A Comparison of Shoe Inserts to
Taping for Painful Arches
David 0. Draper, Ed.D., A.T.C.
Introduction
Most sports require some form of running.
Whether this includes short sprints or continuous running, over a period of time this repeated stress may lead to arch pain (3). Injuries associated with painful medial arches include plantar fasciitis, abductor hallucis
spasm and a stretched spring ligament (2).
In college and high school settings, often
the first person to see an athlete with an arch
injury is the athletic trainer. An athletic
trainer's treatment regimen for arch injuries
often includes cryotherapy, thermotherapy,
administration of oral anti-inflammatory
medication and taping techniques aimed at
supporting the medial longitudinal arch
(MLA). A mode of treatment frequently
overlooked by athletic trainers is a foot orthosis. Arch taping has been a popular practice
among athletic trainers for several years
(1,8). Though the methods of application
may differ, the claim is made that by running
strips of tape from the metatarsal heads,
around the calcaneus and back to the metatarsal heads, the longitudinal arch is reinforced. Until this study was performed, the
only measure of the validity of this treatment
was the athlete's subjective approval. If the
athlete felt that the tape application supported the arch, the assumption was made that
the treatment was sound. With the introduction of electrodynography (EDG) in the early 1980s, a method of measuring forces on
the MLA was made possible. The purpose of
this study was to compare arch taping and
foot orthoses in their ability to support the
MLA. This was assessed through EDG.
Literature
Several studies have been performed that
compared tape application with other
appliances. Gross et al. (4) found that a
semirigid orthosis provided significantly
greater limitations to ankle inversion (9 percent) and eversion (28 percent) than ankle
taping. Studies performed by Rovere et al.
(7) over a six year period, revealed that athletes who wore laced ankle stabilizers experienced half as many ankle sprains as athletes
with taped ankles. Myburt et al. found taping
to be more than twice as effective than braces in limiting ankle joint range of motion
before and during a squash match (6).
Hughes and Steets found no significant difference in retention of support when they
compared pre-exercise and post-exercise
measurements of ankle taping and semirigid
supports (5).
More than 20 articles were reviewed that
compared tape application with an external
support. Though the findings among the
studies may differ, each was similar in the
respect that the studies compared ankle taping with an external ankle support. No literature was found that compared arch taping
with any kind of external arch support.
Methods
The instrument used in this study was electrodynography (EDG). It was developed in
the early 1980s as an aid to the healthcare
professionals' treatment of foot ailments. It
has been found to be a valuable diagnostic
tool when measuring forces on the foot during ambulation. The EDG is made up of
three components, a computer, a computer
pack and electrodes (Figure 1)
.
Typical use of the EDG involves the following four steps: 1) recording the subject's
height and weight; (2) placing the electrodes
on the subject's feet; (3) measuring the
forces placed upon the subject's feet during
ambulation; and (4) retrieving the data from
the computer.
Eighteen individuals, ages 18 to 22, who
were experiencing MLA pain served as subjects. Data regarding each subject's history
of arch pain was collected. Seven electrodes
were placed on the plantar aspect of each
subject's feet in the following sites: (1) hallux; (2) first metatarsal head; (3) second
metatarsal head; (4) fifth metatarsal head;
(5) medial calcaneal tubercle; (6) lateral calcaneal tubercle; and (7) navicular tuberosity
(Figure 2)
.
With the electrodes in place, each subject
underwent four experimental trials. During
each of the four trials, the subject walked at
a cadence of 100 steps per minute for about
20 meters, while the EDG measured forces
applied to the seven areas under the electrodes. The four trials included the 20 meter
walk: (1) while barefoot (Figure 3)
; (2) while
wearing jogging shoes (Figure 4)
; (3) while
wearing orthoses inserted into the jogging
shoes (Figure 5)
; and (4) while wearing the
MLA tape application in the jogging shoes
(Figure 6)
. After the trials were completed,
each subject was asked to compare the arch
taping and the orthoses with regard to comfort and support.
Results
The electrode that was placed on the navicular tuberosity was used to measure the
amount of support that was given to the
MLA. A high force reading in this area
would indicate that the soft tissue structures
under the arch were being lifted up against
the navicular and supporting the arch. Analysis of variance statistics with a Scheffe technique revealed a significant difference,
p>.OS between the arch taping and the orthosis. Although the tape application did provide a small amount of support to the arch,
the orthosis provided significantly more support, and was judged superior (see Table 1
and Table 2
).
Subjective assessment revealed that 17 of
the 18 subjects (94 percent) felt that the orthosis was more comfortable, but that the tape
application provided more support.
Discussion
The pre-fabricated orthosis used in this
study was the "hawk" brand. It was composed of two layers of foam rubber, one
dense and firm, the other soft, and it was
covered with a cotton knit material. The insole was 1 cm thick and had a molded lift to
support the MLA (Figure 7)
.
The results of this investigation point to
the orthosis as being an effective tool that
athletic trainers can employ when treating
MLA pain or injuries. The results of the
subjective assessment might indicate that
athletes confuse comfort and support, and
feel that both cannot co-exist when support
of the MLA is indicated. When the athlete
steps off the table and puts pressure on the
taped arch, the tightness and pressure are
probably misinterpreted as support. Since
there have been no previous studies performed on this topic, the investigator is of
the opinion that athletic trainers tape arches
because the athlete says it gives support.
However, the results of this study indicate
that arch taping is inferior to orthoses when
support of the MLA is indicated.
It is important to note that because of the
cost, the researcher did not fit the subjects
with custom fabricated orthoses but instead
used pre-fabricated soft orthoses. Custom fit
orthoses, made from an impression of the
patient's foot, are often used to support a
painful MLA. The investigator recommends
that future studies be directed toward comparing custom and pre-fabricated foot orthoses for the treatment of arch pain. Based
upon this study, athletic trainers should include orthoses as part of their treatment of
medial longitudinal arch injuries.
Acknowledgements
The author would like to thank Mr. Larry Scire
for his help with this study.
Dr. Draper is Assistant Professor and Undergraduate Program Director of Sports Medicine
and Athletic Training at Illinois State University,
Normal, Illinois 61761. He is also the Head Athletic Trainer at Illinois Wesleyan University,
Bloomington, Illinois.
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injuries. The Physician and Sportsmedicine
1981 ;9:47-58.
- Gross MT, Bradshaw MK, Ventry LC, Weller KH. Comparison of support provided by ankle
taping and semirigid orthosis. The Journal of Orthopaedic and Sports Physical Therapy 1987;9:3336.
- Hughes LY, Stetts DM. A comparison of
ankle taping and a semirigid support. The Physician and Sportsmedicine April 1983; 11:99-103.
- Myburgh KH, Vaughan CL, Isaacs SK. The
effects of ankle guards and taping on joint motion
before, during, and after a squash match. The
American Journal of Sports Medicine
1984;12:441-446.
- Rovere GD, Clarke TI, Yates SC, Burley K.
Retrospective comparison of taping and ankle
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