The Effectiveness of Low-Dye Taping in Reducing Pain Associated With Plantar Fasciitis

Abstract

Plantar fasciitis is one of the most common musculoskeletal disorders of the foot. Initial treatment of plantar fasciitis is typically conservative and may include heel padding, steroid injections, night splinting, calf stretching, ultrasound, foot orthoses, and taping. However, while custom foot orthoses are a common treatment method for plantar fasciitis, there is often a waiting period of a few weeks for them to be manufactured and delivered. Therefore, taping of the foot is often used as a temporary treatment to alleviate pain during the initial waiting period. Furthermore, taping may also be used as an alternative to foot orthoses for patients who may not tolerate the plantar pressures of an orthotic or for tight-fitting footwear that may not accommodate insoles. Specifically, the low-Dye taping (LDT) technique is one of the most frequently used methods, and recent literature has suggested that it may improve pain outcomes. Therefore, this critically appraised topic was conducted to determine the extent to which current evidence supports the use of LDT to reduce pain in patients with plantar fasciitis.

Full text

The Effectiveness of Low-Dye Taping in Reducing Pain
Associated With Plantar Fasciitis
Laura A. Verbruggen, Melissa M. Thompson, and Chris J. Durall
Plantar fasciitis is one of the most common musculoskeletal disorders of the foot. Initial treatment of plantar
fasciitis is typically conservative and may include heel padding, steroid injections, night splinting, calf
stretching, ultrasound, foot orthoses, and taping. However, while custom foot orthoses are a common treatment
method for plantar fasciitis, there is often a waiting period of a few weeks for them to be manufactured and
delivered. Therefore, taping of the foot is often used as a temporary treatment to alleviate pain during the initial
waiting period. Furthermore, taping may also be used as an alternative to foot orthoses for patients who may
not tolerate the plantar pressures of an orthotic or for tight-fitting footwear that may not accommodate insoles.
Specifically, the low-Dye taping (LDT) technique is one of the most frequently used methods, and recent
literature has suggested that it may improve pain outcomes. Therefore, this critically appraised topic was
conducted to determine the extent to which current evidence supports the use of LDT to reduce pain in patients
with plantar fasciitis.
Keywords: physical therapy, foot, arch taping
Clinical Scenario
Plantar fasciitis is one of the most common musculo-
skeletal disorders of the foot.
1–5
Initial treatment of
plantar fasciitis is typically conservative and may include
heel padding, steroid injections, night splinting, calf-
stretching, ultrasound, foot orthoses, and taping. How-
ever, while custom foot orthoses are a common treatment
method for plantar fasciitis, there is often a waiting period
of a few weeks for them to be manufactured and deliv-
ered. Therefore, taping of the foot is often used as a
temporary treatment to alleviate pain during the initial
waiting period. Furthermore, taping may also be used as
an alternative for foot orthoses for the patients who may
not tolerate the plantar pressures of an orthotic or for
tight-fitting footwear that may not accommodate insoles.
Specifically, the low-Dye taping (LDT) technique is one
of the most frequently used methods, and recent literature
has suggested that it may improve pain outcomes when
compared to conservative treatment.
1–5
Therefore, this
critically appraised topic was conducted to determine the
extent to which current evidence supports the use of LDT
to reduce pain in patients with plantar fasciitis.
Focused Clinical Question
Is LDT, in conjunction with other conservative treat-
ments, more effective in reducing pain when compared
to other common modalities alone for patients with
plantar fasciitis?
Summary of Search, Best Evidence
Appraised, and Key Findings
•The literature was searched for studies of level 3
evidence or higher that compared LDT to other
common interventions for plantar fasciitis.
•The literature search returned 6 possible studies
related to the clinical question; 5 studies met the
inclusion criteria.
•One study was excluded because it did not use pain
as an outcome measure.
•Five level 2 studies that compared pain levels with
LDT versus comparison groups amongst indivi-
duals with plantar fasciitis were included.
•Five studies reported a statistically significant
reduction in pain with LDT.
1–5
•One study showed that LDT corrected weight dis-
tribution and improved foot stability.
1
•One study found that LDT and medial arch support
insoles reduced plantar fasciitis pain to a similar
extent.
2
Clinical Bottom Line
Current evidence supports the addition of LDT to con-
servative care in order to help reduce pain in individuals
The authors are with the Physical Therapy Program, University of
Wisconsin–La Crosse, La Crosse, WI. Durall (cdurall@uwlax.edu)is
corresponding author.
Journal of Sport Rehabilitation, 2018, 27, 94-98
https://doi.org/10.1123/jsr.2016-0030
© 2018 Human Kinetics, Inc. CRITICALLY APPRAISED TOPIC
94

with plantar fasciitis.
1–5
Based on the reviewed litera-
ture, clinicians should utilize a multifaceted approach
when treating patients with plantar fasciitis. Specifically,
clinicians should consider the use of LDT in conjunction
with other conservative measures, such as transcutane-
ous electrical nerve stimulation and infra-red treatment,
1
calf stretching,
2,3
and/or therapeutic ultrasound,
2,5
when
treating patients with plantar fasciitis. The LDT tech-
nique may be most beneficial in reducing pain via long-
term (3–6 weeks) treatment.
1,2
Furthermore, since LDT
has been found to reduce pain and pain-related disability
to a similar extent as medial arch supports after a 3-week
period,
2
clinicians may consider using LDT as a viable
alternative to foot orthoses for patients with plantar
fasciitis.
Strength of Recommendation
There is Grade B evidence from 4 level 2 randomized
controlled trials (RCT)
1,2,4,5
and 1 level 2 controlled
clinical trial (CCT)
3
that support using LDT in conjunc-
tion with other interventions to reduce plantar fasciitis
pain. An additional level 2 RCT found LDT to be as
beneficial as medial arch support insoles for plantar
fasciitis.
2
Search Strategy
Terms Used to Guide Search Strategy
•Patient/Client Group: subjects AND plantar
fasciitis
•Intervention/Assessment: low-Dye tape
•Comparison: other conservative interventions not
including injections
•Outcome: pain
Sources of Evidence Searched
•PubMed
•EBSCOhost
•Sport Discus
•Medline
•Google Scholar
•Manual search of reference lists
Inclusion and Exclusion Criteria
Inclusion
•Studies investigating plantar foot pain associated
with plantar fasciitis
•Studies comparing LDT to no care or to another
conservative intervention
•Level 3 evidence or higher
•Limited to humans
•Limited to English language
•Limited to the last 12 years (2005–2016)
Exclusion
•Studies that did use pain as an outcome measure
•Studies that included injections as an intervention
Results of Search
Many relevant studies were found, however, only 5
studies that met the criteria requirements were selected
for review (Table 1).
1–5
All 5 studies investigated the
addition of LDT to no care or common intervention
regimens for plantar fasciitis.
Best Evidence
The 5 studies were identified as the best evidence
and selected for inclusion in this critically appraised
topic (Table 2). Four articles were level 2 RCTs and
1 article was level 2 CCT based on the Oxford Levels of
Evidence 2011.
Implications for Practice, Education,
and Future Research
In each of the 5 studies reviewed, patients with plantar
fasciitis demonstrated statistically significant reductions
in pain in response to LDT when combined with trans-
cutaneous electrical nerve stimulation and infra-red
treatment,
1
calf stretching,
2,3
and/or therapeutic ultra-
sound,
2,5
when compared to conservative management
without LDT. Out of the 5 studies reviewed, only 1 of
them investigated the effectiveness of LDT as a stand-
alone treatment variable.
4
Therefore, while LDT appears
to be beneficial in reducing pain in patients with plantar
fasciitis, current evidence supports its use as part of a
multimodal intervention scheme rather than an isolated
treatment modality.
Treatment duration in the studies ranged from
3 days
3
to 6 weeks,
1
with the LDT technique used on
either a daily basis
3–5
or a 3 times per week basis.
1,2
Table 1 Summary of Study Designs of
Articles Retrieved
Level of
evidence
Study
design
Number
located Reference
2 RCT 4 Park et al
1
Abd El Salam et al
2
Radford et al
4
Sankhe et al
5
2 CCT 1 Landorf et al
3
Abbreviations: RCT, randomized controlled trial; CCT, controlled
clincal trial.
Low-Dye Taping in Reducing Plantar Fasciitis Pain 95
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Table 2 Characteristics of Included Studies
Landorf et al
3
Radford et al
4
Abd El Salam et al
2
Park et al
1
Sankhe et al
5
Study Design CCT RCT RCT RCT RCT
PEDro Score 5/10 7/10 7/10 5/10 6/10
Participants 105 subjects (M = 35, F = 70;
mean age 46.3) clinically
diagnosed with plantar fasciitis.
Treatment allocation was not
randomized. Subjects were
placed in a calf muscle
stretching plus low-Dye taping
group (LDT) or a calf muscle
stretching only group (control).
92 subjects (M = 37, F = 37;
mean age 50 [ ± 14]) clinically
diagnosed with plantar fasciitis.
Randomly assigned to low-Dye
taping with sham ultrasound
group (LDT) or sham ultra-
sound only group (control).
30 subjects (M = 23, F = 7)
between 40 to 60 years old with
unilateral plantar fasciitis.
Randomly assigned to low-Dye
taping group (LDT) with mean
age of 52.9 ± 4.542 years or
medial arch support group
(MAS) with mean age of
52.8 ± 4.003 years.
30 subjects divided into
low-Dye taping group
(LDT, n = 15; mean age
of 35.4 ± 5.03 years),
and a conservative
treatment group receiv-
ing TENS and infra-red
only (control, n = 15;
mean age of 35.9 ±
4.0 years).
52 subjects (M = 27,
F = 25) between 18- to
65-years-old and clinically
diagnosed with plantar
fasciitis. Randomly as-
signed to calcaneal taping
and ultrasound therapy or
low-Dye taping (LDT) and
ultrasound therapy.
Intervention(s)
Investigated
Both groups were advised to
perform calf muscle stretches
and were given advice on
appropriate footwear. The LDT
group received LDT at the first
appointment and were
instructed to leave the tape on
for 3–5 days. Participants
returned for reassessment
2–3 weeks later where they
were asked to rate their pain
during the 3–5 days after the
initial baseline appointment.
Both groups received 1
3-minute treatment of sham
ultrasound to the painful heel.
The LDT group received LDT
and were instructed to leave the
tape on until their follow-up
appointment 1 week later.
Both groups received 3
treatment sessions on
alternating days over 3 weeks.
Subjects received calf stretching
and ultrasound to the plantar
aspect of the foot for 8 minutes,
at 1.2 W/cm
2
, 1 MHz, and
pulsed mode 1:2. The LDT
group had tape applied imme-
diately after and were instructed
to wear it until the next session,
removing it prior to the therapy
session. The MAS group
removed their MAS prior to
therapy and inserted them back
immediately after each therapy
session.
Both groups received
TENS (15 minutes) and
infra-red (5 minutes) to
painful area of foot in
30-minute sessions 3
times per week for
6 weeks. LDT group
received modified LDT
afterwards.
Both groups received 7
sessions on 7 consecutive
days of ultrasound therapy
(5 minutes, 1 W/cm
2
,
1 MHz, continuous mode).
Afterwards the calcaneal
tape or LDT was applied.
Outcome Measure(s) Pain (100-mm VAS) and a
verbal response to either “Did
the strapping help?”(LDT
group) or “Did the stretching
help?”(control group). Four
responses were allowed: “yes, a
lot”;“yes, a little”;“no, not at
all”;“no, made it worse”.
First step pain (100-mm VAS),
foot function, and general foot
health (Foot Health Status
Questionnaire).
Pain (10-cm VAS) and pain-
related disability (Manchester
Foot Pain and Disability
Schedule).
Pain (point VAS) and
stability using the
transfer area of the
center of gravity
(TAOCOG) using a
BioRescue device.
Pain (VAS) and Functional
Foot Index Questionnaire
(FFI).
(continued)
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Table 2 (continued)
Landorf et al
3
Radford et al
4
Abd El Salam et al
2
Park et al
1
Sankhe et al
5
Main Findings LDT group had significant
improvements in pain (31.7 mm
difference on VAS scale)
compared to the control group
(P<.001). Statistically
significant positive results for
the self-reported 4-point
response scale with 63.1% of
subjects in the LDT group
feeling that the LDT combined
with stretching helped “a lot,”
whereas only 40.0% of patients
in the control group felt “a lot”
of improvement from stretching
alone (P= .034). The between-
group effect size for pain was
0.62.
After 1 week of treatment, the
LDT group had significant
improvements in pain (12.3 mm
difference on VAS scale)
compared to the control group
(P= 0.017). No statistically
significant differences between
groups were found for the Foot
Health Status Questionnaire.
The between-group effect size
for pain was 0.22.
After 3 weeks, groups had
significant improvements in
mean pain and pain-related
disability (P<0.05). Significant
between-group differences in
mean pain and pain-related
disability was present at the
examination assessment, favor-
ing the MAS group (P<0.05).
The between-group effect size
for pain was 0.47.
Decreases in VAS
scores after the
intervention period
were significantly
greater in the LDT
group (5.5 points)
compared to the control
group (1.9 points)
(P<0.05). Increases in
TAOCOG values were
significantly greater for
the LDT group (255.2)
compared to the control
group (32.2, P<0.05).
The between-group
effect size for pain was
0.98.
After 1 week of treatment,
both groups showed a
significant reduction in
pain. Calcaneal taping had
a decrease in FFI of
49.37% and LDT had a
decrease in FFI of 55.02%
(P= 0.001). The between-
group effect size for pain
was 0.71.
Conclusion LDT combined with calf muscle
stretching over a 3–5 day
interval significantly reduced
pain associated with plantar
fasciitis compared with calf
muscle stretching only.
LDT was more effective than
sham ultrasound for reducing
first step pain in patients with
plantar fasciitis after a 1-week
period.
LDT reduced pain and pain-
related disability with plantar
fasciitis to a similar extent as
medial arch supports after a
3-week period.
LDT combined with
TENS and infrared
treatments was more
effective for reducing
foot pain, correcting
weight distribution, and
improving foot stability
than TENS and infrared
over a 6-week period.
LDT combined with ultra-
sound therapy was more
effective in reducing foot
pain in a 7-day treatment
session when compared to
calcaneal taping and
ultrasound therapy.
Abbreviations: LDT, low-Dye taping; CCT, controlled clinical trial; RCT, randomized controlled trial; TENS, transcutaneous electrical nerve stimulation.
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Three of the studies investigated the effects of short-term
LDT treatment with a follow-up of 1 week or less,
3–5
while 2 of the studies examined long-term LDT treat-
ment by using a 3-week
2
and 6-week
1
follow-up. The
reviewed studies with the longest treatment durations
yielded the largest effect sizes,
1,3
suggesting that longer
courses of LDT treatment may be more beneficial for
reducing plantar fasciitis pain. Large effects were mea-
sured in the study by Park and colleagues when LDT was
combined with transcutaneous electrical nerve stimula-
tion and infra-red for 6 weeks (effect size = 0.98).
1
Likewise, Landorf and colleagues found clinically
meaningful effects when LDT was combined with
advice on proper footwear and calf muscle stretching
for 2 to 3 weeks (effect size = 0.62).
3
In contrast, Rad-
ford and colleagues found that a 1-week trial of LDT
alone had a small effect on first-step foot pain (effect
size = 0.22). Therefore, longer courses of LDT treatment
may be more beneficial for reducing plantar fasciitis pain
than briefer treatment regimens. However, none of the
long duration studies
1,3
utilized nontreatment control
groups, making it difficult to assess the influence of
natural healing alone over time.
The etiology of plantar fasciitis, although multifac-
torial, appears to involve a mechanical component that
produces untoward strain on the plantar fascia, leading to
an inflammatory response.
1–4
Potential contributors to
plantar fasciitis include obesity, pes planus, prolonged
exposure to weight bearing activities, and limited ankle
range of motion.
1–5
Nonoperative management is usu-
ally multifactorial and may include custom foot insoles
to control heel pain, but these typically require a few
weeks to manufacture. Therefore, LDT may be benefi-
cial during this waiting period to reduce plantar heel
pain.
1–5
Furthermore, LDT may be a viable alternative to
foot orthoses for individuals who cannot tolerate the
plantar pressures of an orthotic or for footwear that will
not accommodate conventional insoles (eg, ballet slip-
pers). Abd El Salam and colleagues found that LDT
reduced pain and disability with plantar fasciitis to a
similar extent as medial arch supports over a 3-week
period, although the clinical effect was modest (effect
size = 0.47).
2
When compared to another commonly used taping
technique for plantar fasciitis, calcaneal taping, LDT was
found to be more effective in reducing pain and increas-
ing foot function in affected patients.
5
Sankhe and
colleagues reported a moderate to strong between-group
effect size for the reduction of pain (effect size = 0.71),
suggesting that the LDT technique produces clinically
significant improvements in pain compared to the calca-
neal taping technique. While the mechanisms whereby
LDT helps to ameliorate pain with plantar fasciitis is
uncertain, the beneficial effects of LDT may be due to
mechanical efforts as it limits unwanted joint movement,
which protects further injury to the tissues and allows for
healing.
5
Specifically, LDT has been shown to increase
navicular and arch height, reduce midfoot mobility,
increase sagittal plane ankle motion, and induce a
more even weight distribution throughout the medial
longitudinal arch.
1,6
These effects, in isolation or com-
bination, may reduce plantar fascia strain, thereby
decreasing pain and improving function.
As with the study by Sankhe et al comparing the
efficacy of calcaneal and LDT in the treatment of plantar
fasciitis,
5
there is a need to compare the relative efficacy
of other taping approaches on pain with plantar fasciitis.
There is also a need to utilize improved methodologies in
future studies on this topic. Most of the studies in this
review failed to blind their patients, therapists, or asses-
sors and had small sample sizes. In the future, larger,
well-controlled studies are needed to determine the
efficacy of LDT along with its ideal parameters. Addi-
tionally, since the studies in this review included only
older populations, future researchers should consider
studying the effect of LDT on a younger, athletic
population.
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