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: [email protected] 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. REFERENCES 1. Barrett SJ, O’Malley R. Plantar fasciitis and other causes of heel pain. Am Fam Physician. 1999;59:2200-2206. 2. Budiman-Mak E, Conrad KJ, Roach KE. The Foot Function Index: a measure of foot pain and disability. J Clin Epidemiol. 1991;44:561-570. 3. Chatman AB, Hyams SP, Neel JM, et al. The PatientSpecific Functional Scale: measurement properties in patients with knee dysfunction. Phys Ther. 1997;77:820-829. 4. Crawford F, Snaith M. How effective is therapeutic ultrasound in the treatment of heel pain? Ann Rheum Dis. 1996;55:265-267. 370 5. Crosby W, Humble RN. Rehabilitation of plantar fasciitis. Clin Podiatr Med Surg. 2001;18:225-231. 6. Davis PF, Severud E, Baxter DE. Painful heel syndrome: results of nonoperative treatment. Foot Ankle Int. 1994;15:531-535. 7. DiGiovanni BF, Nawoczenski DA, Lintal ME, et al. Tissue-specific plantar fascia-stretching exercise enhances outcomes in patients with chronic heel pain. A prospective, randomized study. J Bone Joint Surg Am. 2003;85-A:1270-1277. 8. Ernst B, Walker M, Echternach J, Hoke B. Windlass taping technique for symptomatic relief of plantar fasciitis. Phys Ther. 1999;79:34-39. 9. Genova JM, Gross MT. Effect of foot orthotics on calcaneal eversion during standing and treadmill walking for subjects with abnormal pronation. J Orthop Sports Phys Ther. 2000;30:664-675. 10. Gill LH. Plantar fasciitis: diagnosis and conservative management. J Am Podiatr Med Assoc. 1997;5:109-117. 11. Gross MT. Semirigid orthoses position feet for plantar fasciitis relief. Biomech. 2001;41: 12. Gross MT, Byers JM, Krafft JL, Lackey EJ, Melton KM. The impact of custom semirigid foot orthotics on pain and disability for individuals with plantar fasciitis. J Orthop Sports Phys Ther. 2002;32:149-157. 13. Gudeman SD, Eisele SA, Heidt RS, Jr., Colosimo AJ, Stroupe AL. Treatment of plantar fasciitis by iontophoresis of 0.4% dexamethasone. A randomized, double-blind, placebo-controlled study. Am J Sports Med. 1997;25:312-316. 14. Holmes CF, Wilcox D, Fletcher JP. Effect of a modified, low-Dye medial longitudinal arch taping procedure on the subtalar joint neutral position before and after light exercise. J Orthop Sports Phys Ther. 2002;32:194-201. 15. Jonson SR, Gross MT. Intraexaminer reliability, interexaminer reliability, and mean values for nine lower extremity skeletal measures in healthy naval midshipmen. J Orthop Sports Phys Ther. 1997;25:253263. 16. Keenan AM, Tanner CM. The effect of high-Dye and low-Dye taping on rearfoot motion. J Am Podiatr Med Assoc. 2001;91:255-261. 17. Kitaoka HB, Luo ZP, An KN. Analysis of longitudinal arch supports in stabilizing the arch of the foot. Clin Orthop Relat Res. 1997;250-256. 18. Knight CA, Rutledge CR, Cox ME, Acosta M, Hall SJ. Effect of superficial heat, deep heat, and active exercise warm-up on the extensibility of the plantar flexors. Phys Ther. 2001;81:1206-1214. 19. Kogler GF, Solomonidis SE, Paul JP. Biomechanics of longitudinal arch support mechanisms in foot orthoses and their effect on plantar aponeurosis strain. Clin Biomech (Bristol, Avon). 1996;11:243-252. 20. Kwong PK, Kay D, Voner RT, White MW. Plantar fasciitis. Mechanics and pathomechanics of treatment. Clin Sports Med. 1988;7:119-126. 21. Lange B, Chipchase L, Evans A. The effect of low-Dye taping on plantar pressures, during gait, in subjects with navicular drop exceeding 10 mm. J Orthop Sports Phys Ther. 2004;34:201-209. 22. Lynch DM, Goforth WP, Martin JE, Odom RD, Preece CK, Kotter MW. Conservative treatment of plantar fasciitis. A prospective study. J Am Podiatr Med Assoc. 1998;88:375-380. 23. Martin JE, Hosch JC, Goforth WP, Murff RT, Lynch DM, Odom RD. Mechanical treatment of plantar fasciitis. A prospective study. J Am Podiatr Med Assoc. 2001;91:55-62. 24. Oatis CA. Biomechanics of the foot and ankle under static conditions. Phys Ther. 1988;68:1815-1821. J Orthop Sports Phys Ther • Volume 36 • Number 6 • June 2006 Physician Sportsmed. 2000;28:57-61. 33. Singh D, Angel J, Bentley G, Trevino SG. Fortnightly review. Plantar fasciitis. BMJ. 1997;315:172-175. 34. Tanner S, Harvey J. How we manage plantar fasciitis. Physician Sportsmed. 1988;1:39-47. 35. Vicenzino B, Feilding J, Howard R, Moore R, Smith S. An investigation of the anti-pronation effect of two taping methods after application and exercise. Gait Posture. 1997;5:1-5. 36. Vicenzino B, Griffiths SR, Griffiths LA, Hadley A. Effect of antipronation tape and temporary orthotic on vertical navicular height before and after exercise. J Orthop Sports Phys Ther. 2000;30:333-339. 37. Walling A. Managment of heel pain. Am Fam Physician. 2000;62:2132. 38. Wapner KL, Sharkey PF. The use of night splints for treatment of recalcitrant plantar fasciitis. Foot Ankle. 1991;12:135-137. 39. Waugh EJ. Lateral epicondylalgia or epicondylitis: what’s in a name? J Orthop Sports Phys Ther. 2005;35:200-202. 40. Whitaker JM, Augustus K, Ishii S. Effect of the low-Dye strap on pronation-sensitive mechanical attributes of the foot. J Am Podiatr Med Assoc. 2003;93:118-123. 41. Young CC, Rutherford DS, Niedfeldt MW. Treatment of plantar fasciitis. Am Fam Physician. 2001;63:467-474, 477-468. RESEARCH 25. Pfeffer G, Bacchetti P, Deland J, et al. Comparison of custom and prefabricated orthoses in the initial treatment of proximal plantar fasciitis. Foot Ankle Int. 1999;20:214-221. 26. Porter D, Barrill E, Oneacre K, May BD. The effects of duration and frequency of Achilles tendon stretching on dorsiflexion and outcome in painful heel syndrome: a randomized, blinded, control study. Foot Ankle Int. 2002;23:619-624. 27. Price DD, McGrath PA, Rafii A, Buckingham B. The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain. 1983;17:45-56. 28. Quaschnick MS. The diagnosis and management of plantar fasciitis. Nurse Pract. 1996;21:50-54, 60-53, quiz 64-55. 29. Robbins S, Waked E, Rappel R. Ankle taping improves proprioception before and after exercise in young men. Br J Sports Med. 1995;29:242-247. 30. Ross M. Use of the tissue stress model as a paradigm for developing an examination and management plan for a patient with plantar fasciitis. J Am Podiatr Med Assoc. 2002;92:499-506. 31. Ryan J. Use of posterior night splints in the treatment of plantar fasciitis. Am Fam Physician. 1995;52:891-898, 901-892. 32. Shrier I, Gossal K. Myths and truths of stretching: individualized recommendations for healthy muscles. REPORT J Orthop Sports Phys Ther • Volume 36 • Number 6 • June 2006 371
© Copyright 2024