The Effect of Low-Dye Taping on Kinematic, Kinetic, and Electromyographic Variables: A Systematic Review Joel A. Radford, B App Sc (Pod) Hons 1 Joshua Burns, PhD 2 Rachelle Buchbinder, MBBS (Hons) 3 Karl B. Landorf, PhD 4 Catherine Cook, PhD 5 Study Design: A systematic review. Objective: To determine the strength of evidence of the effect of low-dye taping on lower limb kinematic, kinetic, and electromyographic variables. Background: Low-Dye taping is a foot-taping technique that aims to limit foot pronation and is commonly used to treat a number of foot disorders. Methods and Measures: Systematic review of randomized or quasi-randomized s examining the effect of low-dye taping compared with no taping on kinematic, kinetic, and electromyographic variables. Trials were identified by searching CINAHL, EMBASE, MEDLINE, SPORTDiscus, and CENTRAL, and by recursive checking of bibliographies. Data were extracted from published s and from mail contact with authors for further information as necessary. Meta-analyses were planned for all outcomes using the generic inverse variance method. Sensitivity analyses were planned by pooling data from nonrandomized s. Statistical heterogeneity was assessed using the quantity I 2. Results: Six s met inclusion criteria and, of these, 5 s reported sufficient data on kinematic and kinetic variables to be included in the analysis. Results from the 5 randomized s were considered robust when pooled with data from 7 nonrandomized s in a sensitivity analysis. When compared to no taping, low-dye taping increased navicular height immediately after application (weighted mean difference [WMD], 5.90 mm; 95% confidence interval [CI], 0.41 to 11.39; P =.04) and had no effect on navicular height post exercise (WMD, 4.70 mm; 95% CI, 0.61 to 10.01; P =.08), maximum rearfoot eversion while walking (WMD, 0.59 ; 95% CI, 2.53 to 1.35; P =.55), and total rearfoot range of motion while walking (WMD, 2.3 ; 95% CI, 0.64 to 5.24; P =.13). Conclusions: Low-Dye taping provides a small change in navicular height post application, although it is unclear whether this change is clinically important. There was high heterogeneity between some s examining other variables, indicating that more research is needed to confirm the results of previous s. J Orthop Sports Phys Ther 2006;36(4):232-241. Key Words: arch, foot, pronation, strapping, tape 1 PhD candidate, School of Biomedical and Health Sciences, University of Western Sydney, Campbelltown, Australia. 2 NHMRC Australian Clinical Research Fellow, Institute for Neuromuscular Research, The Children s Hospital at Westmead Sydney, Australia. 3 Associate Professor and Director, Monash Department of Clinical Epidemiology at Cabrini Hospital and Monash University, Malvern, Australia. 4 Senior Lecturer, Department of Podiatry, School of Human Biosciences, La Trobe University, Bundoora, Australia. 5 Senior Lecturer, Occupational Therapy Program, School of Biomedical and Health Sciences, University of Western Sydney, Campbelltown, Australia. Address correspondence to Joel Radford, Campbelltown Campus, Building 24, School of Exercise and Health Science, University of Western Sydney, Locked Bag 1797, Penrith South DC, NSW, 1797, Australia. E-mail: j.radford@uws.edu.au Low-Dye taping is an orthopaedic/sports adhesive strapping technique first described by Dye (1939) 5 and later modified by a number of authors. 2,4,13,18 The taping aims to limit foot pronation and is used in the short-term to reduce the symptoms of disorders thought to be related to excessive foot pronation. These include plantar fasciitis, tibialis posterior dysfunction, and patellofemoral syndrome. 21,25 In contrast to high-dye or ankle taping, which include strips of tape passing over the ankle and onto the lower leg, low-dye taping is generally isolated to the foot alone. 12 No published randomized s have examined the effect of low- Dye taping on the symptoms of foot disorders; however, results from a nonrandomized indicate that this technique may be helpful for pain associated with plantar fasciitis. 20 On the other hand, published s have assessed the effects of low-dye taping compared to no taping in asymptomatic people, with respect to kinematic, kinetic, and electromyographic variables such as foot motion or plantar pressure. We therefore conducted a systematic 232 Journal of Orthopaedic & Sports Physical Therapy
review of the literature to determine whether low-dye taping has benefits with respect to kinematic, kinetic, and electromyographic variables in comparison to no taping. METHODS Inclusion and Exclusion Criteria Randomized or quasi-randomized controlled s investigating any orthopaedic/sports taping technique that aimed to support the inner medial longitudinal arch of the foot were included. Trials were excluded if taping involved strips of tape passing superior to the ankle joint, for example, Gibney Basketweave or ankle stirrup taping. Trials combining the taping with another intervention, such as orthoses, were also excluded. Only data from s examining the effect of taping on kinematic, kinetic, and electromyographic lower-limb variables (for example, foot motion or plantar pressure) were examined and only s that compared the effect of low-dye taping to no taping were included. Randomized crossover s were also included, as it is unlikely that there is a lasting effect of the taping following removal. Search Strategy The Cochrane Central Register of Controlled Trials (fourth quarter, 2005), CINAHL (1982 to October 2005, week 3), EMBASE (1988 to 2005, week 44), MEDLINE (1966 to October 2005, week 4), and SPORTDiscus (1830 to September 2005) databases were searched via OVID in November 2005 to identify relevant s. Non-English reports were included and all reference lists of s identified through electronic searching were searched recursively until no more s were identified. One reviewer (J.R.) conducted all the searches and 2 reviewers (J.R. and J.B.) assessed s for eligibility. The search strategy used for all databases was: 1. (tape or taping or strap$).tw 2. (navicular or rearfoot or midfoot or arch or pronat$ or antipronat$ or fasci$ or subtalar or foot or dye).tw 3. and/1-2 Assessment of Study Quality Two reviewers (J.R. and J.B.) independently used the PEDro Scale to determine the quality of the s. 14 The PEDro-scale is an 11-item scale designed for rating methodological quality of randomized controlled s. Each satisfied item (except item 1) contributes 1 point to the total PEDro score (range, 0-10 points). The scale items are: 1. Eligibility criteria were specified 2. Subjects were randomly allocated to groups (in a crossover study, subjects were randomly allocated an order in which treatments were received) 3. Allocation was concealed 4. The groups were similar at baseline regarding the most important prognostic indicators 5. There was blinding of all subjects 6. There was blinding of all therapists who administered the therapy 7. There was blinding of all assessors who measured at least 1 key outcome 8. Measurements of at least 1 key outcome were obtained from more than 85% of the subjects initially allocated to groups 9. All subjects for whom outcome measurements were available received the treatment or control condition as allocated or, where this was not the case, data for at least 1 key outcome were analyzed by intention to treat 10. The results of between-group statistical comparisons are reported for at least 1 key outcome 11. The study provides both point measurements and measurements of variability for at least 1 key outcome Data Extraction One reviewer (J.R.) extracted data from the s and wrote to authors for further information as necessary. To obtain a pooled estimate of the impact of low-dye taping on kinematic, kinetic, and electromyographic variables, meta-analyses were planned when the data were available. If possible, weighted mean differences (WMDs) were calculated for all continuous outcomes (a weighted average of each s mean difference between taping and no taping). 8 Relative risks were calculated for dichotomous outcomes. The mean difference and standard errors of the difference between taping and no taping were extracted for meta-analysis. Some s 1,4,7,10-12,15,22 reported means and standard errors of scores before and after taping, but not of changes before and after taping. To estimate standard errors of change scores using the formula described by Elbourne et al, 6 we assumed conservatively that the correlation between before and after tests to be 0.5, which is common for crossover s. 3 All statistical testing used the generic inverse variance method 8 and were performed by Review Manager 4.2.7 (The Cochrane Collaboration, Copenhagen, Denmark). 17 Results were considered statistically significant if P.05. As there are different approaches to conducting a systematic review, a sensitivity analysis is required to test how robust the results of the review are relative to key decisions and assumptions that were made in the process of conducting the review. 8 A sensitivity analysis changes the method of the review for a secondary analysis to see whether key decisions or LITERATURE REVIEW J Orthop Sports Phys Ther Volume 36 Number 4 April 2006 233
FIGURE 1. Progress through the stages of the review for randomized s. assumptions might conceivably have affected the results for a particular review. Sensitivity analyses were conducted in this review by expanding the inclusion criteria to also include nonrandomized s (with readily available data) identified through the systematic search strategy. 8 If the effect and confidence intervals in the sensitivity analysis led to the same conclusion as primary meta-analysis values, the results were considered robust. All statistical testing in the sensitivity analysis also used the generic inverse variance method. Where the results of a single could be substantiated against a sensitivity analysis, effect size calculation and statistical testing were performed. Trials were assessed for clinical heterogeneity by comparing inclusion and exclusion criteria of the s and meta-analyses performed when found to be clinically homogenous. The statistical heterogeneity (whether there are genuine differences underlying the results of the s in the review) and homogeneity (whether the variation in findings is compatible with chance alone) of the results of the s were measured using the quantity I 2. 9 The I 2 value is calculated as I 2 = 100%(Q df)/q, where Q is Cochran s heterogeneity statistic and df the degrees of freedom (where n is the number of s). The Cochran s Q is computed by summing the squared deviations of each s estimate from the overall meta-analytic estimate and a P value obtained by comparing the statistic with a 2 distribution with k 1 degrees of freedom (where k is the number of s). This P value was formerly used to determine statistical heterogeneity (P.10). However, Higgins et al 9 replaced it with the quantity I 2,asthePvalue was known to be poor at detecting true heterogeneity among studies as significant. Higgins et al 9 have tentatively assigned adjectives of low, moderate, and high to I 2 values of 25%, 50%, and 75%. Trials in the meta-analysis were considered to have low statistical heterogeneity if I 2 were less than 25%; in such instances, a fixed-effects model was used to estimate the pooled effect. A random-effects model was used for all s with I 2 greater than 25%. A fixed-effect meta-analysis assumes that the true effect of treatment (in both magnitude and direction) is the same value in every (that is, fixed across studies), while a random-effects meta-analysis model assumes that the effects being estimated in the different studies are not identical, but follow a similar distribution. 8 RESULTS Search Results Twenty-one papers were identified through electronic searching (Figure 1). Six s met the inclusion criteria for the review (Table 1). Five were randomized and 1 was quasi-randomized. All randomized and quasi-randomized s were crossover s. Therefore, the order of treatment was randomly allocated (ie, taping then no taping, or no taping then taping). In the quasi-randomized, 13 odd-numbered participants received no taping first and even numbered participants wore taping first. Seven nonrandomized s were identified for inclusion in the sensitivity analyses. 1,7,10,11,15,22,24 Five different kinematic, kinetic, and electromyographic 234 J Orthop Sports Phys Ther Volume 36 Number 4 April 2006
variables were investigated: navicular drop, 4 navicular height, 4,23 plantar pressure, 2,13,18 rearfoot motion, 12 and electromyographic amplitude of the tibialis anterior muscle. 2 The effects of taping were examined immediately post application 4,23 and while walking 2,12,13,18 and running, 2 and post exercise. 4,23 Four of the 6 s also compared the low-dye taping to other treatments, such as other lower-limb taping techniques 2,12,23 and medial foot wedges 4 ; however, in accordance with our prespecified aims, these data were not included in the review. All results presented in this review are the effect of low-dye taping compared to no taping. The range of PEDro quality scores assessing methodological quality of the included s was 4 to 5 (median 5) out of 10 (Table 2). The interrater reliability of the total PEDro score (obtained by summing yes responses to items 2 through 11) was TABLE 1. Description of studies included in the systematic review. Boergers 2 Del Rossi et al 4 Keenan and Tanner 12 Lange et al 13 Trial Design Participants Intervention Outcome Measurement Russo and Chipchase 18 Vicenzino et al 23 Randomized crossover Randomized crossover Randomized crossover Quasi-randomized crossover Randomized crossover Randomized crossover 8 athletes (5 women and 3 men) with mean (±SD) age of 20 (±1) years; inclusion: anterior shin pain, functional pes planus 8 athletes (5 women and 3 men) aged 18 to 26 years; inclusion: minimum navicular drop of 10 mm; exclusion: history of lower-limb injury 18 volunteers (16 women and 2 men) with mean (range) age of 20 (18-29) years; exclusion: history of lower-limb injury 60 volunteers (40 women and 20 men) with mean (±SD) age of 22 (±3) years; inclusion: between 18 and 35 years of age, more than 10mm navicular drop; exclusion: history of lower limb injury, tape allergy 40 volunteers (24 women and 16 men) with mean (±SD) age of 22 (±4) years; inclusion: aged between 18 and 45 years; exclusion: gait affected by pain or injury 17 women athletes with mean (±SD) age of 19 (±1) years; inclusion: 15 mm navicular drop; exclusion: previous experience with prophylactic taping of the foot, current lower limb injuries, tape allergy (Figure 2) with cross strips of tape from metatarsals and around heel (Figure 3) (Figure 2) with cross strips from metatarsals and around heel (Figure 4) (Figure 2) (Figure 2) and longitudinal strips from metatarsals to heel (Figure 5) (Figure 2) and longitudinal strips from metatarsals to heel (Figure 5) (Figure 2) Average and peak electromyography of tibialis anterior; Emed (measuring peak plantar pressures and average contact surface area of medial and lateral midfoot); while walking and running Navicular height; navicular drop; post application and after 15 and 30 minutes of running Rearfoot motion (maximum inversion, maximum eversion, total range of motion, instantaneous velocity); while walking Emed (measuring peak and mean plantar pressure for medial and lateral heel; medial and lateral midfoot; medial, middle, and lateral forefoot; hallux; second toe; toes 3-5); while walking Emed (measuring peak plantar pressure for medial and lateral heel, midfoot and forefoot); while walking Navicular height: post application and after 10 and 20 minutes of jogging LITERATURE REVIEW J Orthop Sports Phys Ther Volume 36 Number 4 April 2006 235
including data from 4 nonrandomized s for navicular height post application 1,10,11,24 and 2 nonrandomized s for navicular height after brief exercise (10- or 15-minute jog). 1,10 Results were consistent to those reported by Del Rossi et al 4 for navicular height post application; however, post exercise, a statistically significant change was found in the sensitivity analysis. The statistical heterogeneity between nonrandomized s was low to moderate (I 2 = 0%-59%). The results were statistically significant (P.001). The Effect of Taping on Plantar Pressure Three s reported results for peak plantar pressures measured using Emed plantar pressure platforms. 2,13,18 None of the results from these s could be pooled with other included s due to clinical heterogeneity (injury status, athletic ability, foot type, different plantar pressure masks) or be confirmed with sensitivity analyses. Only 1 by Boergers 2 investigated average contact surface area, FIGURE 2.. evaluated using intraclass correlation coefficients (ICC 2,1 ). 16 The ICC 2,1 for the reviewer s reliability was 0.67 (95% confidence interval [CI], 0.03 to 0.94). Disagreement between raters was resolved through discussion with one another. The PEDro scores in Table 2 are the scores that the raters agreed upon following discussion. The Effect of Taping on Navicular Drop and Height One 4 evaluated navicular drop after application of taping and after brief exercise and found a decrease in navicular drop which was lost after exercise. The results of navicular drop could not be compared to a sensitivity analysis. Two s examined navicular height after application of taping and brief exercise. 4,23 Del Rossi et al 4 found increases in navicular height after application (WMD, 5.90 mm; 95% CI, 0.41 to 11.39); however, this effect was lost after exercise (WMD, 4.70 mm; 95% CI, 0.61 to 10.01). Vicenzino et al 23 also found an increase in navicular height after taping application that was lost altogether after brief exercise. However, as no measures of variance were reported, their 23 data could not be used for pooling. A sensitivity analysis of the navicular height results from Del Rossi et al 4 was performed (Table 3) by FIGURE 3. Cross strips of tape from metatarsals and around heel to same metatarsal. 236 J Orthop Sports Phys Ther Volume 36 Number 4 April 2006
The s included in the sensitivity analysis for maximum eversion were clinically and statistically homogenous (I 2 = 0.0%). Keenan and Tanner 12 also found no change in total rearfoot range of motion (WMD 2.3 ; 95% CI, 0.64 to 2.54) with taping (Table 3). Two nonrandomized s with total range of motion data 15,22 were used in a sensitivity analysis to confirm the result. However, the high statistical heterogeneity of s in the sensitivity analysis (I 2 = 77.9%) makes it difficult to substantiate the result found by Keenan and Tanner. 12 Although Keenan and Tanner 12 also examined maximum inversion and instantaneous velocity of the rearfoot, no nonrandomized s were found to confirm their results. Keenan and Tanner 12 reported small increases in maximum inversion with taping and no change in instantaneous velocity. The effect of Taping on Electromyography FIGURE 4. Cross strips of tape from metatarsals and around heel to opposite metatarsal. finding that low-dye taping resulted in small decreases in contact surface area while walking and running. Lange et al 13 published the only to report average plantar pressures as well as peak plantar pressures. They found that the results for average plantar pressure were similar to the results for peak plantar pressure. The results for average plantar pressures could not be confirmed with a sensitivity analysis as no nonrandomized s were identified examining the variable. The by Lange et al 13 was the only one to report plantar pressures for the toes and found increases in peak plantar pressure with the application of taping. The results for peak plantar pressure for each are presented in Table 3 for comparison. The Effect of Taping on Rearfoot Motion Boergers 2 published the only to examine electromyography. For tibialis anterior activity, low- LITERATURE REVIEW Only 1 12 examined rearfoot motion. The authors found no change in rearfoot maximum eversion (WMD, 0.59 ; 95% CI, 2.53 to 1.35) while walking. A sensitivity analysis was possible to confirm this result by including 3 additional nonrandomized s with maximum eversion data 7,15,22 (Table 3). FIGURE 5. Longitudinal strips from metatarsals to heel. J Orthop Sports Phys Ther Volume 36 Number 4 April 2006 237
TABLE 2. Trial quality assessed by the PEDro scale. Column numbers correspond to the PEDro scale criteria. Trial 1 2 3 4 5 6 7 8 9 10 11 Total score Boergers 2 + + - + - - - + - + + 5/10 Del Rossi et al 4 - + - + - - - + - + + 5/10 Keenan and Tanner 12 + + - + - - - + - + - 4/10 Lange et al 13 - - - + - - - + - + + 4/10 Russo and Chipchase 18 - + - + - - - + - + + 5/10 Vicenzino et al 23 + + - + - - + - - + + 5/10 Dye taping provided increases in average and peak amplitude while walking and decreases in average and peak amplitude while running. No sensitivity analysis was possible to confirm this result as no nonrandomized s were identified. DISCUSSION This review identified 5 randomized and 1 quasirandomized crossover s that examined the effects of low-dye taping on navicular height, rearfoot motion, plantar pressure, and electromyography. All the variables enable investigation of the effect of taping on components of foot pronation. Therefore the research appears to have focused on whether low-dye taping does indeed reduce foot pronation. An increase in navicular height indicates a reduction in foot pronation. Plantar pressure s hypothesize that a reduction in medial foot pressure with taping, particularly midfoot, may be related to a reduction in foot pronation, 18 although a direct link between plantar pressure and joint motion has not been fully established. 13 In regard to electromyography, the 2 examining the effect of low-dye taping investigated the tibialis anterior muscle, which is known to help control foot pronation. 19 FIGURE 6. Forest plot of results. Values are mean differences and 95% confidence intervals. Note: A result that favours taping is thought to be an increase in navicular height (mm), a reduction in maximum eversion (degrees) and a reduction in total rearfoot motion (degrees). 238 J Orthop Sports Phys Ther Volume 36 Number 4 April 2006
TABLE 3. Kinematic, kinetic, and electromyographic variables, low-dye taping compared to no taping. Note: A beneficial effect from the tape is thought to be an increase in navicular height (positive value in table), a reduction in plantar pressure (negative value in table), a reduction in maximum eversion (a negative value in table), and a reduction in total rearfoot motion (a negative value in table). Values of I 2 = 25% indicates low heterogeneity, I 2 = 50% indicates moderate heterogeneity. 9 I 2 = 75% indicates high heterogeneity. Authors n Weighted Mean Difference (95% CI) Statistical Significance: P (z Score) Navicular height post application (mm) Del Rossi et al 4 8 5.90 (0.41 to 11.39).04 (2.11) - Vicenzino et al 23 17 No data reported Test for Heterogeneity: P (I 2 %) Sensitivity analysis Ator et al 1 10 3.80 (0.06 to 7.54) - - Del Rossi et al 4 8 5.90 (0.41 to 11.39) - - Holmes et al 10 40 7.20 (4.51 to 9.89) - - Jamali et al 11 20 4.00 (0.26 to 7.74) - - Whitaker et al 24 22 3.08 (2.47 to 3.69) - - Pooled effect 100 4.51 (2.58 to 6.44).001 (4.58).05 (58.6%) Navicular height post exercise (mm) Del Rossi et al 4 8 4.70 ( 0.61 to 10.01).08 (1.73) - Vicenzino et al 23 17 No data reported Sensitivity analysis Ator et al 1 10 1.45 ( 2.39 to 5.29) - - Del Rossi et al 4 8 4.70 ( 0.61 to 10.01) - - Holmes et al 10 40 4.40 (1.56 to 7.24) - - Pooled effect 58 3.57 (1.47 to 5.67).001 (3.33).43 (.0%) Peak plantar pressure (Ncm 2 ) Medial heel Lange et al 13 60 2.10 ( 3.08 to 1.12) - - Russo and Chipchase 18 40 3.70 (1.82 to 5.58) - - Lateral heel Lange et al 13 60 1.90 ( 2.76 to 1.04) - - Russo and Chipchase 18 40 4.00 (2.22 to 5.78) - - Medial midfoot Boergers 2 8 8.20 (3.20 to 13.20) - - Lange et al 13 60 0.20 ( 0.29 to 0.69) - - Russo and Chipchase 18 40 1.40 ( 3.18 to 0.38) - - Lateral midfoot Boergers 2 8 28.33 (23.43 to 33.23) - - Lange et al 13 60 1.50 (1.07 to 1.93) - - Russo and Chipchase 18 40 2.60 (1.27 to 3.93) - - Medial forefoot Lange et al 13 60 3.50 ( 4.87 to 2.13) - - Russo and Chipchase 18 40 8.30 ( 11.20 to 5.40) - - Lateral forefoot Lange et al 13 60 1.50 (2.70 to 0.30) - - Russo and Chipchase 18 40 2.60 ( 4.62 to 0.58) - - Maximum eversion (deg) Sensitivity analysis Keenan and Tanner 12 18 0.59 ( 2.53 to 1.35).55 (.60) - Harradine et al 7 14 0.60 ( 3.03 to 1.83) - - Keenan and Tanner 12 18 0.59 ( 2.53 to 1.35) - - Moss et al 15 6 0.30 ( 2.95 to 3.55) - - Schumaker 22 26 0.70 ( 2.87 to 4.27) - - Pooled effect 64 0.29 ( 1.57 to 0.99).66 (.44).90 (.0%) Total rearfoot range of motion during gait (deg) Keenan and Tanner 12 18 2.30 ( 0.64 to 5.24).13 (1.53) - Sensitivity analysis Keenan and Tanner 12 18 2.30 ( 0.64 to 5.24) - - Moss et al 15 6 1.40 ( 3.68 to 6.48) - - Schumaker 22 26 5.80 ( 10.29 to -1.31) - - Pooled effect 50 0.58 ( 5.63 to 4.47).82 (.23).01 (77.9%) LITERATURE REVIEW The review indicates that low-dye taping provides an increase in navicular height after taping application based upon the data of 1 randomized. 4 This result was supported by a sensitivity analysis of pooling an additional 4 nonrandomized s, 1,10,11,24 with moderate statistical heterogeneity. Although the randomized 4 did not find a change in navicular height post exercise, the sensitivity analysis demonstrated a statistically significant difference. The effect sizes reported by the and sensitivity analysis are J Orthop Sports Phys Ther Volume 36 Number 4 April 2006 239
similar for navicular height indicating that the by Del Rossi et al 4 was probably underpowered to detect a statistically significant difference. Further research is needed to detect whether taping provides an effect on navicular height post exercise. The review also determined that low-dye taping had no effect on total rearfoot eversion based on the results of Keenan and Tanner. 12 The result was confirmed by the sensitivity analysis performed by pooling an additional 3 nonrandomized s 7,15,22 with low statistical heterogeneity. The effect of taping on total rearfoot range of motion was also examined by Keenan and Tanner 12 ; however, the statistical heterogeneity of the sensitivity analysis was too high to confirm the result. With respect to plantar pressures, the clinical heterogeneity of the s 2,13,18 did not permit pooling of their results. Further s are needed to confirm their results. All s included in this review were crossover s, based upon the assumption that the effect of taping is short-lived after removal of the tape. As a more prolonged effect cannot be excluded, it may be worthwhile considering noncrossover s in the future. The quality of s could also be improved by ensuring treatment allocation concealment and the conduct and reporting of intention-to-treat analyses. In addition, while it may not be possible to blind participants and therapists to treatment allocation in s that assess the value of taping compared to no taping, it should be possible to blind outcome assessors. The PEDro scores of the s included in the review are, therefore, relatively high (median 5), considering that blinding of participants and therapists is difficult. The PEDro scale was a useful tool for assessing the quality of the s except for the 2 items requiring blinding of participants and therapists. Our review demonstrates that some kinematic changes to the foot occur after taping application (particularly navicular height after application), suggesting a reduction in foot pronation. However, we do not know whether the result is of clinical significance. For example, it is unknown if a 6-mm increase in navicular height is sufficient to reduce the symptoms of a foot disorder. To interpret the results of this review, further research is needed to investigate the correlation between symptom reduction and changes in kinematic, kinetic, and electromyographic variables. Future s evaluating the effectiveness of low-dye taping should therefore examine its effect on painful foot disorders and include outcome measures of importance to the patient such as pain, function, and quality of life. CONCLUSION The systematic review indicates that low-dye taping provides a small change in navicular height after application, which suggests a reduction in foot pronation. However, it is unclear whether this kinematic change is clinically important. High heterogeneity among some s regarding other outcomes (eg, plantar pressure) indicates that more research is needed to confirm the results of previous s. ACKNOWLEDGEMENTS The authors would like to thank Bart van Gheluwe and Eisuke Hiruma for their assistance in translation of non-english articles. The authors would also like to thank Rita Ator, Mark Bishop, Richard Boergers, Mark Cornwall, Anne-Maree Keenan, Belinda Lange, Sonia Russo, Craig Tanner, and Jeffrey Whitaker for their assistance in providing further information regarding their s. REFERENCES 1. Ator R, Gunn K, McPoil TG, Knecht HG. The effect of adhesive strapping on medial longitudinal arch support before and after exercise. J Orthop Sports Phys Ther. 1991;14:18-23. 2. Boergers RJ. Effects of Arch Taping on Peak Force, Surface Contact Area and Neuromuscular Activity at Midstance [dissertation]. Wisconsin, IL: University of Wisconsin-La Crosse; 2000. 3. Curtin F, Altman DG, Elbourne D. Meta-analysis combining parallel and crossover clinical s. I: Continuous outcomes. Stat Med. 2002;21:2131-2144. 4. Del R, G., Fiolkowski P, Horodyski MB, Bishop M, Trimble M. For how long do temporary techniques maintain the height of the medial longitudinal arch? Phys Ther Sport. 2004;5:84-89. 5. Dye RW. A strapping. J Natl Assoc Chiropodists. 1939;29:11-12. 6. Elbourne DR, Altman DG, Higgins JP, Curtin F, Worthington HV, Vail A. Meta-analyses involving crossover s: methodological issues. Int J Epidemiol. 2002;31:140-149. 7. Harradine P, Herrington L, Wright R. The effect of low Dye taping upon rearfoot motion and position before and after exercise. Foot. 2001;11:57-60. 8. Higgins JP, Green S. Cochrane Handbook for Systematic Reviews of Interventions 4.2.5 [updated May 2005]. In: The Cochrane Library, Issue 3, 2005. Chichester, UK: John Wiley & Sons, Ltd; 2005. 9. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327:557-560. 10. Holmes CF, Wilcox D, Fletcher JP. Effect of a modified, low-dye medial longitudinal arch taping procedure on the subtalar joint neutral position before and after light exercise. J Orthop Sports Phys Ther. 2002;32:194-201. 11. Jamali B, Walker M, Hoke B, Echternach J. Windlass taping technique for symptomatic relief of plantar fasciitis. J Sport Rehab. 2004;13:228-243. 12. Keenan AM, Tanner CM. The effect of high-dye and low-dye taping on rearfoot motion. J Am Podiatr Med Assoc. 2001;91:255-261. 240 J Orthop Sports Phys Ther Volume 36 Number 4 April 2006
13. Lange B, Chipchase L, Evans A. The effect of low-dye taping on plantar pressures, during gait, in subjects with navicular drop exceeding 10 mm. J Orthop Sports Phys Ther. 2004;34:201-209. 14. Maher CG, Sherrington C, Herbert RD, Moseley AM, Elkins M. Reliability of the PEDro scale for rating quality of randomized controlled s. Phys Ther. 2003;83:713-721. 15. Moss CL, Gorton B, Deters S. A comparison of prescribed rigid orthotic devices and athletic taping support used to modify pronation in runners. J Sport Rehab. 1993;2:179-188. 16. Portney LG, Watkins M. Foundations of Clinical Research: Applications to Practice. Norwalk, CT: Appleton & Lange; 1993. 17. Review Manager (RevMan) [computer program]. Version 4.2 for Windows. Copenhagen, Denmark: The Nordic Cochrane Centre TCC; 2003. 18. Russo SJ, Chipchase LS. The effect of low-dye taping on peak plantar pressures of normal feet during gait. Aust J Physiother. 2001;47:239-244. 19. Sarrafian SK. Anatomy of the Foot and Ankle. Philadelphia, PA: JB Lippincott; 1993. 20. Saxelby J, Betts RP, Bygrave CJ. Low-Dye taping of the foot in the management of plantar-fasciitis. Foot. 1997;7:205-209. 21. Schulthies SS, Draper D. A modified low-dye taping technique to support the medial longitudinal arch and reduce excessive pronation. J Athl Train. 1995;30:266-268. 22. Schumaker SM. The Effects of a Modified Low-Dye Taping Technique on Rearfoot Kinematics [dissertation]. Fullerton, CA: California State University; 1998. 23. Vicenzino B, Feilding J, Howard R, Moore S, Smith S. An investigation of the anti-pronation effect of two taping methods after application and exercise. Gait Posture. 1997;5:1-5. 24. Whitaker JM, Augustus K, Ishii S. Effect of the low-dye strap on pronation-sensitive mechanical attributes of the foot. J Am Podiatr Med Assoc. 2003;93:118-123. 25. Whitesel J, Newell S. Modified low-dye strapping. Physician Sports Med. 1980;8:129-130. LITERATURE REVIEW J Orthop Sports Phys Ther Volume 36 Number 4 April 2006 241