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April 2011
Foot & Ankle Specialist
⟨ Clinical Research ⟩
Low-Dye Taping Versus
Medial Arch Support in
Managing Pain and PainRelated Disability in Patients
With Plantar Fasciitis
Abstract: Plantar fasciitis is thought to
develop because of repeated mechanical stresses. This study aimed to compare
2 means of foot arches support—lowDye tape (LDT) and medial arch support
(MAS)—in patients with plantar fasciitis. Thirty patients with unilateral plan­
tar fasciitis (23 men and 7 women) were
randomly assigned to the LDT or MAS
groups. Both groups were assessed before
and after experiment for pain and foot
function. Both groups received 9 sessions over 3 weeks consisting of ultra­
sound and calf muscles stretching. They
were instructed to maintain support­ive
intervention (LDT or MAS) through­out
this period. Pre–post comparison showed
reduced pain and improved function
in both groups. Between-groups analy­
sis showed non-significant difference
in pre-VAS and pre-FPDS. Post-VAS and
post-FPDS showed signif­icant improvement in patients in MAS group. Results
indicate that MAS is more convenient for
short-term management of pain and disability in patients with plantar fasciitis
than LDT.
Level of Evidence: Therapeutic,
Level II
Keywords: low-Dye taping; medial arch
support; plantar fasciitis; foot pain
P
Mohammed Shawki Abd El Salam, PhD,
and Yehia Nassef Abd ELhafz, PhD
condition can have a dramatic impact on
physical mobility.4
Although poorly understood, the development of plantar fasciitis is thought to
have a mechanical origin, since the plantar fascia acts as a stabilizer of the
lantar fasciitis is
considered the
most common
Although poorly understood, the
cause of foot pain. It is
a common disorder in
development of plantar fasciitis is thought
both athletic and sedentary populations.1,2
to have a mechanical origin, since the
Buchbinder3 reported
that plantar fasciitis is
plantar fascia acts as a stabilizer of the
a clinical diagnosis that
is most commonly seen
longitudinal arch, which is very important in
in younger runners and
the propulsive phase of gait.”
patients aged between
40 and 60 years.
The disorder is
thought to be multifactorial in origin with longitudinal arch, which is very imporseveral predisposing factors, such as obe- tant in the propulsive phase of gait as
it serves to make the foot a rigid lever
sity, excessive periods of weight-bearing activity, and decreased ankle range of via the “windlass effect” mechanism.5
Particularly important mechanical facmotion, suggested to be involved.3 Pain
tors that contribute to the development of
and discomfort associated with this
“
DOI: 10.1177/1938640010387416. From the Faculty of Physical Therapy, Cairo University, Giza, Egypt (MSAS, YNAE); College of Applied Medical Sciences, University of
Dammam, Dammam, Saudi Arabia (MSAS); College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia (YNAE). Address correspondence to Mohammed
Shawki Abd El Salam, PhD, Department of Physical Therapy, College of Applied Medical Sciences, University of Dammam, Dammam, Kingdom of Saudi Arabia; e-mail:
attmanonly@hotmail.com.
For reprints and permissions queries, please visit SAGE’s Web site at http://www.sagepub.com/journalsPermissions.nav.
Copyright © 2011 The Author(s)
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vol. 4 / no. 2
Foot & Ankle Specialist
plantar fasciitis are pes planus foot type
and other lower-limb biomechanical factors that result in a lowered medial longitudinal arch, which are thought to create
excessive tensile strain within the plantar fascia and produce microscopic tears
and chronic inflammation.6 Moreover,
Wearing et al7 reported that pain severity and fascial thickening seen in cases of
plantar fasciitis have an association with
static medial arch posture and midfoot
mechanical loading.
Several physical therapy interventions
have been used in the treatment of plantar fasciitis, including off-the-shelf insoles,
custom-fabricated insoles, custom-made
night splints, stretching of the plantar
fascia and plantar flexors of the ankle,
corticosteroid iontophoresis, and extracorporeal shock wave therapy, which
should be used in chronic resistant conditions.1 Roxas4 pointed out a wide range
of agreement in the literature with regard
to the importance of rest, activity modification, and shoes with adequate arch
support and cushion heel in controlling
plantar heel pain; he also reported that
the experimental works reviewed suggest
higher efficiency of mechanical intervention (tape, shoe inserts, orthosis) when
compared with anti-inflammatory (corticosteroid injection) and accommodative
interventions.
Low-Dye tape has been reported as an
alternative for achieving mechanical support of foot arches, correction of foot
pronation, and controlling mobility of the
rear foot. Low-Dye taping techniques are
reported to be short-term interventions,
used as a temporary support until
custom-made orthosis is applied.8
Despite being frequently used, we
found, to the best of our knowledge, no
comparative study of low-Dye taping and
medial arch support, as a commonly used
shoe insert, in short-term use. Thus, the
purpose of this study was to compare
the effect of low-Dye taping and medial
arch support in managing pain and painrelated disability in patients with unilateral plantar fasciitis. We hypothesized
that there would be no significant difference in effects when low-Dye taping and
medial arch support are used to manage pain and pain-related disability in
patients with unilateral plantar fasciitis in
the short term.
Methods
Design
This study was designed as a doubleblind randomized clinical trial.
Patient Characteristics
Thirty patients (23 men and 7 women)
suffering from unilateral plantar fasciitis were randomly selected from a list
of patients of a musculoskeletal physical therapy university clinic. The patients
were then randomly allocated to a lowDye tape (LDT) group or to a medial
arch support (MAS) group. Patients were
included in the study if they had a diagnosis of unilateral plantar fasciitis; were
aged between 40 and 60 years; had a
painful attack that started at least 4 weeks
prior to inclusion; had pain at the plantar
heel, which was worse when first standing or walking after rest and improved
initially after first standing but worsened
with increasing activity; and were nonathletes. Patients were excluded from
the study if they had any other cause of
localized or referred plantar foot pain,
had any lower limb deformity or surgery,
had a corticosteroid injection during the
past 3 months prior to participation in the
study, or had any known allergies to taping (Figure 1).
Patients in the LDT group included
12 men and 3 women with a mean
age of 52.933 years (±4.542), a mean
height of 1.684 m (±0.081), and a mean
weight of 86.2 kg (±8.231). The patients
in the MAS group included 11 men and
4 women with a mean age of 52.8 years
(±4.003), a mean height of 1.694 m
(±0.073), and a mean weight of 87 kg
(±8.569). Body mass index (BMI) was
calculated and compared between
patients in both groups.
Procedures
To ensure blinding of the participating therapists, 3 therapists other than the
authors were involved in implementing different parts of the study. The first
therapist carried out both preexperimental and postexperimental assessment procedures; the therapist did not participate
in, and had no knowledge of, any intervention allocation or procedures. The
second therapist, who was well trained,
carried out taping at the end of each session to patients in the LDT group. Again,
this therapist was unaware of any details
about the study procedures other than
simply applying the low-Dye tape to
the patients. The third therapist was in
charge of implementing physical therapy
sessions for patients in both groups. This
therapist was blind to the patients’ group
allocation, evaluation procedures, and
type of supportive interventions.
Prior to the onset of the experimental procedures, one of the authors interviewed each patient and gave a complete
background of the general idea of the
study, and each patient signed a consent form to approve his or her participation according to the general outlines
described. The patients allocated to the
MAS group were given instruction about
the type (Powerstep Original Men’s/
Women’s Full-Length Insoles [FootSmart
Co, Norcross, Georgia]), size, and fitting of the MAS to their most comfortable footwear. Later, they were asked
to remove the MAS before they met any
of the involved therapists at any scheduled evaluation or intervention session
and to fit the MAS by themselves immediately after each session. They were
also instructed to maintain the MAS
throughout their activities of daily living.
Similarly, patients in the LDT group were
asked to remove the tape immediately
before they met any of the participating therapists at any evaluation or intervention session, and when the tape was
applied after sessions, they were asked to
maintain it until the next session.
Patient recruitment, group allocation,
information given to patients, obtaining
informed consent, evaluation, and
the interventions in this study were strictly
according to the Helsinki Declaration and
approved by the council of postgraduate studies and research of physical therapy at the university where the study was
carried out. However, patients were blind
to their exact group differences related to
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April 2011
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Figure 1.
Study consort form.
ASSESSMENT FOR ELIGIBILITY
(N = 35)
Excluded (n = 5)
Not meeting inclusion criteria
(n = 2)
Refused to participate (n = 3)
Enrollment
Allocated to intervention
(N = 15)
Received allocated intervention
(N = 15)
Did not receive allocated intervention
(N = 0)
Give reasons
Lost for follow-up (n = 0)
Give reasons
Discontinued intervention (n = 0)
Give reasons
Analyzed (n = 15)
Excluded from analysis (n = 0)
Give reasons
the intervention in both groups and the
expected outcomes.
Evaluation Procedures
Evaluation of pain severity was carried out using a 10-cm visual analog scale,
where the 0-cm end was “No pain” and
the 10-cm end was “Intractable pain.” A
patient was asked to mark his or her perceived pain severity anywhere throughout the continuum, and the mark was
then measured to the nearest millimeter. Manchester Foot Pain and Disability
Schedule9 was administrated to report
patients’ pain-related disability. It is a
19-item questionnaire, with each item having 3 possible responses: 1 = none of the
time; 2 = On some days; and 3 = On most
Allocation
Allocated to intervention
(N = 15)
Received allocated intervention
(N = 15)
Did not receive allocated intervention
(N = 0)
Give reasons
Follow-up
Analysis
days or every day. Lower scores denoted
no/less disability and higher scores
denoted higher disability because of
foot pain.
The questionnaire was translated
into Arabic, and the preexperimental responses of patients in both groups
were used to ensure internal consistency
of the Arabic questionnaire, which was to
be used as an outcome measure.
Treatment Procedures
Patients in each group received 9 sessions of conventional physical therapy,
3 sessions weekly (alternate day) for
3 weeks, that consisted of identical programs for both groups: ultrasound therapy to the plantar surface of the foot
Lost for follow-up (n = 0)
Give reasons
Discontinued intervention (n = 0)
Give reasons
Analyzed (n = 15)
Excluded from analysis (n = 0)
Give reasons
applied for 8 minutes, 1.2 W/cm2, 1 MHz,
pulsed mode 1:2; stretching of calf muscles for 5 repetitions; holding for 30 seconds each.10
The author who carried out the initial interview discussed the fitting of the
MAS with the patients in the MAS group.
Taping was carried out by another welltrained therapist at the end of each session with patients in the LDT group, using
5-cm Leukoplast rigid tape (Westons,
England).
Statistical Procedures
BMI of the patients in the LDT and MAS
groups was compared using an independent t test. Only BMI was analyzed as
it was the only parameter that has been
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Patients in the current study had comparable BMI in both groups, showing a
mean BMI of 30.092 (±1.471) in the LDT
group and 30.267 (±1.507) in the MAS
group. Both groups showed a nonsignificant difference with regard to BMI (P =
.750).
Within-group analysis showed significant improvement in mean pain intensity
values and mean pain-related disability
values at posttest evaluation when compared with pretest evaluation in both the
groups (see Table 1 and Figures 2 and 3).
Between-groups comparison showed
nonsignificant differences at preexperimental evaluation for both pain intensity
mean values and pain-related foot disability questionnaire. At postexperimental evaluation significant improvements
in mean pain intensity values and mean
pain-related disability questionnaire values were detected in the MAS group (see
Table 2 and Figures 4 and 5).
Within-Group Comparison of Mean Difference in Visual Analog Scale (VAS) and
Foot Pain and Disability Schedule (FPDS) at Preexperimental and Postexperimental
Evaluations
Pre–Post Evaluations of Paired
Differences
95% CI of the
Difference
Mean
Difference
SD
Lower
Upper
t Value Significance
LDT (VAS)
0.873
0.698
0.487
1.260
4.843
.000a
MAS (VAS)
3.347
1.234
2.663
4.030
10.504
.000a
LDT (FPDS)
6.267
1.579
5.392
7.141
15.365
.000a
MAS (FPDS)
11.801
3.005
10.136
13.464
15.210
.000a
Abbreviations: CI, confidence interval; LDT, low-Dye taping; MAS, medial arch support.
a
P < .05.
Figure 2.
Figure 3.
Comparison of mean preexperimental
and postexperimental Visual Analog
Scale (VAS) values of patients in the
LDT and MAS groups.
Comparison of mean preexperimental
and postexperimental Foot Pain and
Disability Schedule (FPDS) scores of
patients in the LDT and MAS groups.
50
10
8
5.873
6
6.681
5.001
Nonsignificant differences in patients’
BMI in the LDT and MAS groups indicated
that patients in both groups are comparable with each other and that patients’
BMI group distribution would not affect
the outcome parameters.
Patients in the LDT group showed significant reduction in pain intensity as
well as significant improvement in painrelated foot disability postexperimentally
when compared with the preexperimental evaluation. This finding is consistent with that in the literature, as some
authors had reported improvement in pain
intensity in cases of plantar fasciitis
3.333
4
2
0
LDT
Groups
Post
followings the application of lowDye taping combined with iontophorsis12 and low-Dye taping combined with
sham ultrasound.8 Several authors provided mechanical explanations of the
role of low-Dye taping in reducing symptoms of plantar fasciitis. O’Sullivan et al13
reported that the application of low-Dye
tape seemed to reduce rear foot pronation through limitation of general rear
foot mobility.
Saxelby et al14 suggested that the effects
of low-Dye taping may lie in its ability to
40
43.667
37.401
44.201
32.401
30
20
10
0
MAS
Pre
Discussion
Paired t Test
Group/
Outcome
FPDS (SCORE)
Results
Table 1.
PAIN INTENSITY
(VAS)
reported to be significantly related to disability in patients with unilateral plantar
fasciitis.11
Within-group analysis of the outcome
parameters, namely, VAS for pain intensity and the foot pain disability questionnaire for pain-related disability, was
carried out to compare preexperimental
and postexperimental outcomes in each
group applying a paired t test. Betweengroups comparison of preexperimental and postexperimental outcomes was
made using an independent t test.
LDT
Groups
Pre
MAS
Post
simply reduce tension in the plantar
fascia; however, they failed to show conclusively that low-Dye taping reduced
foot pronation.
Patients in the MAS group, similarly,
showed significant reduction of pain
intensity, and pain-related disability
improved postexperimentally when compared with the preexperimental evaluation. Previous investigations suggested
that the effects of MAS, along with several other types of orthosis, were because
of the support of the medial longitudinal
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Foot & Ankle Specialist
Table 2.
Comparison of Mean Visual Analog Scale (VAS) and Foot Pain and Disability Schedule
(FPDS) Values in LDT and MAS Groups at Preexperimental and Postexperimental
Evaluations
LDT Group
95% CI of the
Difference
MAS Group
t Test
Outcome/
Evaluation
Mean
VAS pre
5.873 1.435
6.681 1.971 -2.096
0.482 -1.281 .211
VAS post
5.001
1.813
3.333 1.175
2.809
FPDS pre
43.667
5.052
44.201 7.831 -5.462
4.395 -0.222 .826
FPDS post
37.401
4.372
32.401 5.356
8.657
SD
Mean
SD
Lower
0.524
1.343
Upper t Value
Sig
2.988 .006a
2.801 .009a
Abbreviations: CI, confidence interval; LDT, low-Dye taping; MAS, medial arch support.
a
P < .05.
Figure 4.
Figure 5.
Comparison of mean Visual Analog
Scale (VAS) values at preexperimental
and postexperimental evaluations of
patients in the LDT and MAS groups.
Comparison of mean Foot Pain and
Disability Schedule (FPDS) values at
preexperimental and postexperimental
evaluations of patients in the LDT and
MAS groups.
10
8
50
5.873 6.681
5.001
6
4
3.333
2
0
VAS pre
VAS post
Evaluations
LDT group
FPDS (score)
Pain intensity (VAS)
90
32.401
20
10
FPDS pre
FPDS post
Evaluations
LDT group
arch and limitation of rear foot pronation,
which reduces the amount of tension on
the plantar fascia by realigning the foot
and the supporting arch.15 Because of this
mechanism, pain on the plantar surface
of the foot, especially pain at the calcaneal insertion of the plantar fascia, seems
to be alleviated.16
When we compared outcome measures between groups, it was found that
improvements in pain intensity and painrelated disability were significantly better
in the MAS group when compared with
the LDT group. Although the patients
37.401
30
0
MAS group
43.667 44.201
40
MAS group
in the LDT and MAS groups generally
shared a similar mechanism of correction,
namely, reduced foot pronation, elevation and support of the medial longitudinal arch height, and reducing tension
along plantar fascia, these mechanisms
seemed to be more efficient in patients
in the MAS group than in patients in
the LDT group. This idea is consistent
with several studies that documented
a reduced effect of LDT shortly after
application.
For instance, Fleet et al17 investigated
the effect of activity over time on the
stiffness of the applied LDT, by assessing the strength of the tape quantified as the moment required to rotate
the foot passively into inversion, measured using a handheld dynamometer,
and range of motion (ROM), measured
using a goniometer. Within 15 minutes
a 15% decrease in moment required to
rotate the foot was reported, 48% reduction within 1 hour, and 86% reduction over 24 hours. This showed the
fast loss in mechanical support that
amounted approximately to 50% within
1 hour. This is not the case with MAS,
which appears more capable of retaining
mechanical correction and rear foot control throughout its application time.
Fong et al18 reported that MAS was
specially effective in controlling rear
foot eversion during functional activities that implied walking and running,
which clarifies the better responses
reported in patients in the MAS group
in the current study regarding foot pain
and disability schedule, where several items were related to pain during
walking.
Although the clinical effect of MAS
orthotics in plantar fasciitis was reported
to be controversial,2 our results suggest
that in short-term evaluation, over
3 weeks, MAS used with exercises sessions were efficient in reducing pain and
pain-related disability.
Previous research that recommended
LDT suggested that it should be used
for a short period of time until custommade orthosis is fabricated, because of
its adverse effects on the skin and low
patient tolerance to longer durations; it
has also been reported that LDT was significantly effective in reducing pain at
first step in the morning only, not during
daily activities, and that it was because
patients focused on this symptom in
particular.10
We could further suggest that the rapid
decrement of supporting action of LDT
would not enable it to reduce tension
and minimize pain over a prolonged
period throughout the day. LDT would
require several reapplications for tightening over the time of use. So it would be
easier and more effective if prefabricated
MAS is used, even for short-term usage,
early in the treatment of plantar fasciitis,
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vol. 4 / no. 2
Foot & Ankle Specialist
as it has a better potential to improve
clinical outcomes, maintains mechanical
support, fits it easily into patients comfortable footwear without the need for
an expert for readjustment as in case of
LDT, may be used for a prolonged time
when compared with the LDT, and there
are no reports of patient discomfort or
skin problems as with LDT. LDT might
be used for another patient group, such
as athletic runners who suffer plantar
fasciitis pain while running and cannot
perform well with the MAS insert or any
other foot orthosis.
Conclusion
According to the study outcomes, we
suggest that medial arch support is more
convenient than low-Dye taping technique in the short-term management of
pain and pain-related disability in plantar
fasciitis.
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