Academic literature on the topic 'Edema. Ankle Bandages and bandaging. Ankle'

Objectives Slough in chronic venous leg ulcers may be associated with delayed healing. The purpose of this study was to assess larval debridement in chronic venous leg ulcers and to assess subsequent effect on healing. Methods All patients with chronic leg ulcers presenting to the leg ulcer service were evaluated for the study. Exclusion criteria were: ankle brachial pressure indices <0.85 or >1.25, no venous reflux on duplex and <20% of ulcer surface covered with slough. Participants were randomly allocated to either 4-layer compression bandaging alone or 4-layer compression bandaging + larvae. Surface areas of ulcer and slough were assessed on day 4; 4-layer compression bandaging was then continued and ulcer size was measured every 2 weeks for up to 12 weeks. Results A total of 601 patients with chronic leg ulcers were screened between November 2008 and July 2012. Of these, 20 were randomised to 4-layer compression bandaging and 20 to 4-layer compression bandaging + larvae. Median (range) ulcer size was 10.8 (3–21.3) cm2 and 8.1 (4.3–13.5) cm2 in the 4-layer compression bandaging and 4-layer compression bandaging + larvae groups, respectively (Mann–Whitney U test, P = 0.184). On day 4, median reduction in slough area was 3.7 cm2 in the 4-layer compression bandaging group ( P < 0.05) and 4.2 cm2 ( P < 0.001) in the 4-layer compression bandaging + larvae group. Median percentage area reduction of slough was 50% in the 4-layer compression bandaging group and 84% in the 4-layer compression bandaging + larvae group (Mann–Whitney U test, P < 0.05). The 12-week healing rate was 73% and 68% in the 4-layer compression bandaging and 4-layer compression bandaging + larvae groups, respectively (Kaplan–Meier analysis, P = 0.664). Conclusions Larval debridement therapy improves wound debridement in chronic venous leg ulcers treated with multilayer compression bandages. However, no subsequent improvement in ulcer healing was demonstrated.

Context:Elastic bandages are commonly used in sports to treat and prevent sport injuries.Objective:To conduct a systematic review assessing the effectiveness of elastic bandaging in orthopedic- and sports-injury prevention and rehabilitation.Evidence Acquisition:The researchers searched the electronic databases MEDLINE, CINAHL, SPORTDiscus, EMBASE, and Physiotherapy Evidence Database (PEDro) with keywords elastic bandaging in combination, respectively, with first aid, sports injuries, orthopedic injuries, and sports injuries prevention and rehabilitation. Research studies were selected based on the use of the term elastic bandaging in the abstract. Final selection was made by applying inclusion and exclusion criteria to the full text. Studies were included if they were peer-reviewed clinical trials written in English on the effects of elastic bandaging for orthopedic-injury prevention and rehabilitation.Evidence Synthesis:Twelve studies met the criteria and were included in the final analysis. Data collected included number of participants, condition being treated, treatment used, control group, outcome measures, and results. Studies were critically analyzed using the PEDro scale.Conclusions:The studies in this review fell into 2 categories: studies in athletes (n = 2) and nonathletes (n = 10). All included trials had moderate to high quality, scoring ≥5 on the PEDro scale. The PEDro scores for the studies in athletes and nonathletes ranged from 5 to 6 out of 10 and from 5 to 8 out of 10, respectively. The quality of studies was mixed, ranging from higher- to moderate-quality methodological clinical trials. Overall, elastic bandaging can assist proprioceptive function of knee and ankle joint. Because of the moderate methodological quality and insufficient number of clinical trials, further effects of elastic bandaging could not be confirmed.

Objective: To test the use of a low-cost, portable, battery-powered sub-bandage pressure monitor as a part of a quality control measure for graduated compression bandaging in the leg ulcer clinics. Methods: A total of 25 healthy volunteers (mean age 40 years) providing 50 limbs were bandaged with a 4-layer compression bandaging system. Interface pressure was measured by placing pressure sensors on the skin at three points (2 cm above the medial malleolus, on the widest part of the calf and on a point midway between them) in supine and standing positions. A further 16 patients (mean age 62 years) providing 22 limb measurements also participated in this study. Bandages were reapplied in patients with the help of the pressure monitors when the target pressure was not achieved in the first attempt. Results: The interface pressures varied with change of position and movement. With the operator blinded, the target pressure of 35–40 mmHg at the ankle was achieved in only 36% of healthy volunteers (mean±95% confidence interval, 32.3±1.6 mmHg [supine]; 38.4±2.4 mmHg [standing position]). With the help of the pressure monitors, the target pressure was achieved in 78% of the patients. Conclusion: This result suggests that it is important to have a tool that is easy to operate, and available as a part of the quality assurance in connection with treatment and also training of care providers, nurses, etc in how to apply a compression bandage.

Objective: To compare the consistency of the pressure measurements and the practical aspects of three manometers (Salzman MST; Oxford Talley and Diastron) measuring sub-bandage pressures. Methods: Five bandages (tubular elastic straight, tubular elastic graduated, short stretch non-elastic, long stretch elastic, cohesive elastic) were applied to standard models comprising foam-covered 9.5 cm, 12.5 cm diameter plastic tubes and a cone by a single expert bandager using a standard spiral technique with 50% overlap for the non-tubular bandages (NTB). The probes of all three machines were positioned at equidistant points around the circumference of each model at three levels corresponding to the ankle, gaiter and mid-calf measuring points of the MST probe. Two readings were taken for each of three separate applications of each bandage. Statistical analysis utilised ANOVA with Bartlett's test. Results. A total of 135 readings were made for each machine and 81 for each type of bandage. Mean pressures among the five bandages types ranged from 12.2 to 35.5 mmHg. A pressure gradient was apparent when NTB bandaging the straight tubes (means 24.7, 23.5, 22.4 mmHg) but not with the cone. There was a statistically significant difference between the three machines (Bartlett's test 23.6, p<0.0001), with the lowest variances for the MST and similar variances for the Oxford and Diastron. Conclusion. In terms of measurement variance this experiment indicates that the MST is the preferred machine for future experiments.

Background Multi-component medical compression bandages are widely used to treat venous leg ulcers. The sub-bandage interface pressures induced by individual components of the multi-component compression bandage systems are not always simply additive. Current models to explain compression bandage performance do not take account of the increase in leg circumference when each bandage is applied, and this may account for the difference between predicted and actual pressures. Objective To calculate the interface pressure when a multi-component compression bandage system is applied to a leg. Method Use thick wall cylinder theory to estimate the sub-bandage pressure over the leg when a multi-component compression bandage is applied to a leg. Results A mathematical model was developed based on thick cylinder theory to include bandage thickness in the calculation of the interface pressure in multi-component compression systems. In multi-component compression systems, the interface pressure corresponds to the sum of the pressures applied by individual bandage layers. However, the change in the limb diameter caused by additional bandage layers should be considered in the calculation. Adding the interface pressure produced by single components without considering the bandage thickness will result in an overestimate of the overall interface pressure produced by the multi-component compression systems. At the ankle (circumference 25 cm) this error can be 19.2% or even more in the case of four components bandaging systems. Conclusion Bandage thickness should be considered when calculating the pressure applied using multi-component compression systems.

Objective: To compare a new ‘advanced’ hydrocellular Polyurethane dressing (HPD) (Allevyn) with a traditional simple non-adherent knitted viscose dressing (KDV) (Tricotex) in the treatment of chronic venous leg ulcers. Design: A randomized trial of factorial design, with interaction testing, to allow the evaluation of two different therapeutic components (dressing and bandages) within a single trial. The treatment period was 12 weeks or until healing, whichever occurred sooner. Setting: The Leg Ulcer Clinics of Edinburgh and Falkirk and District Royal Infirmaries, Scotland. Patients: 132 patients with chronic venous leg ulcers were randomized, 66 to HPD and 66 to KVD. Principal exclusions were patients with diabetes, rheumatoid disease or Doppler ankle/brachial pressure indices of less than 0.8. There were 28 withdrawals (15 KVD, 13 HPD). These were considered as treatment failures. Interventions: Dressings and bandaging were applied by specialist leg ulcer nurses using standard techniques throughout, the bandaging being randomized to either elastic or non-elastic multilayer systems. Main outcome measure: The principal end-point was ulcer healing. Also monitored were healing rates, pain and the frequency of dressing changes. Results: Pain relief was significantly better in the HPD group ( p=0.01). Thirty-one (47%) of the HPD patients healed within 12 weeks compared with only 23 (35%) of the those treated with KVD (95% confidence limits for difference, −5% to +29%). The higest healing rates (61% for all ulcers and 74% for those less than 10 cm2) were observed in the subgroup in which HPD was used in combination with an elastic bandaging system. Conclusion: Patients treated with HPD did significantly better in terms of pain relief, although the higher healing rates observed in this group failed to reach significance at the 5% level.

Objective: To compare on standardized laboratory models the performance of four commercially available four-layer bandage systems. Methods: Four experienced bandagers applied each of the four systems [Profore® Regular (Smith & Nephew, Hull, UK), Ultra Four (Robinsons, Chesterfield, UK), System 4 (SSL International, Knutsford, UK) and K-Four® (Parema, Loughborough, UK)] to two models: a 12.5 cm diameter padded cylinder and a 9.5-14.5 cm padded cone. Bandages were applied individually in single layers and as a completed system using standard application techniques. Pressures were measured by the Borgnis Medical Stocking Tester at positions corresponding to ankle, gaiter and mid-calf areas as determined by the pressure sensor. Results: A total of 768 observations were made: 384 for each model, 192 for each bandaging system, 192 for each bandager and 128 for each measuring point. The increase in pressure produced by each additional layer was in the range of 50-60% of the pressure achieved by the same bandage when used as a single layer. Each bandage system and each bandager produced a gradient of final mean pressure irrespective of whether the bandage was applied to a cylinder or a cone. However, there were no significant differences in the gradients between the four bandage systems or between the four bandagers. There were significant differences in the final pressures achieved among the bandage systems when applied as completed systems (mean: Profore® = 42 mmHg; System 4 = 45 mmHg; K-Four® = 48 mmHg; and Ultra Four = 51 mmHg; P<0.001). Conclusions: These results challenge a commonly-held assumption concerning the additive effect of pressures generated by successive bandage layers. When applied as part of a multi-layered system each bandage adds just over half the pressure achieved by the same bandage when applied alone. The four completed systems produced pressures within a range appropriate for ulcer therapy, although there were significant differences in mean pressures. This capability of the systems to produce different pressures could be clinically important in the hands of inexperienced bandagers or with patients at risk of pressure damage..

BackgroundCompression is an effective and recommended treatment for venous leg ulcers. Although the four-layer bandage (4LB) is regarded as the gold standard compression system, it is recognised that the amount of compression delivered might be compromised by poor application technique. Also the bulky nature of the bandages might reduce ankle or leg mobility and make the wearing of shoes difficult. Two-layer compression hosiery systems are now available for the treatment of venous leg ulcers. Two-layer hosiery (HH) may be advantageous, as it has reduced bulk, which might enhance ankle or leg mobility and patient adherence. Some patients can also remove and reapply two-layer hosiery, which may encourage self-management and could reduce costs. However, little robust evidence exists about the effectiveness of two-layer hosiery for ulcer healing and no previous trials have compared two-layer hosiery delivering ‘high’ compression with the 4LB.ObjectivesPart I To compare the clinical effectiveness and cost-effectiveness of HH and 4LB in terms of time to complete healing of venous leg ulcers.Part II To synthesise the relative effectiveness evidence (for ulcer healing) of high-compression treatments for venous leg ulcers using a mixed-treatment comparison (MTC).Part III To construct a decision-analytic model to assess the cost-effectiveness of high-compression treatments for venous leg ulcers.DesignPart I A multicentred, pragmatic, two-arm, parallel, open randomised controlled trial (RCT) with an economic evaluation.Part II MTC using all relevant RCT data – including Venous leg Ulcer Study IV (VenUS IV).Part III A decision-analytic Markov model.SettingsPart I Community nurse teams or services, general practitioner practices, leg ulcer clinics, tissue viability clinics or services and wound clinics within England and Northern Ireland.ParticipantsPart I Patients aged ≥ 18 years with a venous leg ulcer, who were willing and able to tolerate high compression.InterventionsPart I Participants in the intervention group received HH. The control group received the 4LB, which was applied according to standard practice. Both treatments are designed to deliver 40 mmHg of compression at the ankle.Part II and III All relevant high-compression treatments including HH, the 4LB and the two-layer bandage (2LB).Main outcome measuresPart I The primary outcome measure was time to healing of the reference ulcer (blinded assessment).Part II Time to ulcer healing.Part III Quality-adjusted life-years (QALYs) and costs.ResultsPart I A total of 457 participants were recruited. There was no evidence of a difference in time to healing of the reference ulcer between groups in an adjusted analysis [hazard ratio (HR) 0.99, 95% confidence interval (CI) 0.79 to 1.25;p = 0.96]. Time to ulcer recurrence was significantly shorter in the 4LB group (HR = 0.56, 95% CI 0.33 to 0.94;p = 0.026). In terms of cost-effectiveness, using QALYs as the measure of benefit, HH had a > 95% probability of being the most cost-effective treatment based on the within-trial analysis.Part II The MTC suggests that the 2LB has the highest probability of ulcer healing compared with other high-compression treatments. However, this evidence is categorised as low to very low quality.Part III Results suggested that the 2LB had the highest probability of being the most cost-effective high-compression treatment for venous leg ulcers.ConclusionsTrial data from VenUS IV found no evidence of a difference in venous ulcer healing between HH and the 4LB. HH may reduce ulcer recurrence rates compared with the 4LB and be a cost-effective treatment. When all available high-compression treatments were considered, the 2LB had the highest probability of being clinically effective and cost-effective. However, the underpinning evidence was sparse and more research is needed. Further research should thus focus on establishing, in a high-quality trial, the effectiveness of this compression system in particular.Trial registrationCurrent Controlled Trials ISRCTN49373072.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 18, No. 57. See the NIHR Journals Library website for further project information.

Category: Trauma Introduction/Purpose: Displaced intraarticular calcaneus fractures comprise the majority of all calcaneus fractures. Many are indicated for open reduction and internal fixation (ORIF) through an extensile lateral approach (ELA). Unfortunately, this approach has reported complication rates of up to 32%. Improved edema management may reduce the incidence of complications. While compression wrapping has been shown to reduce wound complications in ankle arthroplasty, it has not been well studied in lower extremity trauma. This study aimed to evaluate the benefit of compression wrapping in calcaneus fractures treated surgically with an ELA. Methods: This study included 19 patients from 2015-2018 who underwent ORIF of closed intra-articular calcaneal fractures via an ELA by two surgeons. Demographics, comorbidities, fracture characteristics, and time to surgery were recorded. Following surgery, the extremity was initially immobilized in a short leg splint with transition to serial compression wrappings on postoperative day two. Wrappings involved application of multi-layered cotton cast padding and short stretch elastic bandages to the extremity in a distal to proximal fashion. Wraps were replaced every three days by trained physiotherapists until the two- week postoperative visit. The primary outcome was development of a wound complication. A minor complication was defined as wound appearance prompting initiation of oral or IV antibiotics or local wound care. A major complication was defined as development of flap necrosis or return to the OR for debridement. Results: Mean age was 47.7 years. 3 patients (15.7%) were diabetic, and 7 patients (36.8%) were smokers. Mean BMI was 26.9 kg/m2 (SD 4.4). Mean time to surgery was 11.4 days from injury (SD 6.93). The rate of minor soft tissue complication was 4/19 (26.3%); 2 patients required oral antibiotics only, 1 local wound care only, and 1 both antibiotics and local wound care. The rate of major complication was 2/19 (10.5%), with 1 patient requiring a return to OR and another requiring both a return to the OR and IV antibiotics. Of those patients, 1 was noncompliant with the protocol. All patients progressed to eventual soft tissue healing. Statistical analysis identified diabetes as a risk factor for any complication (p=0.02, relative risk 5.3). Conclusion: Compression wrapping resulted in a low incidence of major soft tissue complications in calcaneus fractures treated with an extensile lateral approach. Compression wrapping is an effective method of post-operative soft tissue management for calcaneal fractures, and may have further applications for similar high energy foot and ankle fractures. Further studies are warranted to determine whether this novel wound care technique is superior to standard post-operative wound care.

In this study the evolutionary development of orthopedics (management of diseases of bones and joints), which commenced in early Mesopotamia and Egypt, is followed through Classical times.The Greek infl uence probably commenced in the 6thcentury BC with Democedes of Croton who cured the Persian king’s dislocated ankle. The Corpus Hippocraticum laid the foundation of orthopedic practice in antiquity. Although knowledge of anatomy was limited, its four books on orthopedics (The Nature of Bones, Mochlicon, On Fractures, On Joints) count amongst the outstanding contributions of Hippocratic writers. In systematic manner the general recognition and management of fractures and dislocations are covered, followed by the handling of individual lesions. Hippocrates differentiated between closed and open fractures (with overlaying skin wounds). Closed fractures were reduced to as normal a position as possible – manually where possible, but with large bones and in the presence of formidable muscle mass, mechanical traction was often employed (e.g. the Hippocratic bench and the bizarre succusion ladder for spinal deformities). There is no mention of the use of analgetic drugs. After application of cerate (mixture of olive oil, soda and pitch) to the skin, the fracture was immobilized by a combination of plasters and compresses (often fi rmed up with gum-mixtures) – but never very fi rmly. On the 3rd, 6/7th, 9thand 12th days the bandaging was removed, the lesion inspected and if considered necessary, re-aligned, A variety of splints were then applied. Strict bed rest was enforced, as well as a light diet (no wine or meat for 10 days). It was believed that fractures of the feet, clavicle, ribs and jaw healed after 20 days, of the forearm after 30 days, and fractures of the upper arm and leg after 40 days. Open fractures were considered very serious injuries, and reduced very carefully. Protruding bone fragments were removed (sawn off if necessary) and the wound was covered with black cerate, compresses and light bandages. Pressure and heavy splints were thought to induce infection and gangrene and thus avoided. Dislocations were reduced as soon and as effectively as possible, before muscle spasm set in. As with fractures manual reduction was, where necessary, complemented by mechanical traction. After extensive washing of the joint area with warm water, cerate was applied to the wound and specialised bandaging (even splints) ensured immobilization. Open dislocations like open fractures were considered very serious and reduction was not attempted. Again all pressure bandaging was avoided. A non-functional joint was commonly the end result. The management of 18 specifi c fractures is described in detail. Jaw fractures were fi xed by the binding of contiguous teeth. Fractures of the spinal column clearly presented a major problem. Although knowledge of spinal anatomy was surprisingly good, the diagnosis of fractures was very difficult and its association with spinal curvatures presented almost insurmountable problems of management. It was recognized that rib fractures could cause serious damage to the lung and pleura. Complex problems caused by arm fractures involving the elbow or shoulder joints, and combined radius and ulna fractures, are addressed. Femur fractures presented major problems and permanent leg deformity was very common. Open femur fractures were extremely serious and Hippocrates even stated that a physician who could ethically avoid becoming involved in treating such an injury, should do so. Fractures of femur necks were not recognised. The Hippocratic work, Wounds of the head, dealing with fractures of the skull, is not covered in this study.Management of the major joints are individually described. Seven different techniques of reducing a dislocated shoulder joint are mentioned The original description of the management of the dislocation of the wrist and hand is lost. Proper reduction of hip-dislocation was essential to avoid muscle atrophy and life-long limping, and was achieved by intricate mechanical suspension. Strangely enough, lateral dislocation of the knee was a common occurrence and not seen as a serious problem. Congenital club feet were effectively treated by prolonged fi xation in the correct position by way of tight bandaging with compresses stiffened in glue-mixtures.There is abundant skeletal evidence of osteo-arthritis in Neolithic man, but no clear description of it in the Corpus Hippocraticum. Gout is repeatedly mentioned in the Corpus but without detailed descriptions of the disease. In the Roman era authors like Heliodorus, Antyllus and Celsus in particular, wrote authoritatively on orthopedic subjects, Osteo-archaeological evidence is that fractures were treated expertly in the Roman army. Conditions consistent with degenerative osteoarthritis and true gout (as podagra and chiragra) were described by Celsus and Aretaeus of Cappadocia. Soranus, Rufus of Ephesus and Galen also wrote on orthopedic subjects. We will today differ from many statements made in the Corpus Hippocraticum, but it is clear that the orthopedic basis laid by those documents was not seriously challenged for 1 000 years.

Athletic trainers frequently are required to design rehabilitation and treatment programs for injured athletes. These treatment programs oftentimes involve the use of cryotherapy or ankle taping to create an optimal environment for healing. The purpose of this study was to identify the individual and simultaneous effects of ankle taping and cryotherapy on mechanical power and velocity.Sixteen (16) Division IA Baseball players (Age 20.53+/- 1.15 yrs, Wt 878.45+/105.68 N, Ht 1.85+/- 0.087 m) served as subjects for this study. Subjects met the following criteria: 1) all were asymptomatic from any lower extremity injury for at least six months prior to testing. 2) none had any known cold allergy (ie. hives, hypersensitivity to cold).This study utilized a counterbalanced repeated measures design, in which subjects participated in three treatments, cryotherapy, ankle taping and a combination treatment of cryotherapy and ankle taping. For the taping treatment, each subject was taped using a standard closed basket weave technique` with porous 1.5" cloth athletic tape (Johnson and Johnson, Coach). The cryotherapy treatment was administered a 20 minute ice immersion treatment at 10 deg Celsius to the leg and ankle. In the combination treatment, both treatments were administered with the ice immersion preceding ankle taping. The effects of these treatments on mechanical power and velocity were measured by a Kistler amplifier and force plate platform during a one leg standing vertical jump.The two-way repeated measures ANOVA's for power and velocity showed no significant interaction between cryotherapy, taping or combination treatment. However, significant pre-post treatment effects for power were discovered after cryotherapy and combination treatment. As a result of these findings, it is evident that immediate return to participation after cryotherapy or combination treatment will lead to decreases in muscular performance or injury.
School of Physical Education

The purpose of this study was to compare the protective characteristics of four different ankle braces and one form of ankle taping. An inversion and plantar flexion platform was used to induce ankle movements. The subjects used in this study consisted of 10 volunteer male students. The subjects had no sprains five months prior to testing. All subjects were tested in the same size 10 shoes, high tops and low tops. A Certified Athletic Trainer applied all ankle braces and ankle tapings. A closed basketweave with heel locks, adherent spray, and pre-wrap was used for all taping conditions.After the application of the ankle braces or taping, each subject performed two tests on the inversion and plantar flexion platform. A random order was used among the subjects. An ankle inversion platform was modified to induce 30 degrees of inversion and 35 degrees of plantar flexion simultaneously. The subjects will be filmed using a Locam 16mm at 200 frame/second. All subjects were filmed from the posterior plane with markings on the posterior aspect of the lower leg to help analyze the movement at the subtalar joint. A Calcomp 9100 series digitizer that was interfaced with a VAX computer was used to analyze the data and calculate the amount of angular displacement at the subtalar joint. An ANOVA with repeated measures was used to determine significant differences between support techniques. University procedures for the protection of human subjects was followed. ANOVA procedures indicated no significant difference in angular displacement between braces. A statistical analysis indicated that low top shoes provided significantly more support than high top shoes in braced ankles.
School of Physical Education

Thesis (M.A.)--University of North Carolina at Chapel Hill, 2005.
Includes bibliographical references (leaves 102-106). Also available online (PDF file) by a subscription to the set or by purchasing the individual file.

Thesis (M.S.)--University of North Dakota, 2005.
Includes bibliographical references (leaves 43-44). Also available online (PDF file) by a subscription to the set or by purchasing the individual file.

Thesis (M.A.)--University of North Carolina at Chapel Hill, 2005.
Includes bibliographical references (leaves 109-114). Also available online (PDF file) by a subscription to the set or by purchasing the individual file.

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2017.
Background: Acute ankle sprains and chronic ankle instability syndrome (CAIS) may be managed effectively through conservative management approaches such as strapping. There are two main types of strapping viz. rigid tape which is used to stabilise the joint and limit joint motion and elastic tape which permits joint motion but provides dynamic support. Kinesio™ tape is becoming increasingly popular in the management of various conditions. It is reportedly beneficial in reducing pain, improving circulation, increasing proprioception and correcting muscle function. Due to claimed benefits of Kinesio™ tape, it should, in theory, be beneficial in the management of individuals with CAIS particularly in terms of reducing pain and improving proprioception. AIM: To investigate the effect of three types of strapping applied in the method described for the application of Kinesio™ tape in the management of CAIS. METHODS This study consisted of three groups of 15 participants (recruited through convenience sampling) with each group receiving a different tape (i.e. rigid, elastic or Kinesio™ tape), all three groups, however, received the same taping method which was the Kinesio™ tape functional correction application. After obtaining informed consent each participant underwent a case history, physical examination and a foot an ankle orthopaedic examination. Thereafter, baseline measurements of subjective pain rating (NRS-101), pain threshold (analogue algometer), ankle dorsiflexion, plantarflexion and inversion (analogue goniometer) and proprioception (Biodex Biosway portable balance system) were documented. Depending on the group, the particular tape was then applied and a follow up consultation was made for two to three days later where the tape was removed, measurements were reassessed and the tape was reapplied. At the final consultation three to four days later, the tape was removed and final measurements were assessed and documented. Statistical intra- (using Wilcoxon Signed Ranks Test) and inter-group (using the Mann-Whitney U-test) analyses of the data were performed due to a skewed distribution of the variables. Data was analysed using SPSS version 21.0 with the level of significance set at 0.05. RESULTS The mean (± SD) age of the participants was 24.8 (4.7) and there were 23 male participants in total. Intra-group analyses of subjective outcome measurements showed significant increases (p < 0.05) in subjective pain rating in all three groups across all consultations. Similarly, intra-group analyses of objective outcome measurements found significant increases (p < 0.05) in pain threshold and dorsiflexion range of motion in all three groups across all consultations. Plantarflexion and inversion range of motion also showed significant increases (p < 0.05) but these were not consistent across all consultations. Intra-group analyses of the sway index showed no significant improvements (p > 0.05) in Groups Two and Three across the three consultations. Only Group One showed significant increases during the eyes open foam surface (EOFoS) (p = 0.013) and eyes closed foam surface (ECFoS) (p = 0.047) test conditions between Consultations One and Two. Inter-group analyses of subjective outcome measurements showed no significant increases (p > 0.05) in subjective pain rating across each of the three consults in all three groups. Inter-group analyses of objective outcome measurements revealed a significant increase in pain threshold (p = 0.040) between Groups Two and Three at Consultation One. There was a significant increase in plantarflexion between Groups One and Three at Consultation Two (p = 0.021) and Consultation Three (p = 0.030). There were no other significant results amongst the three groups. CONCLUSION The results suggest that pain rating, pain threshold and ankle dorsiflexion would improve if taping is applied in the manner described for Kinesio™ tape irrespective of the type of taping used in the management of CAIS. The taping method did not result in a significant difference in proprioception. Further studies, with larger sample sizes are required to confirm the findings of this study and to determine the role of taping in the management of CAIS.
M

Plantar heel pain is a common disorder that can involve considerable pain. Many treatments have been suggested to manage the condition however few have been rigorously evaluated. Two treatments commonly recommended in clinical practice are adhesive taping applied to the foot and calf muscle stretching. The effectiveness of neither treatment is supported by good quality evidence. Aim: To examine the effectiveness of two short-term interventions, low-Dye taping and calf muscle stretching, for the treatment of plantar heel pain. In addition, the effect of the interventions on biomechanical variables was investigated. Design: Four studies were undertaken in the thesis. The first study in the thesis (Chapter 3) investigated the biomechanical effect of low-Dye taping on the lower limb by systematically reviewing appropriate clinical trials. Meta-analyses were undertaken where appropriate. The second study (Chapter 4) was a blinded randomised trial conducted to evaluate the effectiveness of low-Dye taping for the short-term treatment of plantar heel pain. The third study (Chapter 5) investigated the effect of calf muscle stretching on ankle joint range of motion by systematically reviewing appropriate clinical trials. Meta analyses were again undertaken where appropriate. The fourth and final study (Chapter 6) was another blinded randomised trial conducted to evaluate the effectiveness of calf muscle stretching for the short-term treatment of plantar heel pain. Setting: Both randomised trials were conducted at a university-based clinic in Sydney, Australia. Participants In the randomised trials, 184 participants who met the inclusion and exclusion criteria for plantar heel pain were recruited from the local community. In the first trial 92 participants were evaluated over a one-week period and randomly allocated to receive either low-Dye taping or a sham intervention. In the second trial 92 participants were evaluated over a two-week period and randomly allocated to receive either calf muscle stretching or a sham intervention. Outcome measures In the first systematic review, all trials that met the inclusion and exclusion criteria evaluated the effect of low-Dye taping on kinematic, kinetic and electromyographic outcomes. For the second systematic review, all trials that met the inclusion and exclusion criteria examined the effect of calf muscle stretching on the outcome of ankle joint dorsiflexion range of motion. Both randomised trials in this thesis used the Visual Analogue Scale and the Foot Health Status Questionnaire as primary outcomes. In the stretching randomised trial secondary outcomes were also assessed, namely the Foot Posture Index-6 and the Ankle Lunge Test. Results: The first systematic review found that low-Dye taping provides a small, statistically significant increase in navicular height immediately after application (weighted mean difference 5.90mm; 95% confidence interval 0.41 to 11.39; p=0.04)1 indicating a reduction in foot pronation. However, after exercise, taping had no statistically significant effect on navicular height (weighted mean difference 4.70mm; 95% confidence interval –0.61 to 10.01; p=0.08). In addition, taping had no statistically significant effect on maximum rear foot eversion (weighted mean difference –0.59°; 95% confidence interval ����2.53 to 1.35; p=0.55) or total rear foot range of motion while walking (weighted mean difference 2.3°; 95% confidence interval –0.64 to 5.24; p=0.13). The first randomised trial found that low-Dye taping had a significantly greater decrease in ‘first-step’ pain compared to a control group. The estimate of the mean difference between the groups (measured on 100mm Visual Analogue Scale) favoured the taping group (-12.3mm; 95% confidence interval -22.4 to -2.2; p=0.017). There 1 P values are provided to three decimal places except when values were generated using systematic review software, Review Manager 4.2.7, which sometimes only calculates results to two decimal places. were no differences detected in any of the other outcome measures. The taping was associated with mild to moderate short-lived adverse events that could be minimised with the use of hypoallergenic tape and careful application of the tape to reduce tightness. The second systematic review found that calf muscle stretching provides a small, statistically significant increase in ankle joint dorsiflexion. Stretching for ≤15 minutes (in a single session or accumulated over multiple sessions) provides a weighted mean difference of 2.07° (95% confidence interval 0.86 to 3.27; p(less than)0.001). 15 to 30 minutes (accumulated over multiple sessions) increased dorsiflexion by a weighted mean difference of 3.03° (95% confidence interval 0.31 to 5.75; p=0.03), and >30 minutes of stretching (accumulated over multiple sessions) increased dorsiflexion by a weighted mean difference of 2.49° (95% confidence interval 0.16 to 4.82; p=0.04) indicating no further increase in dorsiflexion is achieved by stretching for >30 minutes. The second randomised trial found that calf muscle stretching compared to a control group, had no significant effect on ‘first-step’ pain, foot pain, foot function or general foot health. Stretching was associated with mild to moderate adverse effects that were short-lived once stretching ceased. Conclusion: When used for the treatment of plantar heel pain, low-Dye taping provides a small increase in navicular height, and after one week, produces a small reduction in the ‘first-step’ pain. Calf muscle stretching increases ankle joint dorsiflexion approximately 2 to 3 degrees but has no effect on plantar heel pain after two weeks. It can therefore be concluded that low-Dye taping is effective for the short-term treatment of the ‘first-step’ pain associated with plantar heel pain, but calf muscle stretching is not effective for plantar heel pain.
Doctor of Philosophy (PhD)