Gait & Posture 66 (2018) 118–123

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Gait & Posture

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Full length article

Effects of kinesiotaping and athletic taping on ankle kinematics during T

walking in individuals with chronic ankle instability: A pilot study
⁎
Sheng-Che Yena, , Eric Folmara, Katherine A. Friendb, Ying-Chih Wangc, Kevin K. Chuid
a
Department of Physical Therapy, Movement and Rehabilitation Sciences, Bouvé College of Health Sciences, Northeastern University, United States
b
The Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, United States
c
Department of Occupational Science & Technology, College of Health Sciences, University of Wisconsin Milwaukee, United States
d
School of Physical Therapy and Athletic Training, College of Health Professions, Pacific University, United States

A R T I C LE I N FO A B S T R A C T

Keywords: Background: Individuals with chronic ankle instability (CAI) tend to walk with an overly inverted foot, which
Ankle taping increases the risk of ankle sprains during stance phase. Clinicians could perform ankle taping using kinesiotape
Ankle injury (KT) or athletic tape (AT) to address this issue. Because KT is elastic while AT is not, the techniques and un-
Ankle sprain derlying mechanisms for applying these tapes are different, which may lead to different outcomes.
Gait
Research question: To compare the effects of KT and AT interventions on foot motion in the frontal plane and
Foot biomechanics
tibial motion in the transverse plane during stance phase of walking.
Methods: Twenty subjects with CAI were assigned to either KT or AT group, and walked on a treadmill in no tape
and taped conditions. Their foot and tibial motions were captured by 3D motion analysis system. The main
component of KT application was two pieces of tape applied from the medial aspect of the hindfoot to the lateral
to generate a pulling tension towards eversion. AT was applied to the ankle using the closed basket weave
approach. AT was not stretchable and not able to generate the same pulling tension as KT.
Results: KT increased foot eversion during early stance, but showed no effect during late stance. AT increased
tibial internal rotation during late stance, but showed no effect during early stance.
Significance: Compared to AT, KT better provides a flexible pulling force that facilitates foot eversion during
early stance, while not restricting normal inversion in late stance during walking. KT may be a useful clinical tool
in correcting aberrant motion while not limiting natural movement in sports.

1. Introduction with hyper-inversion moves the center of pressure further towards the
lateral border of the heel [10]. This increases the moment arm for the
Ankle sprains are one of the most common athletic injuries with a ground reaction force to generate greater inversion torque during
pooled cumulative incidence rate of 11.55 per 1000 exposures [1]. loading response [3]. Loading response is a gait period when the body
Inversion injuries account for 85% of all ankle sprains [2]. Many in- weight is fully transferred onto the stance leg, and naturally the ankle
dividuals who had an ankle sprain eventually develop chronic ankle moves into eversion for shock absorption [11]. If the eversion motion
instability (CAI), which is characterized by recurrent ankle giving way does not occur effectively, an inversion sprain can occur.
and/or sprains [3]. In high school and Division I athletes, approxi- Decreasing ankle inversion during loading response may play a role
mately 23% were identified as having CAI [4]. Repeated injuries at the in reducing the risk of ankle sprains. One approach to achieve this goal
ankle due to CAI could cause irreversible degenerative changes, with is using non-elastic athletic tape (AT) to restrict ankle inversion [12].
68–78% of individuals with CAI developing post-traumatic ankle os- Two studies applied AT to the ankle using a traditional closed basket
teoarthritis [5]. weave in individuals with CAI, and examined how the intervention
Alteration in gait kinematics may contribute to recurrent ankle affected gait [13,14]. One study showed that the intervention restricted
sprains in individuals with CAI [6–9]. Specifically, they tend to walk ankle inversion during pre-swing (when the foot starts to push off the
with an overly inverted ankle [7,8], which could increase the risk of ground) but not during loading response [13]. However, restricting
inversion injuries following initial contact. Landing the foot on the floor inversion during pre-swing may not be ideal, as this motion is required

⁎
Corresponding author at: Department of Physical Therapy, Movement and Rehabilitation Sciences, Bouvé College of Health Sciences, Northeastern University,
301 Robinson Hall, 360 Huntington Avenue, Boston, MA 02115, United States.
E-mail address: s.yen@northeastern.edu (S.-C. Yen).

https://doi.org/10.1016/j.gaitpost.2018.08.034
Received 19 March 2018; Received in revised form 8 August 2018; Accepted 27 August 2018
0966-6362/ © 2018 Elsevier B.V. All rights reserved.
S.-C. Yen et al. Gait & Posture 66 (2018) 118–123

to lock the midfoot for creating a rigid lever for push off [15]. The other
study examining tibia-rear foot coupling implied that the AT inter-
vention restricted rear foot eversion in relation to tibial rotation during
loading response [14]. However, ankle eversion is critical for shock
absorption during loading response [15]. These results together showed
that AT has the ability to “restrict” ankle motion, but has limited ability
to “facilitate” a desired ankle motion at the right time during a gait
cycle.
We asked if we can use Kinesiotape (KT) to achieve reduction of
ankle inversion during loading response, while not affecting the same
motion during pre-swing. Unlike AT, KT is elastic and can be stretched
to 140% of its original length before being applied to the skin [16]. In
principle, the elasticity of KT provides two advantages. First, KT can
generate pulling force in the direction that the tape is stretched [16,17].
During loading response, this pulling force could be used to provide: (a)
a sensory cue to guide active ankle movement towards eversion and (b)
a mechanical assistance that passively moves the ankle towards ever-
sion [18]. Second, people can overcome the tension generated by KT,
and moves the ankle into inversion as it normally occurs during pre-
swing.
The purpose of this pilot study was to compare effects of AT inter-
vention (provide inversion restriction) and KT intervention (provide
eversion facilitation through generating pulling tension) on foot motion
in the frontal plane and tibial motion in the transverse plane during
loading response and pre-swing. In closed chain, foot inversion drives
the tibia into external rotation as the configuration of the subtalar joint
is like a mitered hinged joint [15]. We hypothesized that KT has greater
ability than AT to reduce foot inversion and increase tibial internal
rotation during loading response, but AT has greater ability than KT to
achieve the same during pre-swing.

2. Methods

2.1. Subject recruitment and assignment

Twenty subjects with CAI were conveniently recruited from a uni-

versity campus. A sample size of 10–20 was previously suggested for a
pilot study [19]. Subjects were included if they aged between 18 and
45, as ankle sprains often happen in the young population [20]. Sub-
jects were determined to have CAI if they scored 24 or lower in the
Cumberland Ankle Instability Tool (CAIT), had more than one event of
ankle giving way in the past six months, and had an ankle sprain one
Fig. 1. The application of kinesiotape. (A) Two pieces of tapes (blue) were
year before enrollment [21]. Subjects did not have current acute in- applied from the medial malleolus to the lateral aspect of the lower leg to
juries affecting their leg joints. generate tension in the eversion direction on the hind foot. Approximately 75%
Quasi-randomization was used to assign subjects to either KT or AT of tension was applied to these two pieces of tapes (i.e., these tapes were 75%
group. Specifically, data collection schedules were set based on the stretched). (B) The application was finished with two figure-of-eights (black
availabilities of a certified KT practitioner (responsible for all KT ap- tapes) to anchor the two blue tapes (for interpretation of the references to color
plications) and an athletic trainer (responsible for all AT applications). in this figure legend, the reader is referred to the web version of this article).
Each subject then selected an available data collection session based on
his/her availability, without knowing that the session was assigned to the foot (over the shoe) to create a shank model and a single-segment
the KT practitioner or the athletic trainer. The KT group consisted of 8 foot model. The marker placement was consistent with our previous
females and 2 males (age: 22.8 ± 1.3 years old) and the AT group protocols [9,22]. In the taped condition, we removed the shoe before
consisted of 7 females and 3 males (age: 23 ± 2.3 years old). Informed applying the tape, and all markers on the shoe stayed in the same lo-
consent was obtained from all subjects, and all procedures were con- cation without moving. After the tape was applied, the subject put the
ducted in accordance with the Helsinki Declaration of 1975 and ap- shoe back onto the foot. Subjects wore their own comfortable sneakers
proved by the local Institutional Review Board. during data collection to avoid potential changes in typical ankle ki-
nematic patterns due to a new shoe configuration.
2.2. Procedures

Subjects walked at a self-selected comfortable speed on a treadmill 2.3. Taping techniques

for one minute in both no tape and taped conditions. The tape was
applied to the affected side (for unilateral CAI) or the more severe side The main component of KT application was two pieces of tape ap-
(for bilateral CAI) based on the CAIT score. Subjects’ leg kinematics plied from the medial to the lateral aspect of the lower leg to generate
were captured using Qualisys motion capture system (Göteborg, eversion tension (Fig. 1A). Tension was applied to these two pieces of
Sweden) with a sampling frequency of 100 Hz. Reflective markers were tape at 75% (i.e. the tape was stretched to 75%). This tension was
placed on the major bony landmarks of the shank (over the skin) and suggested to provide sensory stimulation and mechanical assistance to

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algorithm was used to determine initial contact and toe off [23]. All
position trajectories were segmented into cycles. We selected the first
20 stance phases for analysis. Each stance phase was interpolated to
200 points and evenly divided into 10 zones. Each outcome variable
was averaged within each zone. Zone 1 approximated loading response
while zone 10 approximated pre-swing.
The primary outcome variables were foot inversion/eversion and
tibial internal/external rotation in zones 1 and 10 for hypothesis
testing. The secondary variables were the same position data in zones
2–9. Paired t-tests were used to compare position data between no tape
and taped conditions within each group. We also calculated the change
score between no tape and taped conditions for each group (change
score = taped value − no tape value), and compared the change scores
between the groups using independent t-tests. Prior to the t-tests, we
conducted Shapiro-Wilks tests to check the normality assumption.
When the normality assumption was violated, we alternatively per-
formed non-parametric tests for comparison (Wilcoxon signed-rank for
within-group or Mann-Whitney U for between-group). In the results
section, p values obtained from non-parametric tests were noted.
Cohen’s d was used to quantify the effect size for each t-test. The effect
Z
size for each non-parametric comparison was calculated as: r = N ,
where Z is the Z score of the comparison and N is the number of total
observations [24].

3. Results

3.1. Foot position

Subjects demonstrated a less inverted foot when walking with KT

compared to walking without KT during the early stance phase
(Fig. 3A). Such change only reached significance in zone 1 (without KT:
6.97 ± 3.1°; with KT: 5.28 ± 3.1°; p = 0.03; d = 0.82). The foot po-
sition change observed from zone 2 to zone 10 did not reach statistical
significance.
Subjects showed minimal changes in foot position during each
stance phase zone when walking with AT compared to walking without
AT (Fig. 3B), and none of these changes reached statistical significance.
Fig. 3C shows the change score of the foot position between taped
and no tape conditions during stance phase. Comparing the change
score between groups, we found a significant difference in zone 1 (KT:
−1.69 ± 2.1°; AT: 0.43 ± 2.4°, p = 0.049, d = 0.9). No significant
differences in the change score were detected in any other zones.

3.2. Tibial position

Fig. 2. The application of athletic tape. (A) Two medial-lateral stirrups were Subjects demonstrated minimal changes in tibial rotation in each
applied from the medial to the lateral aspect of the lower leg. These tapes were stance phase zone when walking with KT compared to walking without
not stretchable and did not generate pulling tension. (B) The application was
KT (Fig. 4A), and none of these changes reached statistical significance.
finished with figure-of-eights on top of the medial-lateral stirrups.
Subjects demonstrated an increase in tibial internal rotation during
late stance phase when walking with AT compared to walking without
facilitate motion [18]. The two tapes were anchored by multiple figure- AT (Fig. 4B). Significant differences were found in zone 7 (p = 0.03;
of-eights without tension (Fig. 1B). d = 0.81), zone 8 (p = 0.01; d = 1), zone 9 (p < 0.01; d = 1.1), and
The traditional closed basket weave technique was used to apply zone 10 (p = 0.03; d = 0.79). The differences observed from zone 1 to
1.5-inch AT to the ankle [12]. This technique consisted of medial-lat- zone 6 did not reach statistical significance.
eral stirrups to control the hind foot motion in the frontal plane Fig. 4C shows the change score of the tibial position in the trans-
(Fig. 2A), along with continuous heel locks with a figure-of-eight pat- verse plane during stance phase. Comparing the change score between
tern (Fig. 2B). Unlike KT, AT was not stretchable and was applied in its groups, we found significant differences in zone 7 (KT: −0.03 ± 1.9°;
original length for every component. The ankle was placed in the AT: 1.39 ± 3°; p = 0.03; d = 1.1), zone 8 (KT: 0.05 ± 1.8°; AT:
neutral position during both AT and KT applications. 1.06 ± 2.8°; p = 0.03, Mann-Whitney U test; r = 0.5), and zone 9 (KT:
−0.01 ± 1.7°; AT: 0.13 ± 2.4°; p = 0.04; d = 0.97). No significant
2.4. Data analysis differences in the change score were detected from zone 1 to zone 6 and
in zone 10.
Visual3D (C-Motion, MD) was used to calculate foot/shank position
based on the marker data. Zeni et al.’s coordinate-based treadmill

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Fig. 3. (A) The foot position in the fontal plane during each of the stance phase
Fig. 4. (A) The tibial position in the transverse plane during each of the stance
zones when subjects walked with and without kinesiotape (KT). (B) The foot
phase zones when subjects walked with and without kinesiotape (KT). (B) The
position in the fontal plane during each of the stance phase zones when subjects
tibial position in the transverse plane during each of the stance phase zones
walked with and without athletic tape (AT). (C) The change score in foot po-
when subjects walked with and without athletic tape (AT). (C) The change score
sition (taped – no tape) during each of the stance phase zones between the KT
in tibial position (taped – no tape) during each of the stance phase zones be-
and AT groups. The error bars represent standard deviation. *p < 0.05.
tween the KT and AT groups. The error bars represent standard deviation.
*p < 0.05.
4. Discussion
showed an average of 6.97° of foot inversion when walking normally in
This study had two major findings. First, KT reduced foot inversion
the no tape condition, and this angle significantly decreased to 5.28° in
(or increased foot eversion) right after initial contact during walking in
the taped condition. This suggests that the KT intervention may have
individuals with CAI, but the same effect was not observed in AT.
the ability to increase foot eversion during loading response. In con-
Second, AT increased tibial internal rotation (or reduced tibial external
trast, subjects in the AT group showed an average of 5° of foot inversion
rotation) during late stance phase in walking in individuals with CAI,
when walking normally in the no tape condition in zone 1. This angle
but the same effect was not shown in KT. Based on effect size estimates,
slightly increased to 5.43° in the taped condition, although this increase
all significant results had a medium to large effect [25].
did not reach statistical significance. The results suggest that the AT
The KT and AT interventions showed different effects on foot po-
intervention may have limited effect on altering foot position during
sition during loading response. In zone 1, subjects in the KT group
loading response.

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Two mechanisms may contribute to the increase in foot eversion within-group design. Applying tapes to the ankle essentially generates
due to KT. First, the pulling force generated by KT could provide a force perturbation to affect the joint kinematics. Previous study showed
sensory cue to guide active foot movement towards eversion. Second, that changes in ankle kinematics induced by force perturbation could
the pulling force could provide a mechanical assistance that passively retain even after the perturbation was removed [22]. A between-group
moves the foot towards eversion. These mechanisms were proposed by design was therefore used to avoid potential aftereffects transferring
the developers of KT [18], although the supporting evidence is con- from one condition to another. However, between-group differences in
troversial. For example, a previous study showed that KT application subject characteristics could potentially confound the results. This was
reduced rather than increased the activity of tibialis anterior and a pilot study and we focused on examining the feasibility of using KT to
peroneous longus [26]. In addition, we are not aware of empirical affect ankle kinematics. In future study, we will collect additional
evidence to support the required tension for KT to move a body seg- variables such as electromyography and subjects’ subjective feedback to
ment, which weakens the idea of mechanical assistance. determine the underlying mechanism of KT.
AT did not affect foot position in the frontal plane during loading
response. While AT can provide mechanical restraint to the joint/seg- 5. Conclusion
ment, the restraint may only happen in the extreme range and may have
no effect on influencing the kinematics of the joints or segments when Compared to AT, KT better provides a flexible pulling force that
they are in the functional range of motion [27]. In addition, the closed facilitates foot eversion during early stance, while not restricting nat-
basket weave approach consisted of multiple layers of medial-lateral ural inversion during late stance in walking. The foot and ankle must
stirrups and figure-of-eights [12]. Together, these components mainly move in different directions to achieve different functions in walking.
generate compression sensation around the ankle, rather than creating The elasticity allows KT to facilitate motion in one direction, while not
a directional cue to guide eversion. Also, AT has limited elasticity and limiting motion in the opposite direction. This cannot be achieved by
cannot generate a dynamic pulling tension to assist motion like KT. AT, which has a non-elastic property. The clinical significance of our
During late stance, the ankle naturally moves into inversion to allow results was inconclusive. While KT increased ankle eversion during
the foot to become a rigid lever for push off [15]. Our results showed loading response, the magnitude was small, which may or may not be
that this natural motion was not affected by KT but was affected by AT, able to reduce the risk of inversion injuries. We used walking as a model
particularly in the tibia. The elasticity of KT allowed subjects to over- to test KT’s ability to facilitate foot eversion during early stance while
come the pulling force in eversion and move the foot into inversion. In not restricting natural inversion during late stance. It is clinically sig-
contrast, a previous study showed that AT reduced ankle inversion nificant to examine if the current results are replicable in running in
during late stance [13]. Our results provided additional information, which the foot/ankle also need to move in different directions to
showing that AT restricted tibial external rotation more than foot in- achieve different functions. KT may be a useful tool in correcting
version. The ground reaction force directly applies to the foot during aberrant motion while not limiting natural movement in sports.
stance phase, and may play a role in counteracting the restricting force
generated by AT. The ground reaction force may not achieve the same Conflict of interest statement
effect on the tibia as it does not directly apply to this segment.
Our results suggest that KT does not restrict normal ankle kine- The authors affirm that there is no conflicts of interest that may
matics during walking. This is beneficial because many essential tasks have influenced the preparation of this manuscript.
in walking (e.g., shock absorption and propulsion) are achieved by al-
tering the flexibility of the foot through changing the ankle position Acknowledgements
[15]. Similar functionality is required in many sports like running to
achieve successful performance [28]. Non-elastic taping prevents ankle We thank all students who assisted in subject preparation and data
sprains by restricting ankle mobility, but some evidence suggests that it collection. We thankDr. Stephen Clark for his assistance in athletic
may negatively affect agility [29] and running/jumping performance taping.
[30] during a sport. With its flexibility, KT may be a potential solution
for this issue. Future study is warranted to examine if our results on KT References
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