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Ankle and Lower Leg Injuries

Ankle taping is the most common modality employed to aid the prevention of ankle injuries in many sports. The practice of strapping the ankle joint for sporting activity is applied concurrently with the assumption that, by reinforcing the ligamentous structures and restricting the total range of motion of the ankle joint, especially that of plantar flexion and inversion, the stability of the ankle joint is increased (Verbruggae, 1996).

Thus, the objective of ankle strapping in this sense is to prevent the talus from exceeding its physiologic range of motion in the ankle mortise (Miller and Hergenroeder, 1990). The primary aim of ankle strapping, according to various sources in the literature, is to support the unstable ankle and prevent joint hypermobility without severely handicapping the normal biomechanics of motion (Greene and Hillman, 1990). From aspect of the professional sporting athlete, ankle strapping serves to reduce the probability of injury, financial cost due to rehabilitation and treatment, and the potentially lost playing time (Verbruggae, 1996).

Ankle strapping with adhesive tape can be considered effective for three primary reasons: Ankle strapping aids in the reduction of mechanical ankle instability. 2. Strapping limits the extremes of ankle motion that may occur during physical activity. 3. Strapping, when applied appropriately, can shorten the reaction time of the peroneal muscles by affecting the proprioceptive function of the ligaments and joint capsule around the ankle joint and muscles of the lower leg (Karlsson, Sward and Andreasson, 1993).

Ankle strapping, as with many other modalities used in the prevention of injury, does have certain disadvantages. Strapping can be expensive, time consuming in terms of the athletic trainer, requires application by a trained sports professional and allergies to the zinc oxide compound contained in the tape adhesive are not rare (Burks et al, 1991).

The ability of ankle strapping to lessen the rate and severity of ankle injury in sport is invariably questioned from within the literature. Currently, several studies indicate that ankle strapping provides, at best, little support to the ankle joint after a short period of physical activity.

Miller and Hergenroeder, 1990 cited a study which concluded that between 18% and 50% of support provided by ankle strapping, as measured by the restriction in the range of motion at the ankle joint, is lost after physical activity. Callaghan, 1997, cited studies where 40% to 50% of the effect of strapping was lost after 10 minutes of vigorous activity. Greene and Hillman, 1990, found that no significant restriction was provided by strapping of the ankle joint following one hour of vigorous activity.

Weakening of the strapping tape, which is customarily cloth material with zinc oxide adhesive, is due to a mechanical breakdown of the tape fibers caused by the strain placed upon the material in physical activity. The adhesive properties of strapping tape decreases with moisture accumulation on the skin surface due to sweating (Miller and Hergenroeder, 1990). According to Robbins, Waked and Rappel, 1995, poor tape adherence to human skin decreases the benefit of taping with the duration of exercise.

With the decrease in the restricting effect of ankle strapping after a short period of physical activity, the functional and mechanical instability of the ankle, however, is improved. Strapping may help the functional and mechanical stability of the ankle through the development of muscular responses that result from the effect that strapping places on the neuromuscular mechanisms via cutaneous input.

The importance of the peroneal muscles in preventing ankle sprain has also been discussed within the literature, coinciding with the functional and mechanical advantage that strapping gives the athlete. Peroneal reaction time, rather than the peroneal muscle strength has been described as a discriminating factor after ankle sprain injury (Callaghan, 1997) (Karlsson and Andreasson, 1992).

Ankle strapping unquestionably provides in many instances, a suitable prophylactic device for the athlete, particularly in those partaking in sports with a high incidence of ankle sprains. Although the support provided by adhesive taping decreases significantly during and after physical activity, strapping increases the mechanical and functional stability of the ankle. The proprioceptive properties that ankle strapping has been found to provide is also extremely beneficial in preventing ankle injury.

In the case of the podiatrist, it is important that one has clear understanding of the anatomy and biomechanics involved in ankle injuries, the importance of correct diagnosis and the methods that can be undertaken in order to prevent injury in professional sports. The literature review has proven that ankle strapping is a viable modality in order to prevent the occurrence of ankle injuries.

REFERENCES

Bullard, R., Dawson, J. and Arenson, D. 1979. Taping the athletic ankle. Journal of the American Podiatry Association, 69, (12), pp. 727 – 734. Burks, R., Bean, B., Marcus, R. and Barker, H. 1991. Analysis of athletic performance with prophylactic ankle devices. The American Journal of Sports Medicine, 19, (2), pp. 104 – 106. Callaghan, M. 1997. Role of ankle taping and bracing in the athlete. British Journal of Sports Medicine, 31, (3 ), pp. 102 – 108. Greene, T. and Hillman, S. 1990. Comparison of support provided by a semirigid orthosis and adhesive ankle taping before, during and after exercise.

The American Journal of Sports Medicine, 18, (5), pp. 498 – 506. Karlsson, J. and Andreasson, G. 1992. The effect of external ankle support in chronic lateral ankle joint instability: an electromyographic study. The American Journal of Sports Medicine, 20, (3), pp. 257 – 261. Karlsson, J., Sward, L. and Andreasson, G. 1993. The effect of taping on ankle instability. Sports Medicine, 6, (3), pp. 210 – 215. McMinn, R., Hutchings, R. and Logan, B. 1996. Color Atlas of Foot and Ankle Anatomy (2nd ed).Mosby – Wolfe, London. Miller, E. and Hergenroeder, A. 1990. Prophylactic ankle bracing. Sports Medicine, 37, (5), pp. 1175 – 1185. Robbins, S., Waked, E. and Rappel, R. 1995.

Ankle taping improves proprioception before and after exercise in young men. British Journal of Sports Medicine, 29, (4), pp. 242 – 247. Rovere, G., Clarke, T., Yates, C. and Burley, K. 1988. Retrospective comparison of taping and ankle stabilizers in preventing ankle injuries. The American Journal of Sports Medicine, 16, (3), pp. 228 – 233. Trevino, S., Davis, P. and Hecht, P. 1994. Management of acute and chronic lateral ligament injuries of the ankle. Orthopedic Clinics of North America, 25, (1), pp. 1 – 16. Verbruggae, J. 1996.

The effects of semirigid air stirrup bracing vs. adhesive ankle taping on motor performance. Journal of Orthopedics and Sports Physical Therapy, 23, (5), pp. 320 – 325. Gross, M., Batten, A., Lamm, A., Lorren, J., Stevens, J., Davis, J. and Wilkerson, G. 1994. Comparison of Donjoy ankle ligament protector and subtalar sling ankle taping in restricting foot and ankle motion before and after exercise. Journal of Orthopedic and Sports Physical Therapy, 19, (1), pp. 33 – 41. Konradsen, L. and Bohsen Ravn, J. 1991.

Prolonged peroneal reaction time in ankle instability. International Journal of Sports Medicine, 12, (4), pp. 290 – 292. Larsen, E. 1984. Taping the ankle for chronic instability. Acta Orthopedica Scandinavia, 55, (3), pp. 551 – 553. Liu, S. and Jason, W. 1994. Lateral ankle sprains and instability problems. Clinics in Sports Medicine, 13, (4), pp. 793 – 809. Seto, J. and Brewster, C. 1994. Treatment approaches following foot and ankle injury.

Clinics in Sports Medicine, 13, (4), pp. 695 – 717. Shawdon, A. and Brukner, P. 1994. Injury profile of amateur Australian Rules Footballers. The Australian Journal of Science and Medicine in Sport, 5, (4), pp. 59 – 61. Tweedy, R., Carson, T. and Vicenzino, B. 1994. Leuko and Nessa ankle braces: effectiveness before and after exercise. The Australian Journal of Science and Medicine in Sport, 5, (4), pp. 62 – 66. Wilkerson, G. 1991.

Comparative biomechanical effects of the standard method of ankle taping and a taping method designed to enhance subtalar stability. The American Journal of Sports Medicine, 19, (6), pp. 588 – 595. Yamamoto, T., Kigawa, A. and Xu, T. 1993. Effectiveness of functional ankle taping for judo athletes: a comparison between judo bandaging and taping. British Journal of Sports Medicine, 27, (2), pp. 110 – 112.