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[Physio Explained] Kinesiotape vs. low-dye tape for plantar fasciitis pain with Dr Melinda Smith

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In this episode with Melinda Smith, we discuss a recent article looking at the effect of kinesiotape vs low-dye tape for plantar fasciitis pain. We discuss:

  • The differences in outcomes between these two groups
  • Individual patient preferences 
  • Neuromuscular responses to taping

👉🏻 See Mel’s full Research Review here - https://physio.network/reviews-smith

Dr Melinda Smith is a Lecturer at the University of Queensland and Physiotherapist at Clem Jones Centre Physio & Rehab in Brisbane. Melinda’s clinical, teaching and research focus is lower limb musculoskeletal function and health, with a special interest in the foot and ankle. Her research publications extend across several areas including lower limb function, sports and running related injuries, taping, foot orthoses, footwear, measurement of foot posture and mobility, gait-retraining and musculoskeletal imaging.

Reference to article: García-Gomariz C, Hernández-Guillén D, Nieto-Gil P, Blasco-García C, Alcahuz-Griñán M, Blasco J (2024) Effects of Kinesiotape versus Low-Dye Tape on Pain and Comfort Measures in Patients with Plantar Fasciitis: A Randomized Clinical Trial, Life, 14(2).

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Our host is @sarah.yule from Physio Network

SPEAKER_02:

We do see that the kinesiotaic group did have a larger improvement in pain at day one and also statistically great at day two. But then from there, the tape groups follow the same trajectory. So by the time you get to that day five, so that follow up time point, we didn't see any difference between the two groups. So both groups improved by clinically meaningful difference in their

SPEAKER_01:

pain. Welcome to today's episode of Physio Explained, where Dr. Melinda Smith is outlining her research review for the Physio Network on the RCT titled, Effects of Kinesio Tape versus Low Dye Tape on Pain and Comfort Measures in Patients with Plantar Fasciitis. Melinda is a lecturer at the University of Queensland and physiotherapist at the Clem Jones Centre in Brisbane. Melinda's clinical teaching and research focus is lower limb musculoskeletal function and health with a special interest in foot and ankle. Her research publications extend across several areas, including lower limb function, taping, foot orthoses, gait retraining and musculoskeletal imaging. Stay tuned as we dive into the findings of the article and why and how the results are relevant for your clinical practice. I'm Sarah Yule and this is Physio Explained. Welcome to the podcast, Melinda. Thank you. It is great to be here. I feel like having done your PhD in foot and ankle taping, as you were just telling me, you couldn't be a better person to review this study. So let's get straight into it. Do you mind giving the listeners a little bit of a summary of this research article? Sure.

SPEAKER_02:

Yes, absolutely. So this study was a randomized clinical trial where they recruited 40 people with plantar heel pain and they randomly allocated them to receive either a kinesio tape or a rigid low dye tape intervention across a period of a week. Primary interest that they looked at or measured in terms of effect was pain. So measuring pain before they put the tape on and then every 24 hours after that. But what I I really liked about this study was that they had a really nice suite of secondary measures, which I think we don't see enough in a lot of our taping intervention studies. And that was that they also got patients to rate how comfortable the tape was, how they found their mobility, so whether it felt restrictive or affected their foot mobility, whether they had increased sweating, hygiene aspects, so how it went with showering, and did it come off before it was intended to, which was that four or five day period

SPEAKER_01:

as what it was intended to stay on. Fantastic. I'm curious, what were the findings of the study? So I think from the results,

SPEAKER_02:

we can be confident in seeing that both kinesiotape and a rigid low diatate effective at improving pain in the short term in people with plantar heel pain I think it's probably important to highlight, you know, just tempering the author's conclusion a little bit, which was slightly stronger in that kinesiotape is more effective at short-term pain release. Certainly when we look across the intervention period, which was that week, we do see that the kinesiotape group did have a larger improvement in pain at day one and also statistically great at day two. But then from there, the tape groups follow the same trajectory. So, by the time you get to that day five, so that follow-up time point, we didn't see any difference between the two groups. So, both groups improved by clinically meaningful difference in their pain. The second part I think we can take away from this, from the results, is that perhaps where we can support the author's conclusion, the Kinesio tape did seem to be superior in terms of those secondary outcomes. So certainly we see that participants in the Kinesio tape had higher ratings for comfort, for foot mobility, less of them reported issues with sweating and hygiene. And we also interestingly saw a lower number of people, percentage of the group reporting the tape coming off early.

SPEAKER_01:

So coming off before it was supposed to. Interesting. And I imagine that's going to have some clinical relevance, which I think we should touch base on shortly. But before we explore the clinical side of it, do you mind just outlining for those sitting driving in their car thinking, what would the kinesio tape look like and what would it look like applied to the foot? Do you mind describing the differences between the two taping techniques in the study?

SPEAKER_02:

Yeah, great. And I think that's a really important aspect. Because whenever we're talking about taping techniques, even for example, when we use the term low dye, so the low dye technique we can see differ amongst different papers. And same with kinesio tape, where kinesio tape can be an overarching term used for all elastic tape, or it can also be a term specifically referring to the kinesio tape. method itself. So really important distinctions and great question. So if we look at this particular paper, if we look at the kinesio tape, so it was an elastic kinesio tape. So primarily that stretch in the longitudinal direction. that was applied to the foot in a fairly similar way to the low die initially. So in that we have two strips of tape that run kind of forming an X on the plant aspect of the foot. But from there, then when it differs, so utilising that longitudinal elastic stretch of the Kinesio tape, they then applied longitudinal strips, so kind of parallel to that long axis of the foot. So where we've got going from the heel to the ball of a foot, much like we would think have a plantar fascia and the plantar muscles run. And that's slightly different to the rigid low die, which they started the same. So still had that sort of X technique. So sort of going from the ball of the foot, you know, along behind the heel and then crossing over the sole of the foot. So that technique initially was the same as the kinesio tape, but then followed that traditional path that we would see or expect with a low die, which is then those mini stirrups that are running under the plantar surface of the foot from a lateral to a medial direct So that's really the two main differences. We had a difference in the properties of the tape, so an elastic tape longitudinally versus a rigid tape with little elasticity. But we did also have those slight differences in the way that the tape was applied, which makes sense, though, given what the aims of the different tapes are.

SPEAKER_01:

Thank you for that explanation. I suppose clinically, how do you think clinicians should use the results of this study to decide between whether or not to use kinesio tape or rigid tape? Yeah, that's a great question.

SPEAKER_02:

And I think that's something I've always really been passionate about, about being in amongst this sort of taping literature for quite some time now, you know, first being tweaked with my interest in my own PhD. But I think it really is the case, and this study certainly supports that. We're not necessarily saying that, you know, one tape is better than another. I really do think that it comes down to the patient in front of you, which is not dissimilar to a lot of treatments or interventions, right, is we're often having to consider those patient-specific factors. So here what I would take away from this and, you know, recommend to people listening, what I see as some of those main differences is considering those patient-specific factors, if we think about the elastic taping techniques, so the kinesio technique used here, we had pain relief that was provided. So that's great. But we had people reporting a greater perception of comfort in retaining sort of mobility, so not feeling restrictive. So if you've got a patient where that's going to be important, and I'm thinking here about some of my athletes, so people who are needing to retain some of that mobility in their foot as they're moving, then that might be when you gravitate towards that type of taping application. Contrast, if we think about the patient where actually part of what we might be wanting to do is actually create some restriction around foot mobility and provide more of that external mechanical sort of support, then that might be where we're gravitating to that rigid technique. Albeit, we also acknowledge that we know with rigid tape, that the effect is not purely mechanical. So we certainly appreciate that there's other potential mechanisms around our cutaneous import and some of those neuromuscular aspects. So not disregarding those, but if we think about plantar heel pain, and again, we can see that across spectrums of people with all types of foot posture and all degrees of foot mobility, In the patient that perhaps you do think from your assessment that perhaps their foot posture and certainly if that was a pronated foot posture or excessive amounts of mobility, if you thought that that was related to their symptoms, that might again be the person where you're gravitating to your low-die technique, which we can target some of that control of pronation and that's supported in the studies that we see in the literature. The kind of patient I might gravitate to there. And I guess finally it would then also be thinking about you know all of these tapes are different so we have different skin sensitivities and different adhesives so again that's another consideration you know one Randall type of tape a patient may react to or have an issue with but you know just because you can't use that tape if you could then reach for another tape and apply that and still be able to effectively reduce pain then that's something that might be important as well so I think they would be the main things I'd be looking at in choosing when you might be reaching for those different

SPEAKER_01:

tapes and techniques. Which sounds like it's a fantastic application of the results of this study in that, as you said, they both seem to indicate that there is that reduction in pain in the short term with both.

SPEAKER_02:

Yeah, absolutely. We also, if we look broader beyond just this study that's in front of us, so certainly we saw that difference over that week period. And this was a well-designed study. So, you know, they had random allocation. They also attempted to blind. So, they had the assessor blinded, which means that the person taking the measurements doesn't know what group they were in. So, you know, reducing bias there. And also in the participants themselves. So, they knew that there was two different tapes, but not necessarily which one that they were then receiving and whether there was expectations that that was better or not. So well-designed study. But if we look beyond this study, yeah, we do also know from the broader literature that we do see taping supported for the short-term management of pain in people with plantar heel pain. So short-term, that sort of one to six-week period.

SPEAKER_00:

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SPEAKER_01:

And out of curiosity in the broader literature, how frequently is that taping applied when it's in that short-term timeframe? This particular

SPEAKER_02:

study, it was that quarter five day period. And that I would say is fairly typical for a lot of studies. And a really interesting thing and something I dived into a little bit in my own PhD, where we were really interested in That idea of, well, how long can we take the foot for in terms of those issues with skin breakdown and reactions and that type of thing. And certainly from that, which was not just the low die, but this was an augmented low die. So it starts off with the low die, but then we also add some techniques that anchor it to the leg. But if we just think about that idea of how long can we tape someone for, certainly we found that about the two-week mark is where people start to see. Now, that was having the tape continuously on. So they would take it off. We would re-tape them every three or four days, depending on how they were going with how it was lasting. They would take it off the night before so that their skin had time to breathe. And then they would come in the next day and get re-taped. So we did that. It's so continuous taping other than that overnight. And that was through a two-week period. And even with that, you start to see people really starting to show some of those signs. We definitely can do things to try and minimize that. So, yeah, we're not. And I guess the other thing that goes with that, not just the tolerance of how long can we take, but also we know that taking itself is not going to fix the issue. So if we come back to that plan, if you're paying, you know, situational context. Yes, it's very good for assisting us to manage symptoms, but it's not going to fix the pain and the problem. You know, we are going to need to look at other things in our kind of toolkit for that as well. So that's sort of the context that I usually will explain to patients as well, that this is a great thing that we can do to get some short-term change in your symptoms, which then sometimes is enough to start to enable them to load a bit more normally, perhaps get into some, you know, exercises or all what it might be doing that you're trying

SPEAKER_01:

with that patient. Fantastic. Thank you. As you say, the context is always relevant, isn't it? Yeah, absolutely. And you piqued my interest before, the physiological mechanisms of the rigid taping. Do you mind giving a brief run through, aside from, I

SPEAKER_02:

Yeah, absolutely. So this was, I suppose, a particular interest of mine because that was exactly the focus of my PhD. So slightly different in that it wasn't in people with plenty of heel pain. We're all looking at people both with and without exercise-related leg pain, but really focused around not just the mechanical effect, but looking at, well, what do we see in terms of neuromuscular responses? So particularly there with the, that was an augmented low die. So we're going a little bit different from the low die, but it is a rigid technique still aimed at that I guess, any predatory control. So some restriction of foot mobility. And with that, we do see some neuromuscular effects. So in people when they're walking with this tape applied, we do see reduced levels of activity through tibialis posterior, which is not surprising. And then also through our soleus as well. So quite interesting in those effects. Our tibialis anterior, sorry, was the other one as well. Certainly from a muscular perspective, yes, we do know that with those rigid antipronatory techniques, which the low die is one of those, certainly we do see some of those changes in muscle recruitment or activation when people are walking. But then I guess if we think about the broader literature, there's also some suggestion that, again, you know, is it that we're actually seeing some of that changes in joint perception?

SPEAKER_01:

and

SPEAKER_02:

awareness of where we are in space. And, yes, that's definitely, I think, another mechanism for us to consider. One of the interesting things that we also looked at back in those PhD studies was also the idea of, well, do we get some continued effects? So if we're seeing this change in the way that muscles are activated and the way that muscles are working when people are walking in tape, If they do that for a period of time, what happens when we take the tape off? And do we continue to then see those changes? And the answer is no, we don't. So certainly over the period of time that we looked at, which was that two weeks, when we take the tape off and then we look at people, we measure people walking, we don't see that continue to fix. Essentially, for the tape to have that effect, it needs to be on the foot, at least in that period of time that we looked at, which is that first few weeks. So it's definitely a consideration as well. And again, it comes back to what you're aiming to do with your particular patient? What is it that you want the tape to do? And that was probably a really important lesson early on that my mentor, Professor Bill Vicencino, who again is a bit of a guru of foot and ankle taping, that was one of the things he instilled in me is unless you know what you're intending to do with the tape and have the foot positioned and applying the tape, with a purpose, then we probably shouldn't be using it. We need to know what we want it to do. And I think that applies to the elastic tapes as well. We need to know what we're intending

SPEAKER_01:

to do with that application. And it sounds like, correct me if I'm wrong, but for you personally, in terms of your clinical application, this study might not necessarily change all too much, but just add to that viewpoint of being judicious with the how and the why.

SPEAKER_02:

Absolutely. So I think it just reinforces that we do have choice. We don't have to find that one thing is better than another. I think that this was another nice demonstration that actually there's often several things we can do for a patient and that's actually a good place to be in. So rather than being confused by that or trying to sort of pick one over the other, I think it's about trying to best match that. to the patient that's in front of us. And I think if we can do that, then perhaps then that's when we may get those outcomes because our patient really needs to be on board with any of these interventions. And that's where, sure, if... you know, they prefer the feel of the elastic tapes, then maybe that's going to give us some direction. Or if they actually like the feeling of that slight restriction and support that they get from a rigid tape, well, fantastic, let's go down that path. So I think to me, it just reinforces, you know, that belief that I've always had that we really

SPEAKER_01:

need to match things to the patient in front of us. I think that's a fantastic point to finish on. So Melinda, thank you so much for joining us today. I think that was really valuable and something that we can certainly translate into the clinic tomorrow. Fantastic. I hope everyone finds it useful.