SLR - June 2016 - Eghosa Isa
Reference: Bishop C, Arnold JB, May T. Effects of Taping and Orthoses on Foot Biomechanics in Adults with Flat-Arched Feet. Med Sci Sports Exerc. 2016 Apr; 48(4): 689–96.Scientific Literature Review
Reviewed By: Eghosa Isa, DPM
Residency Program: Wyckoff Heights Medical Center
Podiatric Relevance: The purpose of this study was to examine the relationship seen in foot biomechanics with the use of orthoses versus foot taping in adults with flat-arched feet. Flatfoot deformity is a common condition that affects a large number of our patients. Some individuals with this deformity will not experience any problems related to this condition. However, a vast majority of active flatfoot individuals will experience injuries as a result of that deformity, not limited to plantar fasciitis, Achilles tendinopathy, medial tibial stress syndrome and patellofemoral pain syndrome. Commonly used methods to treat these injuries clinically include foot orthoses and foot taping modalities. While these methods have been shown to be clinically effective for many individuals, this study explains that literature is lacking showing the biomechanical responses of these modalities.
Methods: This was a prospective nonrandomized control study. Participants were recruited from notices placed on the university campus over an unspecified time period at the University of South Australia. Inclusion criteria detailed individuals between 18 and 30 years who have flat-arched feet. Exclusion criteria consisted of having a history of neurological or neuromuscular conditions affecting walking gait, a history of lower-limb fracture, lower-limb surgery within the last 6 months, any musculoskeletal injury within the last six months with absence of greater than one week from sport or work, current pain in the lower limbs or any known allergies to sports tape and current bacterial, fungal or viral skin infections of the feet.
Custom foot orthoses were made for all participants using 4-mm-thick polypropylene with a 350-kgIm2 density ethylene-vinyl acetate heel post and 1.5-mm multiform top cover material. A low-dye taping technique and a second unspecified modified taping technique were used on all participants. 3D gait analysis was conducted and foot kinematics were observed under the four conditions: 1) an ASICS Gel Pulse 3 neutral running shoe, 2) wearing the same shoes with the low-dye taping applied to the feet, 3) wearing the same shoes with the modified taping applied, 4) wearing the same shoes with the customized foot orthoses inserted inside.
Results: Statistical significance was observed in the increase of peak hindfoot eversion in the foot orthoses condition compared with the neutral shoe (P = 0.04). Significance was found in both low-dye taping (P < 0.001) and modified taping technique (P < 0.001) in reducing deformation across the midfoot and medial longitudinal arch of the foot. Both taping and foot orthoses increased peak dorsiflexion of the first MTPJ. Finally, it was observed that biomechanical responses to taping significantly predicted corresponding changes to foot orthoses (P = 0.006 to <0.001).
Conclusions: The study showed that both foot orthoses and foot taping were effective in altering foot biomechanics. Specifically, foot orthoses were more effective in altering timing of hindfoot motion; however, foot taping was the more effective modality in supporting the midfoot and medial longitudinal arch.
The findings of this study seems to support the commonly used practice of using foot taping and custom foot orthoses to treat those with injuries with flatfoot deformity as the etiology. Moreover, it additionally supports the practice of using foot taping as an effective primary treatment modality in acute injuries. The most surprising finding of this study was that foot taping was more effective than foot orthoses in limiting the deformation of the medial arch. Unfortunately, logistically taping the foot is not plausible on a daily basis for prevention of injuries. However, when treating the acute injury, these findings suggest that it would be advantageous to use foot taping for a longer period of time than previously practiced.
While foot orthoses have been shown in this study and many others to be an effective modality in treating this patient population, additional advancements can always be made. Specifically, as this study highlighted taping more effectively supporting the medial arch compared to orthotics, it would certainly be to the benefit of our patients to continue to work on developing a more conducive method of supporting the medial arch instead of using the standard foot orthoses, a “good enough” method. As both observed modalities seem to exert statistically significant findings in different regions of the foot, more research should be done to examine these findings further to better support patients with injuries related to flatfoot etiology.