Beyond support: exploring the dynamic and static biomechanical changes induced by preventive ankle taping: a novel cross-sectional study

Introduction

Preventive strategies for athletes with a history of ankle injuries often include multiple approaches to minimize the injury and re-injury risk. These strategies usually are based on the use of insoles or footwear designed to improve the lower limb and foot biomechanics, educational programs to raise injury awareness, proprioceptive training focused on enhancing motor control of the ankle and foot and the application of functional taping during sports activities to improve joint stability (Kerkhoffs et al., 2001; Janssen et al., 2017).

Functional ankle taping is frequently employed by athletes and medical staff as a preventive method against injuries. Several studies have assessed the biomechanical effects of ankle taping, particularly its capacity for limiting the joint movement, and have often compared it to orthopedic devices. While several authors report similar efficiency to the movement limitation between the two approaches, while other authors defend a greater limitation for the orthopedic devices, leading to improve injury prevention outcomes (Kemler et al., 2011). The widespread use of ankle taping is attributed to its comfort, quick application and perceived increase in joint stability, factors that contribute to the acceptance of this method in athletic environments (Cooke et al., 2009; Kemler et al., 2011).

Currently, it exists a generalized acceptance of the use of preventive ankle taping due to the the high prevalence of lateral ankle sprain (LAS), accounting for 80% of all ankle injuries (Woods et al., 2003). In this line, 70% of LAS patients have been reported to experiment recurrent injuries, leading to the development of chronic ankle instability (CAI) (Anandacoomarasamy & Barnsley, 2005). Residual symptoms are frequent for months or even years following LAS.

Several studies emphasized the importance of appropriate rehabilitation programs after a LAS episode to warrant proper healing context for the injured ligaments, allowing them to endure the tensile forces generated during ankle movements (Denegar & Miller, 2002). There is ongoing debate about the timeframe for achieving mechanical stability after an ankle injury, with some studies recommending a recovery period of at least 6 weeks to 3 months before returning to sports. However, instability may persist for up to a year following LAS (Tohyama et al., 2003; Hubbard & Hicks-Little, 2008).

The biomechanical assessment of ankle and foot pressures and load distributions using pressure platforms has emerged as a highly reliable and non-invasive method, employed in research and clinical practice settings. This technology is particularly useful due to their reproductible data which are essential for evaluating biomechanical interventions, such as preventive ankle taping and their effects on foot function and injury or re-injury risk. As a result, pressure platform analysis has become an indispensable tool for both diagnosis and managing conditions related with foot and ankle biomechanics, while also provides data for the development of targeted rehabilitation strategies and preventive programs (Cuevas-Martínez et al., 2023).

While some evidence suggests that the protective impact of ankle taping is particularly pronounced in individuals with a history of LAS, the actual benefits of such taping in preventing initial injuries or enhancing ankle dorsiflexion, stability, and balance remain unknown. Additionally, recent research indicates that ankle taping may inadvertently increase the risk of knee and ankle injuries due to altered lower limb biomechanics (Romero-Morales et al., 2023; Romero-Morales et al., 2020; Romero-Morales et al., 2023). These findings challenge the effectiveness of ankle taping for injury prevention in healthy populations and call for a critical reassessment of its utility, especially in healthy athletes without prior ankle injuries. Because the use of prophylactic taping is a fairly extended practice in sports even though its effectiveness has not been proven for healthy populations or athletes that had not have a previous LAS history (Handoll et al., 2011), nor has it the mechanisms of why it might be effective as a preventive measure for LAS the present study aims to explore the acute effects of preventive ankle taping on plantar pressure distribution and balance in healthy individuals without previous injuries. the Authors hypothesize that taping alters dynamic and static conditions, potentially shifting the load distribution and balance within the foot, which may influence the risk of injuryost of the reviewed literature focuses on specific populations, such as athletes or sports people recovering from injuries, who may already present biomechanical alterations. To the best of our knowledge, this is the first study to analyze the biomechanical impact of taping on both dynamic balance and plantar pressures under static and dynamic conditions in a healthy population.

METHODS

Tape application

Ankle taping application was performed with a Strappal^® 4-cm width non elastic tape from BSN medical (Essity, Stockholm, Sweden). The technique used was one of the most used ones by physical therapists, athletic trainers, coaches and athletes for ankle injury prevention or rehabilitation processes.

We ensured the accuracy of the bandaging and conditions, as they were performed by a therapist with over 15 years of experience in applying bandages (M.B.A). The ankle taping procedure was detailed in 4 steps (Fig. 1): (1) tape application technique anchoring strips: two Strappal^® anchoring stripes, one at ankle height right above the medial and lateral malleolus and one at the forefoot. (2) Calcaneus stabilization: From those two anchoring stripes five tape stripes were applied to secure the calcaneus into a neutral position: three in an up position from the calcaneus to the ankle anchor and two of them from the calcaneus to the forefoot anchor. (3) Fixation of the talocalcaneal complex: with the ankle at 90-degree angle it was applied a figure-eight strip around the ankle joint with firm but comfortable tension. This strip should start at the forefoot, loop around the ankle, and cross back over to the forefoot, creating the figure called “eight pattern”. (4) Close taping: finish the taping procedure applying additional strips without tension to ensure the entire bandage. These strips should cover and reinforce the previously applied tape (Fig. 2). It is considered mandatory to take into account the tension details: the tape should be applied with enough force to support the ankle joint without restricting blood flow or causing discomfort. This tape moderate tension is crucial for the anchoring strips and the figure-eight pattern. Thus, the ankle taping procedure should be firm but comfortable for the participants.

The order in which the procedure was carried out was to first have the participants measured without being taped at their arrival, then having the pressure and gait analysis recorded at the platform and finally, once they have performed the YBT, they were asked to get taped in order to retake every measurement again.

Results

There were a total of 50 participants in the study, 29 males and 21 females (Table 1). A statistically significant decrease in distance was observed during the anterior YBT in participants while taped versus when not taped (83.00 ± 13.25 and 81.22 ± 8.51 p = 0.001), as well as a decrease in distance during the posterior lateral YBT participants while taped versus when not taped (78.00 ± 14.75 and 76.44 ± 11.92 p = 0.005). The static analysis at the pressure platform measurements, statistically significant changes were observed, an increase in the maximum pressure measured in grams per square centimeters in the midfoot (533.50 ± 125.96 and 558.58 ± 120.37 p = 0. 001), a decrease in peak pressure measured in grams per square centimeters in the forefoot (575.14 ± 106.56 and 530.80 ± 106.83 p = 0.003) and a decrease in contact surface measured in square centimeters in the rearfoot (32.56 ± 5.78 and 30.70 ± 6.38 p = 0.003).

The dynamic measurements made with the pressure platform showed statistically significant changes in the taped condition compared to the non-taped condition, a decrease in the contact surface measured in square centimeters in the rearfoot (33.04 ± 5.08 and 31.00 ± 4.64 p = 0.001), an increase in mean pressure measured in grams per square centimeter in both the midfoot (1,113.77 ± 331.98 and 1,229.46 ± 326.96 p = 0.044) and forefoot (1,169.00 ± 323.50 and 1,174.00 ± 408.50 p = 0.001). A significant decrease in velocity measured in meters per second is also observed in the forefoot in the dynamic assessment (644.00 ± 77.64 and 600.00 ± 105.00 p = 0.003). Table 2

Discussion

The present study evaluated the acute effects of preventive ankle taping on plantar pressure distribution and balance in healthy individuals. Our findings revealed significant changes in both static and dynamic conditions, highlighting the impact of taping on biomechanical parameters such as peak pressures, contact surface, and dynamic balance, as measured by the YBT. Those findings are aligned with previous studies, which reported similar results in pressure variables following the application of the taping (Handoll et al., 2011). The observed redistribution of plantar pressure could be explained by the compensatory mechanisms in response to restricted ankle mobility, particularly in the rearfoot, but this may increase the risk of overuse injuries in the midfoot and forefoot due to the increased concentration of localized stress.

Migel & Wikstrom (2020) conducted a review on different ankle stabilization methods in participants with LAS condition, highlighting the limited number of studies that evaluate the biomechanical effects of taping despite is widespread use in clinical practice. Chinn et al. (2014), compared the effects of ankle taping with respect to no-taping on gait kinematics, demonstrating that taping enhances joint stability and for the limitation of the extreme range of motion movements. However, changes in plantar pressure, as observed in the present study, suggest that while ankle taping may stabilize the ankle joint, also lead to increase peak pressures in the midfoot and may cause uncontrolled load foot redistribution, which could increase injury risk.

In a pilot study developed by Yen et al. (2018), the effects of the kinesiotape bandage on ankle kinematics using 3D motion analysis was assessed. Authors reported that the kinesiotape group exhibited a greater anti-inversion effect due to the properties of the materials. In the current study, similar effects were achieved, which may explain the comparable results. Our findings also showed a reduction in contact surface area in the rearfoot, which could indicate a more concentrated load potentially increasing the risk of overuse injuries or stress reactions. Moreover, the increased mean pressure in dynamic tasks observed in the midfoot and forefoot resulted in restricted rearfoot motion caused by the ankle taping. These findings were consistent with previous studies that suggest taping may alter natural load distribution patterns in the foot. In this line, the observed decreasing in forefoot velocity supports the idea that altered dynamic foot function was related with modifications in gait strategy and foot strike patterns, which could affect overall locomotor efficiency and potentially increase the risk of injury.

Willems et al. (2005) employed a pressure platform to compare non-injuried individuals with those suffering from CAI, showing that CAI group exhibited a lateral shift in the center of pressure. In the present study, the taping appeared to promote a neutral position of the subtalar and talonavicular joint, which could partially explain the prevention effect of externally stabilizing the ankle that had been already described in scientific literature (Quinn et al., 2000; Emery & Pasanen, 2019; Kaminski, Needle & Delahunt, 2019).

Balance deficits are commonly observed in individuals with CAI (Jaffri et al., 2020), and preventive ankle taping plays and important role in addressing these deficits. Trojian & McKeag (2006) found the relationship between poor balance scores and higher incidence of ankle injuries. In the present study, a decrease in YBT performance in the anterior and posterlotaleral directions is consistent with previous findings, where lower YBT scores are strongly linked to a higher risk of lower limb injuries and impaired dynamic balance (Trojian & McKeag, 2006; Mohammadi et al., 2024; Alkhathami, 2023). Individuals with asymmetries in YBT are particulary vulnerable to injury, emphasizing the need for fitted interventions to correct these imbalances (Smith, Chimera & Warren, 2015). Consequently, a reduced ROM dorsiflexion observed in our study correlates with the stabilizing effect of taping on the talonavicular and subtalar joints, which helps to mitigate excessive movements of the talus during plantar flexion (Bernier, Perrin & Rijke, 1997; Hertel et al., 1999; Meyer et al., 1988). Kerkhoffs et al. (2002) remarked in a systematic review the effectiveness of the functional tape stabilization in extreme ankle joint movements. Romero-Morales et al. (2023) also reported a decrease in dorsiflexion following the preventive application of taping for LAS, which is consistent with our findings. The position of the tape stirrups plays an important role controlling the calcaneal adduction and supination (Kaminski, Needle & Delahunt, 2019). Additionally, these results support the use of preventive ankle taping to improve balance and joint stability (Pollock et al., 2000; Zwiers et al., 2016; Chinn et al., 2014).

The significant decrease in forefoot velocity observed during dynamic assessment suggest an altered foot function which is related with altered gait strategies or an increase in injury risk. Static platform analysis further revealed increased midfoot pressure, decreased forefoot pressure and reduced contact surface, consistent with previous findings about pressure redistribution due to ankle taping (O’Sullivan et al., 2008). The changes on the surface distribution may cause compensatory movements or altered load-bearing features associated with a decrease of the movement efficiency. Therefore, strategies focused on minimal biomechanical disruption should be considered (Hopper et al., 2009; Sawkins et al., 2007).

Conclusions

The results of the present study showed that ankle taping alters biomechanical variables, including increased midfoot pressures and decreased forefoot pressures, suggesting a shift in load distribution. The reduction in forefoot velocity and YBT scores indicates changes in gait dynamics and balance. While taping enhances joint stability and may aid in preventing ankle injuries, these biomechanical alterations highlight the need for tailored taping strategies to ensure effective injury prevention without compromising movement efficiency and therefore the authors cannot recommend prophylactic taping for healthy subjects with no prior history of LAS.

Supplemental Information