Accepted Manuscript

Title: Effect of kinesiotaping, non-elastic taping and bracing

on segmental foot kinematics during drop landing in healthy
subjects and subjects with chronic ankle instability

Author: B. Kuni J. Mussler E. Kalkum H. Schmitt S.I. Wolf

PII: S0031-9406(15)03814-6
DOI: http://dx.doi.org/doi:10.1016/j.physio.2015.07.004
Reference: PHYST 853

To appear in: Physiotherapy

Received date: 14-10-2014

Accepted date: 24-7-2015

Please cite this article as: Kuni B, Mussler J, Kalkum E, Schmitt H, Wolf SI, Effect of
kinesiotaping, non-elastic taping and bracing on segmental foot kinematics during drop
landing in healthy subjects and subjects with chronic ankle instability, Physiotherapy
(2015), http://dx.doi.org/10.1016/j.physio.2015.07.004

This is a PDF file of an unedited manuscript that has been accepted for publication.
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*Title Page (with authors and addresses)

Effect of kinesiotaping, non-elastic taping and bracing on

segmental foot kinematics during drop landing in healthy subjects

and subjects with chronic ankle instability†

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B. Kuni*, J. Mussler, E. Kalkum, H. Schmitt, S.I. Wolf

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Clinic for Orthopaedics and Trauma Surgery, Centre for Orthopaedics, Trauma Surgery and

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Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany

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†
Parts of this material were presented at the ESMAC Meeting 2012 and published as an abstract in Gait Posture

2013;38 (Suppl. 1):S93.

*
Corresponding author. Address: Clinic for Orthopaedics and Trauma Surgery, Centre for Orthopaedics, Trauma

Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, SchlierbacherLandstr. 200a, 69118

Heidelberg, Germany. Tel.: +49 6221 452343; fax: +49 6221 5626725.

E-mailaddress:benita@kuni.org (B. Kuni).

Page 1 of 24
*Abstract

Abstract

Objective To compare kinesiotape with non-elastic tape and a soft brace with respect to their

effects on segmental foot kinematics during drop landing in patients with chronic ankle

instability and healthy subjects.

Design Controlled study with repeated measurements.

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SettingThree-dimensional motion analysis laboratory.

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ParticipantsTwenty participants with chronic ankle instability and 20 healthy subjects.

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Interventions The subjects performed drop landings with 17 retroflective markers on the foot

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and lower legin four conditions: barefoot, with kinesiotape, with non-elastic tape and with a

soft brace.
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Main outcome measures Ranges of motion of foot segments using a foot measurement

method.
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ResultsIn participants with chronic ankle instability,midfootmovement in the frontal plane

(inclination of the medial arch) was reduced significantly by non-elastic taping, but
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kinesiotapingand bracing had no effect. In healthy subjects, both non-elastic taping and

bracing reduced that movement. In both groups, non-elastic taping and bracing reduced
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rearfoot excursion significantly, which indicates a stabilisation effect. No such effect was
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found with kinesiotaping. All three methods reduced maximum plantarflexion significantly.

ConclusionsNon-elastic tapingstabilised the midfoot best in patients with chronic ankle

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instability, while kinesiotaping did not influence foot kinematics other than to stabilise the

hindfoot in the sagittal plane.

Clinical Trial Registration Number ClinicalTrials.govNCT01810471

Keywords:Foot kinematics; Chronic ankle instability; Tape; Soft brace; Kinesiotape; Jump

landing

Page 2 of 24
<A>Introduction

More than 20% of high school and collegiate athletes [1] and up to 75% of young

dancers [2] have been identified as having chronic ankle instability (CAI). CAI is associated with

significantly lower functional ankle scores [3]. External support via tape or a brace may help to

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prevent recurrent ankle injuries, especially in previously injured individuals [4–7]. However,

motion-restricting supports may not be suitable for all subjects with CAI in clinical practice (e.g.

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professional dancers on stage). Therefore, newer, more flexible methods, such as elastic taping,

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could be investigated with regard to stabilisation effects in patients with CAI by means of

segmental foot kinematics. As elastic taping (compared with non-elastic taping and barefoot

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conditions) could lower the inversion rate on tilting platforms [6], there may also be some

kinematic effects.
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An adhesive, elastic tape in different colours is used for ‘kinesiotaping’ [8]. This is
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thought to enhance neuromuscular control by stimulating skin receptors, and to improve

lymphatic drainage [9] via the elastic pull effect that reaches the deeper tissues. This method is
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often applied for rehabilitation after musculoskeletal injuries [10]. It is promoted as a means of

positively influencing the motor outcome. Proprioceptive measures could improve in patients
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with functional ankle instability 72 hours after applying kinesiotape [11]. Kinesiotaping and non-
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elastic taping improve performance time in single-leg hurdle jumps in patients with CAI [12]. No

negative effects have been found for kinesiotaping, while non-elastic taping has been found to

reduce performance in other functional tests.

In patients with CAI, non-elastic taping reduces plantar-/dorsiflexion in single-leg drop

landings [13]. Non-elastic taping significantly reduces the maximum inversion while standing on

a platform and tilting sideways [14], and brings the foot into a more neutral ankle position during

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Page 3 of 24
walking and jogging [15]. Non-elastic taping also affects hip kinematics [16]. It seems to provide

mechanical stability due to the non-elastic material and because multiple strips are applied.

Neuromuscular effects [17,18] and some mechanical effects (lasting for 15 to 45 minutes) [19]

may act together.

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Previous studies have shown that kinesiotaping affects ankle range of motion [20] and

kinematics [12,21–23]. However, the literature does not provide any information about the effect

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of kinesiotape on segmental foot kinematics in patients with CAI. If kinesiotaping could provide

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the same effects on segmental foot kinematics as non-elastic taping and bracing, in spite of being

less mechanically restrictive, kinesiotape may be suitable as a stabilisation device for primary

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and secondary prevention in sports activities in which it is not possible to use more restrictive

devices.
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After an initial ankle sprain, residual structural damage of the ligaments and the soft
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tissue of the rear- and midfoot may play an important role in the incidence of recurrent ankle

sprain [24]; as such, these foot segments need to be analysed separately. Previous studies have
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examined the biomechanical impact of braces on foot kinematics [7,25–27] and functional test

situations [26]; however, the effects on the mid- and hindfoot have not yet been differentiated by
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means of a segmental foot model. Quantifying the specific effects of kinesiotaping, non-elastic
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taping and bracing on foot kinematics in jump landing would provide helpful data for secondary

prevention.

Knowledge about optimal stabilisation methods in dynamic sports-related situations is

still lacking. Furthermore, none of the studies cited above compared non-elastic taping,

kinesiotaping and bracing in jump landings by means of a segmental foot model.

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Page 4 of 24
 As such, the aim of this study was to analyse the effect of these methods on mid- and

hindfoot kinematics in order to quantify the stabilisation effect. The main hypothesis was that the

non-elastic tape would stabilise the mid- and hindfoot best, followed by the brace. The non-

elastic tape was expected to be stiffer than the soft brace due to the means of application

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described below. The kinesiotape was not expected to provide mechanical stabilisation as it is an

elastic tape and only two strips would be applied, but it may influence neuromuscular control

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and, therefore, indirectly influence the kinematics.

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<A>Methods

<B>Participants

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Twenty participants with CAI {nine men and 11 women; mean age 25.5 [standard
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deviation (SD) 4.8] years; mean height 175 (SD 10) cm; mean weight 72.8 (SD 15.4) kg} and 20
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healthy subjects (10 men and 10 women; mean age 25.4 (SD 3.2) years; mean height 175 (SD

8.6) cm; mean weight 69.5 (11.5) kg] participated in the study. The patients were recruited from
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the archives of the Centre for Orthopaedics, Trauma Surgery and Spinal Cord Injury, as well as

via advertisements at the University of Heidelberg. Patients with CAI had suffered supination
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trauma at least once within the last 2 years, but not within the last 3 months. Reports of the date
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of the injury/ies and of the initial medical treatment were collected. In addition, at least one

second event had taken place. After the initial trauma, a history of episodes of the ankle joint

giving way and/or reports of subjective ankle joint instability, especially during sports, were

observed in all participants. The ankles were checked for mechanical instability by performing a

thorough clinical examination of the ligaments (anterior drawer sign of the talus and lateral tilt

when performing supination; each test was compared with the non-injured foot). However,

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absence of mechanical instability was not an exclusion criterion if the patient reported subjective

instability or recurrent giving way. Other injuries and surgery of the lower limbs constituted

exclusion criteria. Healthy subjects with a history of ankle injury were excluded. The sample size

was calculated based on the literature [13].

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Before participation, all subjects were informed about the procedures and gave their

written, informed consent. The procedures and the test protocol were approved by the Ethics

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Committee of the Medical Centre for the University of Heidelberg, and followed the tenets of the

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Declaration of Helsinki.

<B>Study protocol

<C>Taping methods an
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The 40 participants were tested under four conditions: barefoot [Fig. Ai (see online
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supplementary material), on the non-injured and the unstable foot], with kinesiotape (NASARA

Kinesiology Tape), with non-elastic tape (Leukotape non-elastic, BSN Medical GmbH & Co.
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KG) and with a brace (MalleoTrain, Bauerfeind), in that order. The kinesiotape was applied in

accordance with the manufacturer’s instructions and following the video spot of the product: ‘K-
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Tape for me – ankle’ (biviax GmbH & Co. KG, article number: 10010), and as introduced by
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Mommsen et al. [28]. First, a single strip from the distal end of the gastrocnemius medialis belly

was wrapped over the medial malleolus, under the foot and over the lateral malleolus up to the

height of the starting point on the medial side. Next, a second strip was applied horizontally

around the ankle over both malleoli (Fig. Aii, see online supplementary material) [28]. The non-

elastic tape (3.75-cm-wide tape) was applied as follows. First, proximal anchors encircling the

distal lower leg, 5 to 10 cm (depending on the height of the person) proximal to the malleoli, and

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Page 6 of 24
distal anchors proximal to the first metatarsophalangeal joint were applied. Next, with the foot in

a neutral position (0° in the ankle joint), heel locks, two stirrups, starting medial and tensioning

in eversion, with horizontal fixation slings after every stirrup (proximal of the Achilles tendon’s

insertion, crossing in front), and figure eights were applied. Subsequently, anchors as described

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above were added again. The taping was finished by applying closure straps (Fig. Aiii, see online

supplementary material). The brace was applied according to the manufacturer’s

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recommendations, whereby the silicone cushion had to be around the malleolus medialis and

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lateralis (Fig. Aiv, see online supplementary material).

A device (Fig. Ai, see online supplementary material) was developed to accurately

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reproduce the marker positions on anatomical landmarks of the foot skeleton. This plate has

multiple fixed laser pointers that are focused exactly on the marked points of the foot model.
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All tests were conducted by the same investigator, who is a trained physiotherapist. He
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applied all tapes and set the brace.

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<B>Single-leg drop fall

Drop landing is commonly selected as a challenging task when analysing kinematics in

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patients with CAI [27,29]. The subjects stood on a box (30-cm high) with both legs positioned at
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a distance of one-third of the patient’s height behind the centre of the force plate. The leg to be

measured was brought forward 30° in hip and knee flexion. The subject stood on the other leg

with the toes flush on the podium, the direction focusing on the force plate. On command, the

subject stepped off the podium on to his/her leg and stabilised or at least stopped for 2 seconds in

a one-legged stance, without touching the floor with the free leg. The arms were held on top of

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Page 7 of 24
the iliac crests. This test was performed three times. If the subject set off the foot during the one-

legged stance, the test was repeated.

<B>Data acquisition

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Kinematic data were collected at 120 Hz using a 12-camera Vicon 612 system (Oxford

Metrics, Oxford, UK), capturing data at 120 Hz. The Vicon system was calibrated before each

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test session. Kinematic data were synchronised using Vicon hardware.

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All trials were performed according to the following protocol. The marker placement was

first drawn on the bare foot with an ink pen, and recorded by means of the laser device (Fig. Ai,

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see online supplementary material) in order to reproduce it exactly for the other conditions

(elastic tape, non-elastic tape and brace). Seventeen retroreflective markers (6 mm in diameter)
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were attached to the skin on each leg according to the Heidelberg foot measurement method
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(HFMM) [30], namely on the distal phalanx of the hallux, the metatarsal heads (DMT1, DMT2

and DMT5), proximally at the first and fifth metatarsal (PMT1 and PMT5), the navicular (NAV),
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the medial and lateral malleolus (MML and LML), and the dorsal position of the calcaneus

(CCL), each placed with the subject barefoot in a standing position. The medial and lateral heel
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markers (MCL and LCL) were placed with the aid of an alignment device while the person was
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sitting and the foot was not bearing any load. Five markers were placed at the tibia (LEP, MEP:

lat./med. epicondyle; TTU: tibial tuberosity; SH1/2: two points on the medial side of the shin). A

static reference measurement was performed in a standing position before every test session

under a new condition. Data acquisition was repeated until three drop landings from the 30-cm-

high platform had been captured.

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Page 8 of 24
<B>Outcomes

Intersegment and joint angles were calculated with the custom-made software ‘MoMo’

within Matlab Version 6.5.1, following the method described by Simon et al. [30]. This program

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also served to average trials for each participant, to visualise charts and to make temporospatial

calculations. The HFMM determines talocrural and subtalar motion via the motion of the three

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calcaneal markers (CCL, LCL and MCL) and the navicular marker (NAV) with respect to the

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tibial markers (LEP, TTU, SH1 and SH2). All other angular parameters are derived as projection

angles between two-dimensional (2D) segments defined by the markers, as described in detail in

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Simon et al. [30]. Unlike typical models that assume a series of two or three rigid and rather

artificial segments in the foot, and allow artificial joints of typically three degrees of motion
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(rotations) as represented by Euler- or Euler-Cardan angles, the HFMM describes the angular
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orientations of anatomical landmarks, possibly spanning more than one anatomical joint, rather

than relying solely on rigid segment modelling. Such a ‘functional segment’ is then described by
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its relative motion via projection angles defined as the angle between two vectors (or 2D

segments) in the perspective view along the axis of rotation. For ease of interpretation, the
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medial arch is defined directly as the angle spanned by the triangle of the markers MCL, NAV
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and PMT1. The medial arch and its inclination are functional parameters. The inclination of the

medial arch describes frontal plane foot motion by monitoring the mediolateral excursion of the

NAV marker in the triangle of the markers MCL, NAV and PMT1. The reliability of these

parameters was tested in a previous study [30].

The repeatability for placing the markers assisted by the laser device was determined by

comparing the following marker distances in the static trials while barefoot and after applying

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Page 9 of 24
the devices: MML–MCL: intraclass correlation coefficient (ICC) = 0.89 [confidence interval

(CI) 0.83 to 0.94); NAV–DMT1: ICC = 0.88 (CI 0.82 to0.93); and CCL–DMT1: ICC = 0.94 (CI

0.91 to 0.97). Two exemplary Bland and Altman plots for the most and least reliable

comparisons of these three parameters between the four conditions (barefoot, kinesiotape, non-

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elastic tape and brace) are shown in Fig. Ba and ii (see online supplementary material).

The following parameters were chosen to describe the kinematics in drop landing:

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rearfoot excursion, inclination of the medial arch, and dorsi-/plantarflexion in the tibiotalar joint.

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In order to describe the relative movement of the hindfoot compared with the tibia, the parameter

‘tibio-talar flex’ (HFMM) [30] is referred to when using the term ‘ankle dorsi-/plantarflexion’ in

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this paper. The term ‘rearfoot excursion’ describes the movement in inversion/eversion that is

described as ‘subtalar rotation’ in Simon et al. [30].

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<B>Statistical analysis

Statistical analyses were performed using Statistical Package for the Social Sciences
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Version 17 (IBM Corp., Armonk, NY, USA). Measures of central tendency and dispersion were

calculated for all variables, and goodness-of-fit to normal distribution was assessed using the
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Kolmorogov–Smirnov test. Non-parametric tests were used as some parameters were not
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normally distributed: the Friedman test for overall differences, the Wilcoxon test for

comparisons between the different conditions, and the Mann–Whitney U-test for group

comparisons. The significance level was assigned at alpha = 0.05.

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Page 10 of 24
<A>Results

In both groups, the rearfoot excursion in eversion/inversion was significantly lower in the

non-elastic tape and brace conditions than in the barefoot condition, whereas the differences

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compared with the kinesiotape condition were not significant (Table 1). In patients, non-

elastic taping was the only method that significantly reduced the maximum lateral inclination of

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the medial arch (Table 2), while in healthy subjects, bracing also showed some effect (Table 2).

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<insert Tables 1 and 2 near here>

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All three methods (kinesiotaping, non-elastic taping and bracing) reduced the maximum
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plantarflexion in landing compared with the barefoot condition (Table 3).
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<insert Table 3 near here>

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<A>Discussion
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The aim of this study was to investigate the effect of different stabilisation methods on
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the segmental kinematics of the ankle–foot complex in patients with CAI and healthy subjects.

To the authors’ knowledge, this is the first study to quantify the influence of these methods on

segmental foot kinematics.

The principal finding was that, in patients, non-elastic taping provided stronger

stabilisation in the midfoot than bracing or kinesiotaping.

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Page 11 of 24
<B>Kinesiotaping

The effects of kinesiotaping were less than expected. It seems that the stabilisation

provided by the other two devices (non-elastic tape and brace) was mainly achieved by

mechanically restricting the joint excursion, as kinesiotaping did not show a significant

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stabilising effect on foot kinematics other than on hindfoot motion in the sagittal plane. An

indirect kinematic effect by a neuromuscular influence of the kinesiotape on the skin was

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expected. Very little evidence can be found in the literature concerning the effect of

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kinesiotaping on ankle kinematics [12,21–23] and its influence on functional parameters in

patients with CAI. The present results suggest that, when applied in this manner, kinesiotape

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only affects hindfoot kinematics in the sagittal plane by restricting plantarflexion in landing. No

positive effects were found on rearfoot excursion or the lateral inclination of the medial arch.
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Whereas the non-elastic tape covered part of the midfoot, the kinesiotape did not reach this area
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of the foot. This could be one reason why kinesiotaping was not found to affect the inclination of

the medial arch.

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Non-elastic tape and the brace also cover a greater total amount of skin than kinesiotape.

Therefore, the greater influence on skin receptors could explain the more intense effect of the
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non-elastic tape and brace.

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Kinesiotaping and non-elastic taping had a positive influence on performance times in

basketball players with CAI in a single-limb hurdle test [12]. This finding suggests that both tape

types may enhance neuromuscular pathways. Therefore, further investigations may be needed to

analyse the effects of kinesiotaping other than kinematic effects. Potential effects on

neuromuscular control could probably be seen by adding electromyography. Nonetheless, the

present study adds important knowledge about the quantitative amount of primary kinematic

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effects of kinesiotaping in comparison with other methods. The foot joint excursions were not

influenced other than in the sagittal plane by kinesiotape. However, a previous study revealed

certain kinematic effects on proximal joints in subjects with CAI [31].

The clinical value of kinesiotaping in stabilising the foot in other planes and segments

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needs to be proven, and its value for primary or secondary prevention of ankle sprains is still

unknown. Interestingly, most participants reported that kinesiotaping was the most

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comfortable/best of the three conditions. The idea to investigate the potential segmental kinetic

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effects of kinesiotaping was prompted by the need to find a form of support for athletes/dancers

with CAI that does not restrict them in daily practice (i.e. on stage or in gymnastics). Restricting

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devices such as non-elastic tape or a brace would prevent them from performing all the

movements required for their technique, and also showed the aforementioned negative effects
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while performing other sports. However, injuries of the ankle are most common in dancers;
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therefore, secondary prevention is highly recommended with respect to the long-term

consequences for these individuals. Therefore, one of the other two devices should be applied.
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<B>Non-elastic taping or bracing?

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If kinesiotaping does not provide the necessary stabilising effect, there is a need to
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determine whether non-elastic taping or bracing is more suitable for patients with CAI in clinical

practice.

The biomechanical impact of non-elastic taping has been described previously in a

comprehensive review [24]. Primarily, the non-elastic tape procedures, such as basket-weave,

figure of eight and heel lock, restrict inward and lateral displacement of the hindfoot within the

frontal plane. The lateral subtalar sling procedure may also limit the subtalar inversion and

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Page 13 of 24
anterolateral rotary subluxation of the talus [24]. The more anterior on the foot a tape sling is

applied, the longer the moment arm [24], which also implies that the midfoot is stabilised. The

chronic instability may mainly be due to damage of the subtalar ligament structures, and to the

soft tissue injury/scars and the resulting rotational instability of the talocrural joint [24].

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The effects of the external supports on these structures, which possibly cause CAI, could

be analysed by means of the experimental setup as the HFMM shows movements of the midfoot

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and the hindfoot in all planes. The subtalar ligament structures and the soft tissue represent the

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restricting elements of the rearfoot.

Bracing and non-elastic taping were found to have a comparably restrictive effect on

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rearfoot motion. Talocrural motion was also influenced by bracing, but to a lesser extent than

non-elastic taping. Previous studies also found that bracing restrict ankle motion in the sagittal
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plane [25] during jump landing. In passive tests of ankle motion, semi-rigid orthoses reduced
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talar and calcaneal plantar flexion, internal rotation and varus angulation in patients with CAI

[32]. Semi-rigid ankle braces seem to limit the rearfoot angular displacement and angular
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velocity more than a lace-up style brace in the ankles of healthy subjects [33].

Despite the fact that motion needs to be restricted (in the sense of stabilisation of the foot
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structures) in patients with CAI, potential negative effects of these devices should also be
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discussed.

A review of eight studies concluded that neither ankle bracing nor non-elastic taping has

any effect on proprioceptive acuity in participants with CAI [34]. The present study only tested a

soft ankle brace as rigid braces have been shown to have significant performance restrictions,

both in different jump and run tests and subjective values [35] and also in sports practice. Braces

of different types have been analysed with respect to their effect on sports performance. Only

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Page 14 of 24
rigid braces showed some negative effects on vertical jumps compared with semi-rigid and soft

braces [35].

In summary, this study showed that soft braces have a quantitative effect on talocrural

and rearfoot kinematics. However, in patients with CAI, non-elastic taping provided additional

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stability in the midfoot. Therefore, the initial effect of non-elastic taping seems to be superior in

patients with CAI, while the two methods were equally effective in healthy ankles.

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In conclusion, non-elastic taping in the aforementioned manner provides the best

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stabilisation. However, there are also disadvantages in comparison with the use of a brace,

including loosening, higher costs [36] and the need for professional help for application.

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This study did not support the hypothesis that kinesiotape would provide a kinematic

effect comparable with that of these commonly used devices. Therefore, these data do not
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support the notion of using kinesiotape as a preventive stabilisation measure in sports when other
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devices cannot be used.

Based on the present data, it is suggested that non-elastic taping, including the midfoot, in
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patients with CAI is the optimal stabilisation method in clinical practice. It seems to provide

sufficient support of all the structures responsible for the CAI symptoms. For previously
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uninjured athletes, non-elastic taping or bracing can be used equally well for stabilisation.
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<B>Limitations

Applying the foot measurement method, skin motion may produce a relevant systematic

bias, underestimating the joint excursion. Previously, others have attempted to quantify skin

motion [37–39]. This study aimed to reduce examiner-induced marker inaccuracies by using a

very strict protocol [30] and a laser-supported device. One examiner set all the markers.

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Page 15 of 24
 The present results are valid for the brace and tape types applied in this study, but not

necessarily for other types of braces and other taping techniques. In particular, other

kinesiotaping techniques could produce other results. Therefore, the authors will continue to

investigate this area in a subsequent study.

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Using an unblinded assessor could have influenced the means of taping and therefore

indirectly enhanced the effects of the tapes. However, the method of brace application would not

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be biased in any case. Generally, taping has to be performed with a specific, standardised tension

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in order not to restrict blood supply or cause discomfort. Therefore, it is considered that the

potential bias for the tape method can be ignored.

<A>Conclusion an
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Segmental foot analysis clearly showed the stabilising effect of both non-elastic taping
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and bracing on the subtalar structures and the talocrural joint. Non-elastic taping seems to

provide more restricted conditions in the midfoot. As this study analysed a dynamic situation, the
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results are useful in the clinical setting as advice for athletes with CAI. The effect of

kinesiotaping needs to be clarified by further investigations, including indicators of

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neuromuscular control. Interesting goals for subsequent studies include investigation of any
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preventive effects of kinesiotaping on the incidence of recurrence, or its use in reducing

instability symptoms and functional impairment.

<A>Acknowledgments

The authors would like to thank Prof. Frank Braatz, MD, and Dipl.-Ing. Merkur Alimusaj for

advice on the choice of brace; Thomas Bruckner and Simone Gantz for statistical support;

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Page 16 of 24
Sherryl Sundell for English language revision; and Priv.-Doz. Dr. med. Nikolaus Alexander

Streich, MD PhD and Dr. med. Alexander Barié, MD, Heads of the Sports Orthopaedics

Division, for general support.

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Ethical approval: The procedures and the test protocol were approved by the Ethics Committee

of the Medical Center for the University of Heidelberg (407-05) and followed the tenets of the

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Declaration of Helsinki.

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Funding: The study was funded by the Ministry of Science Baden-Württemberg, Germany. No

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funds were received from industrial companies (tape or brace producers). These products were

purchased commercially.
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Conflict of interests: None declared.
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<A>References
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[1] Tanen L, Docherty CL, Van Der Pol B, Simon J, Schrader J. Prevalence of chronic ankle

instability in high school and division I athletes. Foot Ankle Spec 2014;7:37–44.
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[2] Simon J, Hall E, Docherty C. Prevalence of chronic ankle instability and associated
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symptoms in university dance majors: an exploratory study. J Dance Med Sci 2014;18:178–84.

[3] de Vries JS, Kingma I, Blankevoort L, van Dijk CN. Difference in balance measures

between patients with chronic ankle instability and patients after an acute ankle inversion trauma.

Knee Surg Sports Traumatol Arthrosc 2010;18:601–6.

[4] Verhagen EA, Bay K. Optimising ankle sprain prevention: a critical review and practical

appraisal of the literature. Br J Sports Med 2010;44:1082–8.

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[5] Hubbard TJ, Cordova M. Effect of ankle taping on mechanical laxity in chronic ankle

instability. Foot Ankle Int 2010;31:499–504.

[6] Trégouët P, Merland F, Horodyski MB. A comparison of the effects of ankle taping styles

on biomechanics during ankle inversion. Ann Phys Rehabil Med 2013;56:113–22.

t
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 Table 1

Rearfoot excursion range in degrees

Patients Controls

t
ip
Median IQR P Median IQR P

cr
Barefoot 8.2 6.6 to 10.2 8.6 5.6 to 10.5

Elastic tape 8.9 6.4 to 11.1 0.55 7.4 6.6 to 8.9 0.30

us
Tape 5.7 3.5 to 6.7 <0.001 5.8 4.1 to 8.2 0.004

Brace 4.4 3.7 to 6.7 0.001 5.5 4.5 to 7.0 <0.001

IQR, interquartile range.

an
M
P-value for Wilcoxon test compared with barefoot condition.
ed
pt
ce
Ac

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 Table 2

Maximum lateral inclination of the medial arch in degrees

Patients Controls

Median IQR P Median IQR P

t
ip
Barefoot 10.3 5.9 to 17.9 11.8 7.1 to 16.0

cr
Elastic tape 8.9 6.5 to 19.6 0.97 10.9 6.6 to 14.7 0.22

Tape 6.9 -1.5 to 11.9 0.001 3.8 -0.1 to 6.9 <0.001

us
Brace 11.7 4.0 to 20.0 0.97 5.6 2.1 to 14.6 <0.001

IQR, interquartile range.

an
P-value for Wilcoxon test compared with barefoot condition.
M
ed
pt
ce
Ac

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Page 23 of 24
 Table 3

Maximum plantarflexion in degrees

Patients Controls

Median IQR P Median IQR P

t
ip
Barefoot 24.7 19.5 to 27.3 20.8 14.3 to 25.0

cr
Elastic tape 18.6 16.0 to 23.0 0.006 17.0 15.1 to 21.8 0.023

Tape 14.8 10.1 to 18.9 <0.001 12.2 5.2 to 16.5 <0.001

us
Brace 21.3 16.5 to 23.7 0.003 19.0 12.3 to 22.7 0.001

IQR, interquartile range.

an
P-value for Wilcoxon test compared with barefoot condition.
M
ed

Fig. A. Device with laser pointers for reproduction of the correct anatomical position of the
pt

markers according to the Heidelberg Foot Measurement Method in (i) the barefoot condition, (ii)

with kinesiotape, (iii) with non-elastic tape, and (iv) with a soft brace.
ce
Ac

Fig. B. Exemplary Bland and Altman limits of agreement for the comparison between (i)

barefoot and kinesiotaping conditions for the distance between the navicular (NAV) and the first

metatarsal head (DMT1), and (ii) between barefoot and non-elastic taping conditions for the

distance between the medial malleolus (MML) and the medial heel marker (MCL). SD, standard

deviation.

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