The effect of ankle taping on functional performance in participants with functional ankle instability

ObjectiveTo investigate the effect of rigid ankle tape on functional performance, self-efficacy and perceived stability, confidence and reassurance during functional tasks in participants with functional ankle instability.DesignClinical measurement, crossover design.MethodsParticipants (n = 25) with functional ankle instability (Cumberland Ankle Instability Score < 25) were recruited from university students and sporting clubs. Participants performed five functional tests with and without the ankle taped. The tests were: figure-8 hopping test, hopping obstacle course, star excursion balance test (SEBT), single-leg stance and stair descent test. Secondary outcome measures were self-efficacy and perception measures.ResultsRigid tape significantly decreased the stair descent time by 4% (p = 0.014), but had no effect on performance in the other tests. Self-efficacy increased significantly (p < 0.001). Perceived stability, confidence and reassurance also increased with the ankle taped (p < 0.05) during the stair and two hopping tasks, but not during the SEBT or single-leg stance test.ConclusionAlthough taping the ankle did not affect performance, except to improve stair descent, it increased self-efficacy and perceived confidence in dynamic tasks. These findings suggest that taping may reduce apprehension without affecting functional performance in those with functional ankle instability and permit continued physical activity or sport participation.     

The effect of ankle taping or bracing on proprioception in functional ankle instability: A systematic review and meta-analysis

ObjectivesTo determine if wearing an ankle brace or taping the ankle, compared to no brace or tape, improves proprioceptive acuity in people with a history of ankle sprain or functional ankle instability.DesignSystematic review and meta-analysis.MethodsStudies using controlled, cross-over designs whereby participants who had sprained their ankle at least once or had functional ankle instability, underwent some form of proprioceptive sensation testing with and without ankle brace or tape, were included. Proprioceptive acuity was reported for the ankle tape/brace condition and the condition where no tape or brace was worn. Meta-analysis was employed to compare proprioceptive acuity with and without ankle tape/brace.ResultsEight studies were included in the review. Studies measured either sense of movement or sense of joint position. The mean differences in 19 of 32 comparisons were not significant. Of the remaining mean differences, 10 were positive, indicating better proprioceptive acuity in the taped/braced condition and 3 were negative, indicating poorer proprioceptive acuity. Overall, there was no significant effect with ankle tape/brace compared to the no tape/brace condition (mean difference: 0.08°, 95% CI: ?0.39 to 0.55). This finding was consistent when the two aspects of proprioception (sense of movement or joint position) were considered separately.ConclusionsThe pooled evidence suggests that using an ankle brace or ankle tape has no effect on proprioceptive acuity in participants with recurrent ankle sprain or who have functional ankle instability.     

The influence of Mulligan ankle taping during balance performance in subjects with unilateral chronic ankle instability

Objective: To determine whether Mulligan ankle tape influenced the performance in subjects with unilateral chronic ankle instability (CAI) during static balance; postural sway recovery patterns after hopping and dynamic tracking balance tasks.Design: A cross-sectional, within-subjects experimental study design between 4 ankle conditions (taped; untaped: injured and uninjured).Participants: 20 volunteer recreational athletes with unilateral CAI were recruited. Means and standard deviations highlighted the athletes' characteristics: age = 23 ± 1 years; height = 173.1 ± 2.4 cm; weight = 69.3±3 kg; Functional Ankle Disability Index (FADI) = 93.5 ± 5.1% and FADI Sport = 84.2 ± 9.4%.Interventions: Mulligan ankle taping.Main Outcome Measurements: Static balance (10 s); postural sway recovery patterns after a 30 s functional hop test (immediately, 30 and 60 s); dynamic tracking balance tasks (wandering, target overshoot and reaction-time).Results: Between the four conditions, static balance showed no significant differences (p = 0.792); significant changes occurred in postural sway over time (p < 0.001); no significant changes were reported for the dynamic tracking tasks. Wandering was highly correlated with reaction-time and overshooting (p < 0.01).Conclusion: Under resting and fatigued conditions, Mulligan ankle taping did not impact on the neuromuscular control during static and dynamic balance in subjects with healthy and unstable ankles.     

The effect of osseous ankle configuration on chronic ankle instability

Background

Chronic ankle instability (CAI) is a common orthopaedic entity in sport. Although other risk factors have been studied extensively, little is known about how it is influenced by the osseous joint configuration.

Aim

To study the effect of osseous ankle configuration on CAI.

Design

Case–control study, level III.

Setting

Radiological examination with measurement of lateral x rays by an independent radiologist using a digital DICOM/PACS system.

Patients

A group of 52 patients who had had at least three recurrent sprains was compared with an age‐matched and sex‐matched control group of 52 healthy subjects.

Main outcome measures

The radius of the talar surface, the tibial coverage of the talus (tibiotalar sector) and the height of the talar body were measured.

Results

The talar radius was found to be larger in patients with CAI (21.2 (2.4) mm) than in controls (17.7 (1.9) mm; p<0.001, power >95%). The tibiotalar sector, representing the tibial coverage of the talus, was smaller in patients with CAI (80° (5.1°)) than in controls (88.4° (7.2°); p<0.001, power >95%). No significant difference was observed in the height of the talar body between patients with CAI (28.8 (2.6) mm) and controls (27.5 (4.0) mm; p = 0.055).

Conclusion

CAI is associated with an unstable osseous joint configuration characterised by a larger radius of the talus and a smaller tibiotalar sector. There is evidence that a higher talus might also play some part, particularly in women.Ankle ligament injuries are the most common injuries in sport and recreational activities.¹ The anterior talar‐fibular ligament is affected in 85% of ankle sprains.^2,3,4 This type of injury represents a sprain with a major component in the sagittal plane.^5,6 This kind of injury is therefore best investigated using lateral views of the ankle, where the osseous containment of the talus in the tibia can be assessed. Although most of these ligamentous ankle injuries can be successfully treated with physical rehabilitation and non‐operative treatment, 20–40% of patients with ankle injuries develop chronic ankle instability (CAI) and experience recurrent sprains.^7,8,9,10 Many of these patients with CAI can be satisfactorily treated with reconstruction of the injured ligaments.^{3,11,12,13,14,15,16} However, good results of surgery and physical rehabilitation notwithstanding, some patients keep experiencing persistent symptomatic ankle instability^10,17 and have the propensity to develop post‐traumatic ligamentous ankle osteoarthritis.¹⁸The risk of spraining an ankle depends on both intrinsic factors (hindfoot alignment, ligament laxity, muscular force, neuromuscular control and so on) and extrinsic factors (shoes worn, type and intensity of sport, warm up and so on).^19,20,21 The shoulder, a rather unstable joint, is characterised by a humeral head that is large compared with the glenoid, whereas in the hip, a stable joint, the femoral head and the acetabulum are of equal size. This suggests that there is a relationship between joint stability and osseous joint configuration, but to date, the effect of the osseous configuration on the predisposition to develop CAI has not been investigated.The current study examines whether the osseous joint configuration of the ankle joint plays a role in the development of CAI. The hypotheses of this study were that (a) a flat talus, characterised in terms of a large radius, contributes to CAI; (b) a lack of restraint of the talus in the tibia, characterised in terms of a small tibiotalar coverage, contributes to CAI; and (c) a higher talar body with consequently more torque forces contributes to CAI.     

Immediate effect of walking with talus-stabilizing taping on ankle kinematics in subjects with limited ankle dorsiflexion

ObjectiveTo determine the effects of walking with talus-stabilizing taping (TST) on ankle dorsiflexion (DF) and heel-off time in the stance phase of gait and ankle DF passive range of motion (PROM).DesignPre- and post-intervention study.SettingUniversity motion analysis laboratory.ParticipantsTen subjects participated in this study. Sixteen ankles with limited ankle DF PROM were tested.Main outcome measuresAnkle DF PROM was measured using a goniometer, and maximum ankle DF before heel-off and time to heel-off in the stance phase of gait were measured using a 3D motion analysis system before and after walking with TST. Data were analyzed using a paired t-test.ResultsAnkle maximum DF before heel-off (p = 0.001), time to heel-off during the stance phase of gait (p = 0.005), and ankle DF PROM (p < 0.001) were significantly increased post-intervention compared with pre-intervention.ConclusionsWalking with TST is an effective self-exercise for improving ankle kinematics during gait and increasing ankle DF PROM in individuals with limited ankle DF PROM.     

A comparison of ankle taping methods

Four different types of ankle tapings were applied to a model of the human ankle joint. The model was constructed so that it contained a hinge to represent the ankle joint and had an external shape identical to a real ankle and foot. A mechanical testing machine was used to apply moments to the model at a controlled loading rate. From these tests, the deflection and torque to failure and the tangent stiffness were determined. Loadings of an ankle joint in vivo revealed that the angular deflection to initiate pain was approximately 8 degrees. Only the figure eight and full tapings could withstand 8 degrees of angular displacement on the ankle model prior to failure. Analysis of athletic trauma revealed that torques of 420 Nm could be applied to the ankle joint. Only the figure eight taping with three or more wraps has adequate strength to withstand this moment, and thus this taping is recommended. In practice, tapings failed by shearing away from the surface of the foot of shrinking rather than by rupture of the tape.     

Retrospective comparison of taping and ankle stabilizers in preventing ankle injuries

The effectiveness of taping and the effectiveness of wearing a laced stabilizer in preventing ankle injuries and reinjuries over six seasons of collegiate football practices and games were assessed retrospectively. For 1 1/2 years the players all had taped ankles, and for the remaining 4 1/2 years the players chose their type of ankle support. Over the entire period, the players chose high-top or low-top shoes as preferred. During 51,931 exposures to injury (46,789 practice-exposures and 5,142 game-exposures), the 297 players sustained 224 ankle injuries and 24 reinjuries. Tape was worn during 38,658 exposures to injury (233 players), stabilizers during 13,273 exposures (127 players). Tape had been worn when 159 of the injuries and 23 of the reinjuries occurred; a stabilizer had been worn when 37 of the injuries (P = 0.003) and one of the reinjuries occurred. The combination allowing the fewest injuries overall was low-top shoes and laced ankle stabilizers.     

The effects of proprioceptive exercise and taping on proprioception in subjects with functional ankle instability: A review of the literature

ObjectiveTo investigate the effects of proprioceptive exercise rehabilitation and taping techniques on proprioceptive measures in chronic functional ankle instability (FAI).DesignLiterature review.Data sourcesKeyword search of the AMED, CINAHL, Medline, PEDro and SPORTDiscus online databases from January 1985 to February 2007. Also reference lists of articles obtained were manually searched for relevant literature.ResultsThe search yielded nine studies that investigated the effects of proprioceptive exercise training on proprioceptive measures. Four studies investigated the effects of ankle taping on proprioceptive measures. The exercise literature was limited due to poor methodological quality. There is some agreement that muscle reaction time, kinaesthetic deficits and postural sway may improve with proprioceptive exercise; however, due to differences in study methodology and quality, no specific recommendations for practice can be made. Taping literature is also limited in terms of quantity and methodological quality. The effect on muscle reaction time, kinaesthesia, and postural sway rely on one study for each element, therefore conclusive recommendations for practice cannot be made.ConclusionThere is a paucity of high-quality evidence investigating the effects of proprioceptive exercise and taping. Further high-quality clinical trials are needed to enhance the evidence base in order to help guide physiotherapists in selecting appropriate, effective strategies when managing FAI.     

The effect of external ankle support in chronic lateral ankle joint instability. An electromyographic study.

We examined the effect of ankle taping on ankle joint stability by measuring mechanical stability using standardized stress radiographs. Anterior talar translation and talar tilt, both with and without ankle tape, were examined. The reduction of anterior talar translation and talar tilt with tape as compared to without tape was insignificant. The reaction time of the peroneus muscles was measured by electromyographic signal after a simulated ankle sprain on a tilting trapdoor. The reaction time was significantly slower in the unstable ankles of 20 athletes with unilateral ankle instability than in the stable contralateral ankles. With tape, the reaction time was significantly shortened, although not back to normal. The greatest improvement in reaction time was achieved in ankles with the highest degree of mechanical instability. Thus, the mechanism behind the function of ankle tape may be to restrict the extremes of ankle motion and to help shorten the reaction time of the peroneus muscles by affecting the proprioceptive function of the ankle.     

Kinematics of ankle taping after a training session

This study aimed to test the effectiveness of ankle taping on the limitation of forced supination during a change of direction, as well as the losses of effectiveness after a 30-minute training session. Fifteen young men with no ankle injury volunteered for the study. The static and dynamic ranges of movement (ROM) were measured before and after a training session. The dynamic measurements were recorded using high-speed 3D photogrammetry. The differences between static and dynamic measures of ankle supination and plantar flexion were significant. The losses of effectiveness during supination and ankle plantar flexion restriction were 42.3 % and 47.6 %, respectively. Ankle taping was effective in restricting the maximal static ROMs before a training session, but the effectiveness decreased after 30 min of training. The present study shows the necessity of performing dynamic ROM analysis of sports techniques involved in the ankle sprain mechanism in order to determine the degree of tape restriction after a training session, because there were differences between static and dynamic ankle ROMs. The lack of effects on the restriction of the dynamic plantar flexion would bring into question the necessity of ankle taping in subjects without previous injuries.     

Role of ankle taping and bracing in the athlete.

Adhesive tape is often used to help athletes recover from ligament sprains of the ankle or to prevent further injury. The choice of taping technique or material is often decided by personal preference, superstition, or anecdote. More recently, the use of ankle braces has become more prevalent, but reasons for their use are similarly variable. As ankle sprains are a major cause of an athlete's disability and time off sport, the choice of the method of support should be more scientifically reasoned. This paper attempts to review the literature concerning the effects of various methods of ankle support on swelling, stability, range of movement, proprioception, muscle function, gait, and performance tests. There is still some contradiction in the literature about the effects of taping and braces in both the acute and chronic phases of ligament sprains of the ankle.     

The use of thermal energy in ankle instability

With appropriate indications, ankle arthroscopy can be of significant benefit to both the patient and physician. The additional use of thermal energy significantly enhances surgical techniques. Midterm follow-up of thermal treatment of ankle instability demonstrates excellent patient satisfaction, with preserved stability, good overall function, and return to sports. Further long-term follow-up studies will continue to provide us with data that will help guide the expansion of uses of thermal energy about the ankle in a safe and efficacious manner.     

The effect of dual tasking on foot kinematics in people with functional ankle instability

BackgroundSome cases of repeated inversion ankle sprains are thought to have a neurological basis and are termed functional ankle instability (FAI). In addition to factors local to the ankle, such as loss of proprioception, cognitive demands have the ability to influence motor control and may increase the risk of repetitive lateral sprains.ObjectiveThe purpose of this study was to investigate the effect of cognitive demand on foot kinematics in physically active people with functional ankle instability.Methods21 physically active participants with FAI and 19 matched healthy controls completed trials of normal walking (single task) and normal walking while performing a cognitive task (dual task). Foot motion relative to the shank was recorded. Cognitive performance, ankle kinematics and movement variability in single and dual task conditions was characterized.ResultsDuring normal walking, the ankle joint was significantly more inverted in FAI compared to the control group pre and post initial contact. Under dual task conditions, there was a statistically significant increase in frontal plane foot movement variability during the period 200 ms pre and post initial contact in people with FAI compared to the control group (p < 0.05). Dual task also significantly increased plantar flexion and inversion during the period 200 ms pre and post initial contact in the FAI group (p < 0.05).Conclusionparticipants with FAI demonstrated different ankle movement patterns and increased movement variability during a dual task condition. Cognitive load may increase risk of ankle instability in these people.     

The placebo effect

The placebo effect will have a growing importance in the field of nuclear medicine as the potentials for palliative therapy with internal sources are realized. It is important for nuclear medicine physicians and their colleagues to be familiar with the role of placebo responses in clinical trials, especially when such trials involve the subjective assessment of pain. A summary of the literature on the placebo effect in pain studies is presented in which traditional values for placebo responses are contrasted with more current thinking in the field. The few published double-blind studies of pain relief after treatment with radiotherapeutic agents are summarized specifically with respect to their cited placebo response.     

Landing in netball: effects of taping and bracing the ankle

OBJECTIVES: To investigate the effect of bracing and taping on selected electromyographic, kinematic, and kinetic variables when landing from a jump. METHODS: Fifteen netball players performed a jump, so as to land on their dominant limb on a force plate. Electromyographic activity was recorded from the gastrocnemius, tibialis anterior, and peroneus longus muscles. Subjects were also filmed and measures of rearfoot motion were derived. RESULTS: Significantly less electromyographic activity (p<0.007) was observed from the gastrocnemius and peroneus longus muscle groups when subjects were braced. No other significant electromyographical findings were observed. Peak vertical ground reaction force and time to peak for vertical ground reaction force were not affected by bracing and taping, nor were the rearfoot and Achilles tendon angles at foot strike. CONCLUSIONS: The effect of bracing and taping on the selected biomechanics variables associated with landing was specifically limited to a reduction in muscle action, particularly for the braced condition. Netball players can be confident that the biomechanics of their landing patterns will not be altered whether they choose to wear a brace or tape their ankle joints.     

Effectiveness of functional ankle taping for judo athletes: a comparison between judo bandaging and taping.

This study was conducted to compare the effectiveness of the traditional method of ankle bandaging and the new method of ankle taping for judo athletes in Japan, and to introduce a functionally effective taping method for judo players. Four university judo athletes with ankle instability were selected to undertake radiography of the ankles before and after exercise, with bandaging at one time and taping at the other. Talar tilt (TT) angles were measured in order to compare the ankle-supporting effects. The results showed that the old ankle bandaging method had no role in eliminating the talar tilt during judo practice. In contrast, the new taping method was more effective in eliminating the talar tilt and supporting the involved ankles both mechanically and functionally.     

Chronic instability of the ankle

Evans tenodesis is one of the techniques used much for correcting the chronic lateral instability of the ankle. Long-term results (average follow-up 8 years) are reported for 113 operations on 109 patients. It is concluded that the method used gives a good functional result when the major complaint is recurrent sprains of the ankle. Functional stability does not necessarily correlate with mechanical stability when tested clinically or by radiographs.