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LEADING ARTICLE

Sports Med 2008; 38 (8): 617-631 0112-1642/08/0008-0617/$48.00/0 © 2008 Adis Data Information BV. All rights reserved.

A Physiological and Psychological Basis for Anti-Pronation Taping from a Critical Review of the Literature
Melinda Franettovich,1,2 Andrew Chapman,2,3,4 Peter Blanch1 and Bill Vicenzino2
1 2 3 4 Department of Physical Therapies, Australian Institute of Sport, Canberra, Australian Capital Territory, Australia Musculoskeletal Pain and Injury Research Unit, University of Queensland, Brisbane, Queensland, Australia School of Kinesiology, Simon Fraser University, Vancouver, British Columbia, Canada Applied Research Centre, Australian Institute of Sport, Canberra, Australian Capital Territory, Australia

Abstract

Anti-pronation taping is a treatment technique commonly used by clinicians in the management of lower extremity musculoskeletal pain and injury. The clinical efficacy of anti-pronation tape is described anecdotally and has some support through clinical trials for some foot conditions. However, the mechanism(s) underlying its clinical efficacy is unknown, but are broadly categorized under mechanical, neurophysiological and psychological hypotheses. This article explores these hypotheses and contributes to the understanding of the technique. A computer database search was conducted to identify relevant experimental studies using an a priori defined search strategy. Data were extracted from reviewed articles and wherever possible mean differences between baseline and taped condition and the 95% confidence interval, as well as percentage change scores and effect size statistics were calculated. Articles were organized pertaining to the hypothetical mechanism investigated and presented accordingly into biomechanical, neurophysiological or psychological paradigms. Overall, the research to date has focused predominantly on the mechanical paradigm with far fewer papers being found for the neurophysiological and psychological paradigms. The literature provides evidence that anti-pronation tape has a biomechanical effect, which has been demonstrated by increases in navicular height and medial longitudinal arch height, reductions in tibial internal rotation and calcaneal eversion and alteration of plantar pressure patterns, under both static (i.e. standing) and dynamic (i.e. walking, jogging, running) conditions. The reduction in pronation was dependent on the surrogate measure of pronation used, but generally ranged from as little as 5% increase in longitudinal arch height during jogging to as much as a 33% change in calcaneal eversion during walking.

A main issue.[1] anti-pronation taping has been widely used by clinicians in the management of lower extremity conditions. There is emerging evidence of a neurophysiological effect. As its name suggests. one study[5] also evaluated pain scores 24 hours after the removal of taping and reported that the pain score remained reduced compared with baseline. 1. and was followed by a series of strips of tape directed from the lateral to the medial aspect of the anchor. Consequently. these effects are currently not well understood.[4-8] Interestingly. Anti-pronation tape has demonstrated reductions in pain scores (as measured by 100 mm pain visual analogue scale) by 19 mm immediately © 2008 Adis Data Information BV. Preliminary evidence from few studies suggests that anti-pronation tape has a neurophysiological effect as it has been shown to reduce the activity of several muscles of the leg during dynamic tasks such as walking.[3] plantar fasciitis was reported as the third most prevalent overuse injury experienced by a cohort of 2002 injured runners. there has been limited investigation of the psychological effects of anti-pronation tape. Due to insufficient evidence. respectively). back pedalling and drop jumps. is that of an appropriate comparator in this regard. as with most placebo or sham interventions for physical therapy research. in another study. A recent systematic review of running injuries[2] reported the lower leg and foot to be the second and third most common site of lower extremity injury (prevalence 9–32% and 6–40%.[9. Data were difficult to extract from these papers. Further research is required in this paradigm before sports medicine practitioners can utilize these findings in day-to-day clinical practice. this article was unable to draw any conclusions as to the psychological effects of the tape. but caution is urged in over-interpreting a few studies on small sample sizes. To date. following application[4. This article reports of evidence in support of anti-pronation tape exerting a biomechanical effect.[4] and altered direction of application of strips placed medial to lateral across the plantar surface. The original low-Dye consisted of an anchor strip of tape directed from the head of the fifth metatarsal to the back of the heel and around to the head of the first metatarsal. There is preliminary evidence of the clinical utility of anti-pronation tape as a treatment technique in the management of lower extremity conditions. These conditions can interfere with sports participation and activities of daily living.[4. such as heel pain and plantar fasciitis. it does reduce pronation. but the article does prompt the need for further exploration into the possible role of placebo in the clinical effects of antipronation taping.5] and by 4–23 mm following 1–7 days of application. More specifically. 38 (8) . such as plantar fasciitis and heel pain. cutting. which is generally one of reduction in muscle activity.15] Despite the Sports Med 2008.10] Over time. which is similar to the low-Dye but with extension of the strips of tape up onto the distal leg when the strips covered the rear foot. Background Since its original description in 1939 by Dye.[5. hopping. several modifications of the low-Dye technique have been described such as the addition of an ‘X’ strip to the plantar surface. but it would appear from a small study that the reduction is in the order of about 45% for tibialis posterior.[1] Dye also described the highDye.11-14] incorporating forefoot eversion and dorsiflexion of the hallux. All rights reserved.618 Franettovich et al.

we present data from the reviewed papers as the mean differences between baseline and the taped condition. Data are presented in tables I–V.13. with only the augmented low-Dye incorporating the low-Dye. several other techniques have been described in the literature. correct foot posture (table I).[5. these techniques consist of tape that is extended from the foot to the ankle and leg. by mechanical means.7. ‘tap* and foot’. Evidence from studies of anti-pronation taping is presented wherever it exists. Despite the clinical efficacy of anti-pronation tape being established in the treatment of some conditions and healthcare practitioners’ continued use of the technique.25] with the notion that a reduction in calcaneal Sports Med 2008. The reference lists of articles obtained from primary database searches © 2008 Adis Data Information BV. 3.14.11. effect size statistics (mean difference divided by standard deviation) and 95% confidence intervals for mean differences were calculated where possible. we do not know its physiological bases. crossover studies and randomized controlled trials that were English-language sources were included. We used the classification system of Hopkins[19] as trivial (0. The search strategy used the following combination of keywords: ‘tap* and pronation’.1 Does Anti-Pronation Tape Alter Foot/ Leg Posture? Weight-bearing foot pronation is a tri-planar movement involving calcaneal eversion. 2. CINAHL. Percentage change scores.[4. MEDLINE. This literature review examines the hypotheses for the physiological (categorized under the biomechanical and neurophysiological paradigms) and psychological bases of anti-pronation tape proposed in the literature. however. Infotrac. lowering of the medial longitudinal arch height and abduction of the forefoot.Effects of Anti-Pronation Tape 619 many variations of the technique. An improved understanding of the underlying physiological mechanism(s) of anti-pronation tape is likely to facilitate improved knowledge of the technique. Methods Relevant studies were identified by a computer search of SportDiscus. with each modification the fundamental feature of the low-Dye (taping intrinsic to the foot) is retained.23.29] 3. moderate (0. Effect size statistics are presented in order to provide an estimate of the treatment effect that can be used for comparing measures with different units and as a proxy for an estimate of the clinical meaningfulness of an effect given that there are no widely accepted indices of clinical utility. small (0.2–0.21] control motion (table II).6). such as simply applying stirrups from lateral to medial that are anchored to the distal third of the leg (approximately). and ‘tap* and EMG’. Articles with an experimental design including cohort studies. Web of Science.[7. 38 (8) .0–0.28.2).[7.2) and large (>1. ‘tap* and muscle’. were also hand searched.[18] In comparison to the low-Dye. Biomechanical Paradigm This paradigm hypothesises that the mechanism underpinning the effectiveness of tape is the ability to directly. ‘tap* and ankle’. Wherever possible. talar adduction and plantar flexion.6–1.2) to interpret these effect size statistics.20-27] and reduce stress on the plantar surface of the foot (table III).20. All rights reserved.10. the literature of other taping techniques is explored.12. in cases where there are no direct data from antipronation tape studies. Alterations in a pronated foot posture could be identified by measurement of either of these motions.[16] the reverse-8 stirrup[17] and the augmented low-Dye. Several investigators have used the component motion of calcaneal eversion to investigate the effect of anti-pronation tape on foot posture (table I). which may optimize its clinical application and contribute to clinical selection guidelines. In addition to these techniques. Cochrane and Pedro databases from 1939 (first published anti-pronation tape article) to June 2006.

navicular drop >10 mm (12 F. –5.031 (0. 11 M) a ALD consists of the low-Dye.4 (1.8 (8.[18. 20 0.8)* 0.4 (–2.4. NR = not reported.4 (2.3 (–5.2)* 3. 6 M) Whitaker et al.4. 7.2 1.4.7 Standing 0 –4. F = females.1.6. 38 (8) Franettovich et al.8 (0.2.5)* 1.[30] 17 Asymptomatic individuals. navicular drop >15 mm (17 F) Vicenzino et al.1 Standing 0 –4.2.8 0.1 (–4.05. 10.8)* 1. 2. 10.0 0. navicular drop >10 mm (3 F. 7.620 Table I.4 Hadley et al.31] Sports Med 2008.5 1. 3 M) © 2008 Adis Data Information BV.6) 0.5 (–2.[4] 20 Individuals with plantar fasciitis (14 F.5 0. 5 M) Tibial rotation (°) ALDa Jogging 0 10 20 4.[18] 17 Asymptomatic individuals.2 NR NR NR NR NR 2. navicular drop >10 mm (14 F) Arch height ratio ALDa Standing 0 0.2 (4.[15] 45 Asymptomatic individuals (25 F.9)* 4.[12] 8 Asymptomatic individuals.[31] 14 Asymptomatic individuals. 13. three reverse sixes and two calcaneal slings. ALD = augmented low-Dye. 20 M) Ator et al. –0. 20 0 10 20 0 15 30 Standing Jogging 0 10 Standing Walking 0 10 Standing 0 4.[25] 22 Asymptomatic pronators (gender not provided) Harradine et al.6 0.5 0.6. 7.3 Jamali et al.3)* 3.[11] 10 Asymptomatic individuals (10 F) del Rossi et al.1.023. The effect of anti-pronation tape on foot and leg posture Technique Activity Time (min) Mean difference (95% CI) Effect size Study n Participants Calcaneal eversion (°) Low-Dye Low-Dye Low-Dye Standing Walking 0 30 –2.[14] 7 Asymptomatic pronators (4 F. 1.0 (0. navicular drop >10 mm (5 F. M = males.5 Jamali et al.7 Vicenzino et al. All rights reserved.0)* 1.[4] 20 Individuals with plantar fasciitis (14 F.3. Navicular height (mm) Low-Dye Low-Dye Low-Dye Low-Dye Standing Running Running Jogging Jogging Standing Jogging Jogging 0.8 0. 0.1)* –0. * p < 0. 5.30. .7)* 7. 3 M) Low-Dye ALDa ALDa Vicenzino et al. –3.6 (–3.[22] 14 Asymptomatic individuals.22.6)* 2. 6 M) Holmes et al.3) NR NR NR NR NR 10.3.5.038)* 1. 9. 4.6 2.0 (1.

30.11.[4.033)* 0. 38 (8) .. NR = not reported.[37] An increase in navicular height or arch height ratio corresponds with an increase in medial longitudinal arch height and is associated with a reduction in pronated foot posture. The effect of anti-pronation tape on motion Study Calcaneal eversion Harradine et al. * p < 0. The external validity of the observed reduction in calcaneal eversion (2.[14] Keenan and Tanner[10] Moss et al.8. 3 M) Asymptomatic individuals (16 F.7 0.6) 3.[18. The augmented low-Dye has also demonstrated a superior effect in maintaining the initial effects.14.25] In the study of Harradine et al. navicular drop >10 mm (12 F.7 (–0.9. 5.3 (–2.007. the distance from the posterior calcaneus to the first metatarsophalangeal joint. ALD consists of the low-Dye. Navicular height has been defined as the vertical distance from the floor to the navicular bone in standing[11] and arch height ratio as the height of © 2008 Adis Data Information BV.[15] but not jogging.9)b 0. 2.6 2.[14] is questionable because of likely discrepancies between foot and shoe position. table I).[18. F = females.e. table I) reported by Harradine et al.1 NR n Participants Technique Activity Time (min) Mean difference (95% CI) Effect size Arch height Vicenzino et al. Mean discrepancies of 7.3 0.[17] Kersting[16] 7 18 6 10 Asymptomatic pronators (4 F. such as.024)* 1.2 (–4. 2 M) Asymptomatic individuals (3 F.7. 2.31] ALD = augmented low-Dye. whereas the remaining studies measured calcaneal position directly and did not use shoes. M = males.026 (0. 3. initial increases in navicular height. throughout 10 and 20 minutes of jogging.018.2 compared with 0. calcaneal eversion in resting standing posture has been reported to be reduced by 9–17%.to post-sham tape (p = 0. the dorsum at 50% of foot length standardized to truncated foot length.2* 0. 0.4) NR 0.18] One study of the low-Dye is an exception[12] and reported maintenance of effect following 15 minutes of treadmill running.[4. Our calculations were based on pooled population SD and not the SD of the pair-wise differences.[11.Effects of Anti-Pronation Tape 621 Table II.3) –0.18] A greater magnitude of effect (19%) has been reported for the augmented lowDye.[30] 17 Asymptomatic individuals. 2.22] whereas the low-Dye has maintained initial effects throughout 10 minutes of walking.1°. Immediately following the application of low-Dye tape.9 a b c Reverse-8 stirrup consists of 2–3 reverse-8 stirrups and heel lock.e.8. 3 M) Asymptomatic individuals (10 M) Low-Dye High-Dye Low-Dye Reverse-8a Low-Dye Stirrups Walking Walking Walking Running Running Running 0 30 During During During During During –1. All rights reserved. navicular height and arch height ratio (table I). three reverse sixes and two calcaneal slings.[12] the investigators applied a component of the low-Dye technique using moleskin in compariSports Med 2008.e. i.[18. i.05.22.028).1 0. Foot posture has been examined further in the literature using measures of the medial longitudinal arch.5.15. the low-Dye has been reported to produce moderate increases of 8–16% in navicular height.[14] calcaneal eversion was measured as the angle between the posterior bisection of the shoe and the horizontal. A possible explanation for this is that in the study of del Rossi et al.2 NR NR 0. eversion is associated with a less pronated foot posture.4° between the shoe markers and underlying calcaneum have been reported from a bone marker study[36] and questions the results of studies that imply calcaneal motion from shoemounted marker systems.[17] reported a significant difference pre. Moss et al. 5 M) ALDc Walking Jogging During During 0.22] which is reflected in a large effect size (i.016 (0. 0. Immediately following application.6 (–3.

2 0.5 (1. 0. 13.4 (–12.622 Table III. 0.6 (–5.2 (–0.0)* –2.4 (0. 3. 0.5)* 9. All rights reserved.4 3.1 (–0.9) –8.7 0. 2 M) 0.3 0.9. 0. 6. –4. 1.3 0. .1.2)* 0. 38 (8) Franettovich et al.6.3)* Walking Medial midfoot 0. –3.4 0.0 (1.1 0.6)* 0.5 (–2.8.3 1. 20 M) Sanzo and Bauer[33] 10 Individuals with plantar fasciitis (8 F.7 (0. 2.8 0. –0. 10. 16 M) Chipchase[24] 1. drop >10 mm (40 F.1)* –1.8.5 (–7.3 0. –5.7.6 Walking Medial midfoot 0.1 (–0.4)* –0.5) 1.6) –2.1.7.7 0.6 (–0.0 4.5 0.1.3) Vicenzino et al.6 0. [32] 60 Asymptomatic individuals.1 1.6. 7 M) Continued next page Sports Med 2008.1 (–3.3 (5. –1.3 (–11.3)* –3. 1. The effect of anti-pronation tape on plantar surface stressesa Technique Activity Area of foot Mean difference (95% CI) Effect size Study n Participants Peak pressure (N/cm2) Low-Dye Lateral midfoot Medial heel Lateral heel Medial forefoot Lateral forefoot Low-Dye Lateral midfoot Medial heel Lateral heel Medial forefoot Middle forefoot Lateral forefoot Low-Dye Forefoot Rearfoot ALDb Walking Medial midfoot Lateral midfoot Medial heel Lateral heel Medial forefoot Central forefoot Lateral forefoot Walking Midfoot –1.3.9 (–2.9)* 5.8) 4.6 (–3.5 Russo and 40 Asymptomatic individuals (24 F.9)* –2. 1.1.5)* Lange et al.8)* –8.9)* 0.2 (0.5. navicular © 2008 Adis Data Information BV. 6.1.7.1 0.7)* –2.2.0 0.9. –4. –3. 0.9 (3.1.9 0.6 1.4 0.2. 0.7.1 (–1.1)* –4.3) 0.3.8 0.5. 6.0)* –1.4. [34] 18 Asymptomatic individuals exhibiting excessive pronation (15 F.5 (–4.5 (0.3) 0.3 (–6.

3. –0. back pedal Impact peak Impact peak Time to impact peak NR NR NR NR NR NR NR NR NR NR Elizondo et al.2 0.9.6.1 (0.2)* –1.2 (–2.1. –0.3 0.0 0. navicular drop >10 mm (11 F.22. –6. M = males. navicular Effects of Anti-Pronation Tape drop >10 mm (40 F.1 Lange et al. F = females. Contd Technique Activity Area of foot Mean difference (95% CI) Effect size Study n Participants Mean pressure (N/cm2) Low-Dye Lateral midfoot Medial heel Lateral heel Medial forefoot Middle forefoot Lateral forefoot ALDb Walking Lateral midfoot Medial heel Lateral heel Medial forefoot Central forefoot Lateral forefoot Medial midfoot –0.3) –4.5.2.7 1.5)* 2. 20 M) © 2008 Adis Data Information BV. 11 M) a All measurements were made during the stated activity.6 0. Vicenzino et al.1)* –1. –1. 1.5)* 5. –1.7)* –0.[32] 60 Asymptomatic individuals.1.4)* 1.7)* –1.8 (0.[35] 18 Asymptomatic individuals.3 –0. * p < 0. b ALD consists of the low-Dye.3 (–0.6.9 0.[28] 22 Individuals with and without shin pain.3 2.30.0 Walking Medial midfoot 0.31] Sports Med 2008.0)* –2.1 (–0.2 0.[18. NR = not reported.1)* 0. 0.1. 623 . 2.5 (–0. three reverse sixes and two calcaneal slings. –0.6 (–2.3) 0.4 (–1.4.2) 2. navicular drop >10 mm (18 M) Kersting[16] 10 Asymptomatic individuals (10 M) Wall et al. 38 (8) ALD = augmented low-Dye.6 (–2.6 (–3.4.05.3 (–0. –2.1 (–1. All rights reserved.0)* –0.1 (–0. 0. 7 M) Impact forces Low-Dye Drop jump Drop jump Impact peak Time to impact peak High-Dye ALDb Running Cutting hopping.1. drop jump.6 –0.8)* –1.5 0.Table III.4 0.9.8.7. 0.2 (1. 0.[34] 18 Asymptomatic individuals exhibiting excessive pronation (15 F.

17] are limited by the assumption that the single plane measurement of rearfoot angle is indicative of the triplanar motion of pronation.[30] This effect has not been further investigated throughout a prolonged period of activity (10 or 20 minutes). but not after exercise. as well as reductions in tibial internal rotation position and standing calcaneal eversion posture.[31] investigated the ability of the augmented low-Dye to control transverse tibial rotation and reported that immediately following application there was a 17% change in tibial position into external rotation (table I).1). a more abducted foot indicates a lower angular value. Results from studies that determined rearfoot angle using leg and shoe bisections[14. there are no existing studies inSports Med 2008. Several studies have used 2-dimensional motion analysis of the rear foot to investigate the ability of anti-pronation tape to control pronation during walking and running (table II). as they hypothesised that it would provide a strengthened end product. the low-Dye has not been shown to change maximum rearfoot eversion during treadmill walking[10.17] should be interpreted with caution because of likely discrepancies between foot and shoe position already outlined previously in this article (section 3.17] which were obtained from a single posterior camera view. © 2008 Adis Data Information BV.[17] In comparison. which with intact ligaments translates to internal rotation of the tibia. in the transverse plane.[39] On this basis. is the 9% increase in standing arch height ratio.2 Does Anti-Pronation Tape Control Motion? The name of the anti-pronation tape technique infers that it controls motion. Kersting[16] measured rearfoot angle during treadmill running using an in-shoe goniometer and reported a similar tapeinduced reduction in maximal rearfoot eversion (table II). however.6° reduction in calcaneal eversion or 10. All rights reserved. A recent systematic review on the effect of low-Dye tape also concluded that low-Dye tape produced increases in navicular height immediately after application. son to a rigid adhesive strapping tape used in other studies.14.7 for calcaneal eversion and arch height ratio and 2. For example.[41] Both problems are potentially avoided by using a 3-dimensional method.[17] In these studies.8-mm increase in navicular height is sufficient to reduce the symptoms associated with a lower-limb condition.[14.14] or running. Hadley et al. this study and the three previously discussed[10. not during jogging) and thereby provide an indication of augmented low-Dye-induced changes to leg posture. The high-Dye technique has been reported to significantly reduce maximum rearfoot eversion by 33% during treadmill walking[10] and the Reverse-8 by 16% during treadmill running.17] the method of rearfoot measurement is problematic because measurements of rearfoot angle are strongly influenced by the alignment of the foot with respect to the camera. measurements of pronation were determined by calculating the angle formed by either the leg and calcaneal bisectors[10] or the leg and posterior shoe heel bisection. A 7% change was maintained through 10 minutes of jogging but not after 20 minutes. table I).[40] In a more recent study. it is unknown whether a 4. Although the magnitudes of some observed changes were large (effect sizes up to 1.e.[38] Consistent with the increase in navicular height. 38 (8) . the literature consistently demonstrates that anti-pronation tape produces reliable increases in navicular height and arch height ratio.624 Franettovich et al. 3. but not motion. During weight bearing. For example.[36] For all three studies[10. Measurements of tibial rotation were performed in relaxed calcaneal stance (i. Although this approach addresses the issue of foot alignment with respect to the camera. the motion of pronation has been hypothetically related to adduction of the talus. the clinical significance of changes in foot posture is unknown. which conceivably represents a reduction in pronation. In summary. specifically pronation.2 for navicular height.14.

during walking with the augmented low-Dye.[34] investigated the augmented low-Dye on excessive pronators and observed large (effect sizes 1.2. Consequently. the clinical significance of these changes is unknown. A more recent study by Lange et al. the observation of no change could have resulted from differential changes occurring under the medial and lateral components of the midfoot. table III) in mean maximum pressure at the medial forefoot of 29% and medial rearfoot by 9% were also observed.1. 3.[32] reported a similar low-Dye-induced increase in plantar pressures under the lateral midfoot (peak 16%.3) than the medial midfoot (0.4 and 0.7). but not the low-Dye.Effects of Anti-Pronation Tape 625 vestigating the effects of anti-pronation tape on motion using 3-dimensional motion analysis.1.9. compared with Lange et al. reduces calcaneal eversion and increases arch height ratio during activity. 0.0) and lateral heel (0. 1. however.32] an earlier study by Sanzo and Bauer[33] reported that the low-Dye produced no change in plantar pressures under the midfoot during gait. respectively). see table III. Vicenzino et al. and reduced at the medial forefoot by 20%. table III). inferences drawn from this study are again limited by the assumption that a single plane measurement (arch height ratio) is indicative of triplanar pronation. More recently. 2. mean –5%) and lateral (peak –6%. Similarly to anti-pronation tape-induced changes in foot posture. One study used 2-dimensional motion analysis of the medial aspect of the foot to obtain measurements of arch height ratio during walking and jogging and evaluated the ability of the augmented low-Dye to control motion (table II). The literature suggests that the augmented lowDye. In contrast to these studies. and the stresses that are experienced by the foot and lower extremity during activity. 38 (8) . specifically ‘pronation’.[24] Lange et al. such as that reported by Russo and Chipchase. and moderate at the medial forefoot (0. due to methodological assumptions.[24] Effect © 2008 Adis Data Information BV.[32] who observed individuals exhibiting excessive frontal plane motion. Peak plantar pressures were also increased at the medial and lateral heel by 11% and 13%. mean –14%). respectively. These Sports Med 2008. which conceivably represents a reduction in pronation.7.5.6. Moderate reductions (0.8).1). However. mean 25%) and reduction under the medial forefoot (peak –14%. All rights reserved.[42] Russo and Chipchase[24] observed that low-Dye taping reduced peak plantar pressures under the medial midfoot by 18% and increased peak plantar pressures under the lateral midfoot by 26% during gait. One explanation for the discrepancy between these studies is that Sanzo and Bauer[33] reported plantar pressures for the midfoot as a whole compared with the other studies that reported the medial and lateral components of the midfoot separately.6.[30] Application of augmented low-Dye tape increased arch height ratio by 8% during walking and 5% during jogging.4. with moderate effect sizes at the lateral midfoot (0. respectively. mean –3%) heel. 0. table III) increases in peak and mean maximum pressure at the lateral midfoot by 52% and 77%.5. despite moderate effect sizes. 0. Of note is that Russo and Chipchase[24] observed normal feet.[24] but this is speculative. sizes were small at the medial and lateral heel (0.6. 0. In contrast to Russo and Chipchase. this does not irrefutably translate into support that antipronation tape controls motion. with small effect sizes (0. Effect sizes were greater at the medial (0. 5. As stated in section 3.[24.0) and the medial forefoot (0.5 and 0.3 Does Anti-Pronation Tape Alter Plantar Surface Stress? Assessment of plantar pressures can provide insight into the interaction of the foot and the supporting surface.[32] observed no change in plantar pressures under the medial midfoot and a reduction in plantar pressures under the medial (peak –7%. pronation of the foot is associated with a lowering of the medial longitudinal arch.9.

[35] investigated the effect of the low-Dye on these impact forces during a drop jump in asymptomatic individuals and reported no change in timing or magnitude of peak vertical ground reaction force when taped (table III).[28] observed no effect of the augmented low-Dye on peak vertical ground reaction force. The magnitude of the change observed by Kersting[16] was not reported.[45] Similar increases in tibialis anterior. back pedalling and drop jumps) and reported that peak activity of peroneus longus and soleus were reduced in individuals with and without shin pain. respectively. Similarly. It is likely that in its application. Sports Med 2008. In contrast to both studies. impact forces occur when the foot and plantar structures make contact with the supporting surface. All rights reserved.8% for tibialis anterior. The contrasting results between these studies could reflect differences in taping technique between studies. however. as mechanical stimulation (via rapid stroking and sustained indentation) of cutaneous receptors on the sole of the foot has been shown to produce median increases in electromyography activity in the order of between 2. However.0% and 2. to support this hypothesis. hopping. and the clinical significance of this observation is unknown. Elizondo et al.[28] the augmented low-Dye and Kersting[16] used the application of five stirrups that were anchored proximally to the leg and distally at the foot. 38 (8) .1. Neurophysiological Paradigm Another biologically plausible hypothesis is that anti-pronation tape stimulates underlying sensory receptors via surface contact or stretch of the skin that alters the sensory input to the CNS and subsequently influences its perception and execution of movement.1 Does Anti-Pronation Tape Induce Neurophysiological Changes? Preliminary data[47] provide an indication that during gait anti-pronation tape produces large (effect sizes 1. 4. this hypothesis is speculative and requires further investigation. yet they did observe increased time to peak vertical ground reaction force during cutting and a drop jump in individuals with shin pain while taped. it must be highlighted that these responses in muscle activity were produced with stimulation of individual cutaneous receptors. The literature provides indirect evidence © 2008 Adis Data Information BV. During dynamic activity. table IV) reductions in peak activity of tibialis posterior and tibialis anterior by 45% and 24%.[18] A brief report by Wall et al. studies provide evidence that anti-pronation tape produces changes to loading patterns of the plantar surface. This is in contrast to Boergers[48] who reported no change in peak tibialis anterior activity whilst walking with low-Dye taping.9 and 2.[44] Elizondo et al.[46] One may question the clinical significance of these small magnitudes of change.[35] investigated the low-Dye technique. anti-pronation tape would stimulate many underlying receptors. soleus. soleus and gastrocnemius lateralis activity have been produced with muscles in a relaxed state. Kersting[16] reported that taping increased impact peak in the ground reaction force whilst running in asymptomatic individuals. but it must be noted that an association between plantar pressures and foot motion has not been established[43] and these measures should be interpreted within their limitations.626 Franettovich et al. Wall et al. medial gastrocnemius and lateral gastrocnemius during a weak voluntary contraction (<10% maximum voluntary contraction). However.[28] examined the augmented low-Dye during four dynamic tasks (cutting. which through a mechanism of summation. Wall et al. the Boergers[48] study investigated the low-Dye technique against which the augmented low-Dye has been demonstrated to be superior in its ability to change arch height. and not to infer changes to foot motion. would likely result in a larger effect. 4. as an indicator of loading patterns.

Psychological Paradigm A further hypothesis is that there may be a psychological mechanism underlying the effects of anti-pronation taping. this needs to be further evaluated.[7.31] ALD = augmented low-Dye.[28] n 8 22 Participants Asymptomatic individuals (5 F. 5) NR NR –24 (–17.[7] reported that a modified low-Dye tape.62] and a reduction in motor-neuron excitability (as measured by the H-reflex) of medial and lateral gastrocnemius was observed when a strip of tape was applied along the muscle fibres of medial gastrocnemius.[53] Similarly.4 0. 21) Effect size 0. NR = not reported.[51] Ankle taping has also produced changes in the latency of the peroneal response during a stimulated inversion perturbation. 11 M) Asymptomatic individuals exhibiting excessive pronation (3 F. The effect of anti-pronation tape on muscle activitya Study Boergers[48] Wall et al. 3 M) Individuals with and without shin pain.Effects of Anti-Pronation Tape 627 Table IV. which increases arch height[4.4 2.15.18.[49] During a stimulated inversion perturbation.8] Hyland et al.47] may have clinical utility in individuals who have flat feet because these flat-footed individuals exhibit increased levels of extrinsic muscle activity during standing[64] and walking. back pedal Walking Muscle Tibialis anterior Tibialis anterior Peroneus longus Soleus Tibialis anterior Tibialis posterior Peroneus longus Mean difference (95% CI) 8 (–6. it is compelling to speculate that antipronation tape. –31)* –45 (–26. descent) and isokinetic knee extension. patella taping has induced neurophysiological responses in both asymptomatic individuals and those with knee pain.11.66] However. increased vastus medialis obliquus activity in the absence of patella repositioning. F = females.[18. applied to resist inversion sprains.[65.22.3 0.30] and reduces electromyographic activity (preliminary data). All rights reserved. M = males. drop jump. a sham tape and plantar fascia stretches each produced a reduction in Sports Med 2008.[28. Ankle taping. but with conflicting reports from a delay of 3 ms (4%). navicular drop >10 mm (11 F. three reverse sixes and two calcaneal slings.3 Franettovich et 5 al. 22) –14 (–33.[54-59] Tape-induced neurophysiological responses could be explained by associated biomechanical effects such as reductions of range of motion and/or changes in alignment of underlying joints. tibialis anterior and soleus activity during single leg standing[61. demonstrated by alterations in activation and onset timing of vastus medialis obliquus and vastus lateralis during functional tasks (stair ascent. However. –65)* 5 (–11. 2 M) ALDb Technique Low-Dye Activity Walking Running Cutting. hopping. Two studies have compared the pain-relieving effect of anti-pronation tape to a control or sham treatment group in individuals with plantar heel pain (table V).[60] Similarly. ankle taping has produced reductions in the amplitude of the peroneal response by 17%[50] and 18%. stretch applied via tape to the skin over the patella in a lateral. has demonstrated a moderate reduction of 30% (11–49%) in soleus activity during landing from a drop jump.22.30. * p < 0. 4. ALD consists of the low-Dye.[63] From the forgoing evidence in cognate taping literature.05.[47] a b All measurements were made during the stated activity.[52] to an augmentation of 11 ms (13%). a single strip of tape over peroneus longus has produced increased peroneus longus. 5. 38 (8) .2 Is There Evidence of Neurophysiological Changes from Other Taping Techniques? Whilst there is limited research into neurophysiological responses in the anti-pronation taping literature.12.5 NR NR 2. there is evidence to support that neurophysiological changes do occur with lower-limb taping. medial and superior direction all produced © 2008 Adis Data Information BV.

respectively). table V) and it is compelling to attribute this to a mechanical effect.. We were unable to access the original data and our calculations were based on pooled population SD and not the SD of the pair-wise differences. it is a methodological challenge for the researcher to administer an appropriate placebo that removes all active components of a taping technique. 38 (8) .1 2.0)* 1. The investigation into the psychological effect of anti-pronation tape remains inconclusive and incomplete.[7] this study provides more convincing evidence of a psychological effect. it must be recognized that. (–1. © 2008 Adis Data Information BV.to post-sham tape (p = 0. Psychological effects of anti-pronation tape Study n Participants Treatment Mean difference (95% CI) –4.0 mm (–37.[7] 41 Individuals with plantar fasciitis (20 F. The reduction in pain observed with the sham tape suggests that the mechanical component of anti-pronation tape’s application may not be the only mechanism contributing to its pain-relieving effect.2 –18 mm (–24.[8] compared the pain-relieving effect of low-Dye tape with sham ultrasound to sham ultrasound alone and reported that both treatments produced a reduction in pain (42% and 25%. Radford et al.3)a 0. However. Table V.e.037).[8] a 92 –30. respectively. * p < 0. 6% and 27%. 37 M) 46 individuals per group Low-Dye Sham tape Control (no intervention) Plantar fascia stretches Low-Dye + sham ultrasound Sham ultrasound Radford et al.5. and there was no control group to account for natural resolution of the condition. pain by 61%. Although further work investigating the psychological mechanism of tape is required. (–0.5)* 0.05. the ability of these results to provide evidence of a psychological effect is limited because the placebo treatment did not remove all active components of the treatment.3 compared with 0.1.5)* 0. effect size of 3. the active tape produced a much greater effect than the sham tape (i. In comparison to Hyland et al. control (n = 10). unlike medication (pills). –3.3 –0.7 (–5. the sham tape was overlaid on the skin without medially directed force and did not attempt to correct foot posture.628 Franettovich et al.2)* Effect size 3. The results of this study are strengthened by the inclusion of a control group who did not experience a change in pain. For example. Sports Med 2008.4.1. However. –23. All rights reserved. stretches (n = 10) Individuals with plantar heel pain (55 F.4 –0. but the key mechanistic element (analogous to the active ingredient in medication) of tape has not been elucidated and requires further investigation. 21 M) Tape (n = 11).6) –1. in administration of the sham tape the mechanical component (medially directed force) of the taping technique was removed. as the placebo treatment (sham ultrasound) removed all active components except for the impression to the individual that a treatment was being delivered. being limited to pain efficacy studies only. –11. M = males.0. whereas a control group (no treatment) did not. sham (n = 10).8 Hyland et al. suggesting that the reduction in pain observed in both taping groups was not due to natural resolution of the condition. (–2.3 Pain visual analogue scale Hyland et al. but the tape may have exerted an effect via stimulation of underlying sensory receptors.2. F = females.4 0. yet still convince the recipient that treatment has been delivered. In comparison to the modified low-Dye tape.8. interpretation of these results are limited because sham ultrasound may not be the most appropriate placebo comparison for a taping technique.3 0. reported a significant difference pre. Notably.1 –1.

7: 64 9. et al. Hyland MR. Andrew Chapman is supported by the Australian Research Council. The effect of high-Dye and low-Dye taping on rearfoot motion. Bygrave CJ. sham taping.e. ‘Low-dye’ taping on the foot in the management of plantar-fasciitis. Res Sports Med 2006. et al. and plantar fascia stretching for the short-term management of plantar heel pain. J Orthop Sports Phys Ther 2006. Fiolkowski P. Wilcox D. Windlass taping technique for symptomatic relief of plantar fasciitis. Br J Sports Med 2007. neurophysiological and psychological effects of anti-pronation tape. lowdye medial longitudinal arch taping procedure on the subtalar joint neutral position before and after light exercise. Finally. © 2008 Adis Data Information BV. van Middelkoop M. Buchbinder R. 10 (1): 6-11 14. Landorf KB. J Am Podiatr Med Assoc 2005. Wright R. 32 (5): 194-201 16. Landorf KB. J Sport Rehab 2004. McPoil T. Keenan AM. biomechanical and neurophysiological investigations are limited to acute effects of anti-pronation tape (immediately after application) and it is unknown what effects are observed following application of a longer duration or following removal of the tape. Radford JA. neurophysiological and psychological effects is unclear and warrants further investigation. Radford JA. The effect of low Dye taping upon rearfoot motion and position before and after exercise. del Rossi G. but there appears evidence to indicate that it should not be discounted in explaining the mechanisms underpinning anti-pronation tape and warrants further exploration. Effectiveness of low-Dye taping for the short-term management of plantar fasciitis. 14: 18-23 12. Am J Sports Med 1982. A retrospective casecontrol analysis of 2002 running injuries. J Orthop Sports Phys Ther 2002. The foot book. jogging. The effect of adhesive strapping on medial longitudinal arch support before and after exercise. Whilst there is no evidence to indicate that there are differences in the anti-pronation taping treatment effect between symptomatic and asymptomatic subjects. 36 (2): 95-101 4. J Natl Assoc Chiropodists 1939. 5 (2): 84-9 13. et al. Saxelby J. There are no relevant conflicts of interest for any author. Br J Sports Med 2002. Foot 2001. Mountain View (CA): World Publications. the reader should be mindful that many of the studies reviewed were conducted in asymptomatic individuals. Dye RW. Further investigation is required to evaluate 3-dimensional kinematic.e. 13 (3): 228-43 5. Harradine P. et al. Webber-Gaffney A. Herrington L. Keenan AM. Scranton PE. Hoke B. Acknowledgements Melinda Franettovich is supported by the National Health and Medical Research Council. Effectiveness of low-Dye taping for the short-term treatment of plantar heel pain: a randomised trial. Kersting UG. et al. J Am Podiatr Med Assoc 2001. 91 (5): 255 11. Incidence and determinants of lower extremity running injuries in long distance runners: a systematic review. The psychological or placebo effects of tape are not well understood. the nature of the interplay between biomechanical. J Orthop Sports Phys Ther 1991. running) as demonstrated by increases in navicular height and arch height ratio. Randomised controlled trial of calcaneal taping. Foot 1997. Tanner CM. 11 (2): 57-60 15. Conclusions and Future Directions for Research Existing evidence supports that anti-pronation tape changes foot and leg posture statically (i. Cohen L. For how long do temporary techniques maintain the height of the medical longitudinal arch? Phys Ther Sport 2004. The role of footwear-independent variations in rearfoot movement on impact attenuation in heel-toe running. et al. However. walking. through 1–7 days in situ and up to 24 hours following removal. but caution is advised in over interpreting the results of a few studies of small sample sizes. et al. Preliminary evidence suggests that anti-pronation tape alters muscle activity of the leg during dynamic activity. Jamali B.Effects of Anti-Pronation Tape 629 6. Walker M. Gait analysis: alterations in support phase forces using supportive devices. Tauntan J. Pedegana LR. 7 (4): 205-9 6. All rights reserved. Hlavac HF. References 1. 29: 11-2 2. Betts RP. 38 (8) . 1977 10. 95 (6): 525-30 7. Horodyski MB. Holmes CF. standing) and possibly dynamically (i. Clement D. 41: 469-80 3. van Gent RN. Ator R. Ryan M. et al. BMC Musculoskelet Disord 2006. A strapping. Gunn K. Fletcher JP. Whitesel JP. 36 (6): 364-71 8. The reduction in pain observed with the application of antipronation tape has been demonstrated immediately after application. and alterations in plantar pressure patterns. reductions in tibial internal rotation and calcaneal eversion. Siem D. Effect of a modified. 14: 117-34 Sports Med 2008.

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