptoms,
stretching does not address the underlying pathology
of poor foot biomechanics, and therefore may only
provide temporary relief.
Nonsurgical interventions, such as rest, exercise,
and modalities, focus on relieving the symptoms
associated with plantar heel pain; however, orthotics
and taping techniques address the underlying problem of poor foot biomechanics. Arch taping applied
to reduce foot pronation has been used as an adjunct
to physical therapy for the treatment of plantar heel
pain.5 Taping can be applied in either the acute or
chronic stage in lieu of or prior to the use of
orthotics.35
The low-Dye taping technique has been shown to
be an effective treatment option for pain relief,
providing support of the medial arch.14,28,36 Low-Dye
medial longitudinal arch taping used by Holmes et
al14 resulted in pain reduction for patients with
plantar heel pain. Ernst et al8 examined the windlass
effects of a taping technique supporting the longitudinal arch to relieve pain. This technique used a
low-Dye tape with active hallux dorsiflexion and
eversion of the forefoot to stabilize the first ray.
Nineteen of 20 subjects reported a decrease in pain
posttaping. Vicenzino et al37 investigated the effect of
2 taping techniques applied vertically to support
navicular height. Low-Dye tape and low-Dye with
calcaneal slings were used. Low-Dye tape with
calcaneal slings was found to be more effective
immediately after application and after exercising.
Keenan and Tanner16 examined the effects of highDye and low-Dye taping of the rear foot. Eighteen
subjects were tested under 3 conditions: barefoot,
low-Dye taping, and high-Dye taping. Good success
rates were found with both the low-Dye and high-Dye
taping techniques; however, the high-Dye taping was
more effective for control of pronation. Lynch et al22
performed a study in which taping of the arch was
more effective (based on patient reported outcome,
pain, and treatment failure) than other conservative
interventions for the reduction of plantar heel pain.
Orthotics that support the medial longitudinal arch
under load should decrease the strain on the plantar
fascia, thereby reducing pain. In cadaver studies by
Kogler19 and Kitaoka17 plantar fascia strain was found
to be lowest under conditions in which load was
applied to a higher medial longitudinal arch versus a
collapsed arch. In a study by Genova and Gross,9 it
was shown that orthotics have a significant effect on
calcaneal eversion and excessive foot pronation,
which are both believed to contribute to the etiology
of plantar heel pain.1,5,20,29,34,41 Orthoses help control foot alignment and maintain the calcaneus in a
more neutral position.9,20,36 However, a limitation to
the use of orthotics in the acute treatment of plantar
heel pain is the great variability in choice of orthotics
and the high cost.12,25 Taping, prior to orthotic use
may minimize these potential problems. Relief of
symptoms with taping techniques is considered a
strong indicator for the successful long-term application of orthotics. However, current taping methods
tend to be cumbersome and time consuming and
often uncomfortable for the patient.
To date, there have been no studies investigating
the acute effects of attempting to control the position
and alignment of the calcaneus and Achilles tendon
during weight bearing through the use of taping.
RESEARCH
The plantar fascia is a thick fibrous connective
tissue which originates at the medial tuberosity of the
calcaneus and inserts into the plantar plates of the
metatarsophalangeal joints, the base of the proximal
phalanges, and the sheaths of the flexor tendons.9,29,34,42 The plantar fascia acts like a bowstring
to maintain and provide support for the longitudinal
arch of the foot and to assist with dynamic shock
absorption.9,42 The plantar fascia plays an important
role in providing foot support and rigidity throughout the gait cycle.5,29 During loading, the plantar
fascia allows for flexibility of the midfoot when
conforming to the ground and provides shock absorption.39 At preswing, the metatarsophalangeal
joints are in extension, the plantar fascia is taut, and
there is an increase in the height of the longitudinal
arch, which results in supination of the foot and
assists in propulsion.1,5,20,29,34,39,41 Poor biomechanics
in any of these phases can lead to foot pathology and
associated plantar heel pain.
Excessive pronation is a commonly cited risk factor
for developing plantar heel pain.1,5,20,29,34,41 Excessive
pronation is caused by plantar flexion and adduction
of the talus during weight bearing, causing the
calcaneus to evert. The biomechanics of an adducted
talus and an everted calcaneus results in increased
tension in the structures on the plantar surface of the
foot, causing the arch to collapse and creating
excessive stress on the plantar fascia. 1,4-6,9-
Previous strapping and taping techniques attempted
to provide support for the arch (midfoot region)
rather than controlling the calcaneus (rearfoot region). With the biomechanical premise that a decreased height of the longitudinal arch of the foot is
caused by eversion of the calcaneus and plantar
flexion/adduction of the talus, the purpose of this
study was to examine the effects of a calcaneal and
Achilles tendon taping technique utilizing only 4
pieces of tape, that do not involve the medial arch of
the foot, on the symptoms of plantar heel pain.
Theoretically, this technique places the foot in an
improved biomechanical position by repositioning
the calcaneal alignment closer to neutral and increasing the medial longitudinal arch height, thus reducing stress and subsequent microtraumas to the
plantar fascia. It is this focus on biomechanics at the
rearfoot versus the midfoot that makes this technique
unique.
It is hypothesized that this calcaneal taping technique will show a greater decrease in pain, utilizing a
visual analog scale (VAS), and an increase in functional activity, as measured by a patient-specific functional scale (PSFS), compared to stretching of the
plantar fascia, sham taping, and no treatment.
METHODS
Subject Selection
Subjects were included through a sample of convenience and recruited via fliers placed in gymnasiums
and physician offices in and around Manhattan, NY.
The following inclusion/exclusion criteria were used
to determine eligibility. Inclusion criteria: (1) age
between 18 and 65 years, (2) pain with first steps
upon waking (greater than or equal to 3 on a 0-to-10
VAS scale), (3) pain located at the heel or plantar
surface of midfoot consistent with plantar fasciitis
(defined as pain immediately upon awakening and
pain with walking or jogging), and (4) presence of an
everted calcaneus greater than or equal to 2°
(goniometric measurement taken on the posterior
surface of the hindfoot in the frontal plane in
relaxed bilateral stance).24 Exclusion criteria: (1)
previous surgery or treatment for plantar fasciitis in
the previous 6 months and during the study period
(including use of pain or anti-inflammatory medications), (2) history of ankle or foot fracture, (3)
congenital deformity of the foot or ankle, (4) spasticity throughout the lower extremity, (5) use of an
assistive device for ambulation, (6) bilateral plantar
heel pain, or (7) refusal to participate in the study.
Each prospective subject completed a questionnaire
containing the following information pertaining to
the inclusion/exclusion criteria: age, plantar heel
pain symptomatology as indicated on the PSFS, level
of pain on the VAS, location of pain, triggers of pain,
366
and past medical history. Forty-five individuals were
screened and 42 subjects were entered into the study
(1 subject was excluded for previous ankle surgery
and 2 for current treatment of plantar fasciitis).
Forty-one subjects completed the study (1 subject
dropped out due to scheduling conflicts).
Subjects were randomly assigned to 4 groups with
the use of a random number table. Ten subjects were
in group 1 (stretching alone), 11 subjects were in
group 2 (calcaneal taping only), 10 subjects were in
group 3 (control), and 10 subjects were in group 4
(sham taping). All subjects signed appropriate consent forms approved by the Mercy College Institutional Review Board.
Procedures
The study utilized a prospective, experimental,
randomized, single-factor, pretest/posttest design. All
testing and training procedures were performed in
the physical therapy office of 1 of the investigators
(L.C.). Each subject admitted to the study underwent
the following procedures at baseline: (1) questionnaire for recording of demographic information, (2)
VAS for pain measurement, (3) PSFS for self-rated
functional limitations, (4) group assignment, and (5)
first group-appropriate intervention. Midway through
the treatment week (day 3 or 4), subjects in groups 2
and 4 returned to the office for a second and final
retaping, and subjects in group 1 returned for a
second and final stretching treatment. One week
after initiating the study all the subjects returned to
the office and completed the VAS and the PSFS for a
second time. Posttreatment measures of VAS and
PSFS were made with the tape in place for subjects in
the calcaneal- and sham-taping groups.
Subjects were all tested and treated individually
and had no contact with, or knowledge of, the
identity of any other individuals in the study. Subjects
in the calcaneal- and sham-taping groups were
blinded to type of treatment and were educated to
detect possible adverse reactions. All subjects were
instructed to maintain normal behavior patterns during the week.
Independent Variable: Calcaneal Taping
There were 4 levels of the independent variable:
stretching, calcaneal taping, no treatment (control),
and sham taping. Group 1 received passive stretching
of the ankle plantar flexors and plantar fascia on day
1, and day 3 or 4 in the physical therapy office of one
of the investigators. The soleus muscle was stretched
with the knee flexed and the gastrocnemius muscle
was stretched with the knee extended. Overpressure
was placed upon the bottom of the foot while the
ankle was in dorsiflexion. A passive stretch was
applied to the big toe flexors to incorporate stretch
J Orthop Sports Phys Ther • Volume 36 • Number 6 • June 2006
Dependent Variables
to the plantar fascia. The stretch to both muscle
groups was performed by 1 of the primary researchers for 3 repetitions, each held for a count of 30
seconds.32 Subjects in group 1 were instructed not to
perform these stretches at home. Group 2 received
calcaneal taping alone. Cover-Roll stretch bandage
(Beirsdorf, AG, Hamburg, Germany) was applied to a
clean and dry skin surface and then covered with
Leukotape (Leuko Sportstape; Beirsdorf, AG, Hamburg, Germany). Once the Cover-Roll was applied
(Figure 1A), taping with the Leukotape followed.
Piece 1 was applied just distal to the lateral malleolus,
pulling the calcaneus medially, and was attached to
the medial aspect of the foot distal to the medial
malleolus (Figure 1B). Pieces 2 and 3 followed the
same pattern with overlap of approximately one third
of the tape width moving in the distal direction
(Figures 1C and 1D). Piece 4 went around the back
of the heel starting distal to the lateral malleolus,
wrapping around the posterior aspect of the
J Orthop Sports Phys Ther • Volume 36 • Number 6 • June 2006
Statistical Analysis
To correct for baseline differences between the
groups in age and body mass (Table 1) an analysis of
covariance (ANCOVA) was used to determine the
significance of mean differences between groups 1
through 4 for the pain VAS and for the PSFS
measurements. Tukey post hoc analysis was used to
determine specific differences among the 4 groups
for variables identified as significantly different by the
367
REPORT
FIGURE 1. Calcaneal-taping technique. Once the Cover-Roll was
applied (Figure A), taping with the Leukotape followed. Piece 1 was
applied just distal to the lateral malleolus, pulling the calcaneus
medially, and was attached to the medial aspect of the foot distal to
the medial malleolus (B). Pieces 2 and 3 followed the same pattern
with overlap of approximately one third of the tape width, moving
in the distal direction (C and D). Piece 4 went around the back of
the heel, starting distal to the lateral malleolus, wrapping around the
posterior aspect of the calcaneus, and anchoring distal to the medial
malleolus (E). Piece 4 also serves as an anchor for the first 3 pieces
(F).
VAS The VAS is a line scale with anchors at 0 and
10 (0 indicating no pain, 10 indicating the worst pain
imaginable). The subjects self-rated their foot pain,
based on their first few steps in the morning, by
placing a mark on the line representing their level of
pain. Price et al27 demonstrated the validity and
reliability of the VAS to measure pain.
PSFS Subjects were asked to list 3 activities they
were unable to do, or had difficulty doing, as a result
of foot pain. The subjects then self-rated these
activities on a scale of 0 to 10, with 0 indicating
inability to perform the activity and 10 indicating
ability to perform the activity at preinjury level.3
Specific directions from the scale were: ‘‘Identify 3
important activities that you are unable to do or have
difficulty with as a result of your problem. Today, how
difficult is it to perform each activity? Choose a
number between 0 and 10 indicating your ability to
do each activity.’’3
Chatman et al3 showed the PSFS to have excellent
test-retest reliability, sensitivity to change, and validity.
RESEARCH
calcaneus and anchoring distal to the medial malleolus (Figure 1E). Piece 4 also serves as an anchor
for the first 3 pieces (Figure 1F). Theoretically, this
technique places the foot in an improved
biomechanical position by repositioning the calcaneal
alignment closer to neutral and increasing the medial
longitudinal arch height, thus reducing stress and
subsequent microtraumas to the plantar fascia.
Group 3 was the control group. Subjects in this
group were measured at baseline and at 1 week with
no treatment provided. Group 4 received sham taping (Cover-Roll stretch bandage and Leukotape) that
did not attempt to control the alignment/position of
the calcaneus. No medially directed force was applied
to the tape during application, the tape simply being
overlaid on the skin.
Subjects in the calcaneal- and sham-taping groups
were instructed to keep the tape in place for 24
hours a day. Postintervention VAS and PSFS scores
were reflective of the period the tape was worn.
Subjects in all 4 groups were instructed to maintain
their usual activity level during the period of the
study, not terminating or initiating anything new.
TABLE 1. Characteristics (mean ± SD) of the subjects.
Age (y)
Stretching group
Calcaneal-taping group
Control group
Sham-taping group
34.1
45.5
37.6
40.4
±
±
±
±
5.9
12.0
10.1
9.4
Gender
Height (cm)
Body Mass (kg)
BMI (kg/m2)
8M,
5M,
3M,
5M,
176.5
172.7
169.9
173.7
82.6
74.4
74.2
73.8
26.3
24.8
25.4
23.6
2F
6F
7F
5F
±
±
±
±
9.4
10.4
7.1
8.9
±
±
±
±
18.6
16.6
18.3
10.2
±
±
±
±
3.8
4.4
4.3
1.7
Abbreviations: BMI, body mass index; M, males; F, females.
TABLE 2. Preintervention and postintervention data (mean ± SD) for the pain visual analog scale (VAS) and the patient-specific functional scale (PSFS).
Stretching group (n = 10)
Calcaneal-taping group (n = 11)
Control group (n = 10)
Sham taping group (n = 10)
Pre-VAS
Post-VAS
Pre-PSFS
Post-PSFS
6.3
7.0
6.3
6.4
4.6
2.7
6.2
6.0
5.6
4.5
5.3
5.3
4.9
6.2
4.8
5.4
±
±
±
±
0.8
0.8
1.2
1.2
±
±
±
±
0.7*
1.8*
1.0
0.9*
±
±
±
±
1.1
1.6
1.5†
0.5
±
±
±
±
1.2
1.8
1.3†
0.6
* Indicates a significant difference between pre-VAS and post-VAS (P , .05).
†
Indicates a significant difference between pre-PSFS and post-PSFS (P , .05), suggesting a decline in function.
ANCOVA. Paired Student t tests were used to determine within-group differences pretreatment to posttreatment for the pain VAS and the PSFS
measurements. Data are presented as mean ± SD.
All analyses were performed using SPSS Version
14.0 (SPSS Inc, Chicago, IL). Alpha level was set at
less than or equal to .05.
PSFS
Demographic characteristics of the subjects are
shown in Table 1.
Within-group analysis revealed a significant difference pretreatment to posttreatment for the control
group (mean ± SD, 5.3 ± 1.5 to 4.8 ± 1.3; P = .003),
indicating a decrease in function. The other groups
did not significantly change in PSFS score (Table 2).
At baseline, ANCOVA showed no significant difference among the groups for the PSFS values (F =
1.398, P = .259; Figure 3). Posttreatment, no significant difference was found among the groups for the
PSFS values (F = 2.460, P = .078; Figure 3).
VAS
DISCUSSION
Within-group analysis revealed a significant difference in VAS score from pretreatment to posttreatment for the stretching (mean ± SD, 6.3 ± 0.8 to 4.6
± 0.7; P, .001), calcaneal taping (mean ± SD, 7.0 ±
0.8 to 2.7 ± 1.8; P, .001), and sham taping (mean ±
SD, 6.4 ± 1.2 to 6.0 ± 0.9; P = .037) groups. There was
no significant change in the VAS score for the
control group (Figure 2).
At baseline, the ANCOVA showed no significant
difference among the groups for the VAS scores (F =
1.228, P = .313; Figure 2). Posttreatment, a significant
difference was found between the groups for the VAS
scores (F = 18.580, P ,.001; Figure 2). Tukey post
hoc analysis revealed significant differences between
stretching and calcaneal taping (mean ± SD, 4.6 ± 0.7
versus 2.7 ± 1.8; P = .006), stretching and control
(mean ± SD, 4.6 ± 0.7 versus 6.2 ± 1.0; P = .026),
calcaneal taping and control (mean ± SD, 2.7 ± 1.8
versus 6.2 ± 1.0; P, .001), and calcaneal taping and
sham taping (2.7 ± 1.8 versus 6.0 ± 0.9; P, .001)
(Table 2 and Figure 2). There was no significant
difference between stretching and sham taping or
between control and sham taping (Figure 2).
This study examined the effects of a calcanealtaping technique on the symptoms of plantar heel
pain. This technique has not been previously studied
and differs from other taping methods in its
biomechanical approach. The calcaneal-taping technique inverts the heel to raise the medial longitudinal arch of the foot, unlike other taping methods
that place the tape directly on the arch to support it.
Within 2 treatment sessions the use of the calcanealtaping technique resulted in a significantly greater
reduction in pain than stretching, sham taping, or no
treatment. Taping resulted in no adverse reactions for
any of the participants.
This study showed significant improvements for
pain in the stretching and sham-taping groups (–1.7
and –0.4 on the VAS, respectively); however, calcaneal
taping showed a significantly greater decrease than
either (–4.3 on the VAS). Previous studies have shown
stretching to be a viable treatment technique for pain
associated with plantar heel pain.28,32,38 In this study,
the frequency of stretching may have been insufficient to get or expect greater results, as subjects in
that group were instructed not to replicate the
RESULTS
368
J Orthop Sports Phys Ther • Volume 36 • Number 6 • June 2006
technique at home. The slight reduction in pain in
the sham-taping group may have been due to
proprioceptive feedback from the tape, or a placebo
effect.
While Davis et al6 found that 89% of patients have
some relief of plantar heel pain in 1 year, the
calcaneal- and Achilles-taping technique create immediate relief. It is also consistent with previous taping
studies that showed a reduction in pain with various
techniques to support the medial longitudinal
arch.8,14,16,22,28,36,37
The taping technique described in the present
study differs from previous attempts to mediate pain
and function with tape in its ease of application and
cost. With only 4 pieces of tape it is easier and faster
for a therapist to apply, and it is less expensive than
techniques using larger quantities of tape. The tech-
PSFS
Postintervention
9
8
7
6
5
4
3
2
1
0
Stretching Calcaneal
Taping
Control
Sham
FIGURE 3. Preintervention and postintervention data (mean ± SD)
for the Patient-Specific Functional Scale (PSFS) for the 4 groups.
Higher score (scale, 0 to 10) indicates better function. No significant
preintervention to postintervention differences were noted.
J Orthop Sports Phys Ther • Volume 36 • Number 6 • June 2006
369
REPORT
Preintervention
RESEARCH
FIGURE 2. Preintervention and postintervention data (mean ± SD)
for the pain visual analogue scale (VAS) for the 4 groups. The VAS is
a line scale where 0 means no pain and 10 means worst pain
imaginable. *The postintervention calcaneal taping group VAS score
was significantly lower than for the other 3 groups (P , .05). † The
postintervention stretching group VAS score significantly lower than
for the control group (P , .05).
nique is an ideal precursor to orthotics, which has
been shown by Gross et al12 to be a long-term option
to relieve symptoms of plantar heel pain. However,
the relative benefits of this technique compared to
other methods of taping have yet to be explored.
This calcaneal-taping technique brings together 2
important aspects of clinical care: patient pain relief
and the identification of a long-term solution. While
other interventions, such as ultrasound, iontophoresis, and cryotherapy, address the symptoms of
plantar heel pain, taping addresses one presumed
cause of the pathology—poor foot biomechanics.
Taping the calcaneus to prevent excessive pronation
and maintain a more neutral position presumably
helps control the height of the medial longitudinal
arch, thus taking the force off of the plantar fascia.
The results of the present study need to be viewed
in light of several limitations. The study was performed over a 1-week period thus excluding analysis
of long-term benefits for calcaneal taping. However,
the technique is primarily intended as a short-term
bridge to other, longer-term therapies such as
orthotic use; therefore, the study was specifically
designed to be completed over a 1-week period.
Second, the PSFS may have not been sensitive
enough to pick up changes occurring over such a
short period. Additionally, the PSFS was not intended
to be a tool that allows for between-group comparisons. Therefore, its usefulness in this study may be
questioned. However, the rationale behind its choice
was its appropriate application in a previous pilot
study that was aimed at obtaining specific functional
information related to foot pain. For the present
study, a tool such as the Functional Foot Index2 may
have yielded more relevant and valid information
over a short period. Third, there was no reliability
analysis performed on the goniometric measurements
of calcaneus eversion as part of the inclusion criteria.
While it was important to the researchers that
calcaneus eversion was present, the known measurement error of goniometric measurement is acknowledged as a limitation. Although the calcaneal and
Achilles taping technique was designed to correct any
degree of calcaneal eversion, a threshold of 2° for
inclusion was selected. However, this choice of angle
is not substantiated by any literature. As identified by
Jonson,15 a threshold of 5° may be more appropriate
to identify people with greater pronation. Lastly,
duration of symptoms was not obtained, so the effect
of chronicity on pain reduction was not examined. It
is possible that the length of time an individual
suffers from plantar heel pain may affect response to
calcaneal taping.
Although the present study shows short-term relief
of pain, studies utilizing a longer period are warranted to determine if there is a continued reduction
in symptoms and if taping remains more effective
than stretching over time. Another area of investiga-
tion would be to substantiate the theoretical mechanical benefits of the technique through the use of
biomechanical analysis.21 As identified by Robbins, et
al30 there are 2 competing theories as to the mechanism through which the taping technique may be
alleviating heel pain. One possible mechanism is at
the proprioceptive level, with the tape providing foot
position awareness.30 This mechanism could explain
the small decrease in pain observed in the shamtaping group. The second proposed mechanism is
that taping changes foot mechanics. The significantly
larger effect shown in the calcaneal-taping group may
provide some support to this theory.30 Finally, a study
examining symptom relief, cost, and orthotic success
on subjects who receive taping prior to orthotic use
compared to subjects receiving orthotics as the primary treatment would demonstrate the efficacy of
calcaneal taping as part of an overall treatment plan
for patients with plantar heel pain.
CONCLUSION
The advantage to the calcaneal-taping technique is
its ability to provide relief from the symptoms of
plantar heel pain that frequently keep patients from
attending work and participating in their functional
activities. The present study has shown calcaneal
taping to be an effective tool for relief of plantar heel
pain, and may act as a precursor to long-term
management through the use of orthotics. It is easy
and quick for the therapist to apply, and creates
immediate symptom relief.
ACKNOWLEDGEMENTS
The authors would like to acknowledge and thank
former Mercy College Physical Therapy Students: Dan
Macca, Laura Watson, Donna Jenkins, and Stephen
Makita, who contributed much time and effort to this
project. We would also like to thank Robin Carlucci,
DPM and Rock Positano, DPM for lending their
expertise to the study, as well as Lester Ferguson and
George Mattei at Helen Hayes Hospital for assisting
in the photography.
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