Comparative Radiological Study of the Influence of Ankle Joint ...

0196-6011 /85/0703-Ol10$02.00/0 THEJOURNAL OF ORTHOPAEO~C AND SPORTS PHYSICAL THERAPY Copyright 0 1985 by The Orthopaedic and Sports Physical Therapy Sections of the American Physical Therapy Association

Comparative Radiological Study of the Influence of Ankle Joint Strapping and Taping on Ankle Stability* -

-

P. VAES, MS, PT, AT,t H. DE BOECK, MD,* F. HANDELBERG, MD,* P. OPDECAM, MD§

Journal of Orthopaedic & Sports Physical Therapy® Downloaded from www.jospt.org at on October 30, 2015. For personal use only. No other uses without permission. Copyright © 1985 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.

A comparative radiological study was carried out to test the stabilizing value of ankle strapping and taping on unstable tibiotalar joints. Unstable ankle joints of 51 sportsmen were examined without bandages, with strapping, and with taping before and after an activity program. The use of taping proved to give the greatest decrease of the talar tilt angle. This improvement was still greater, even after activity, than the stabilization obtained by strapping, before any activity.

Trauma in varus of the ankle seems to be the most frequent sports injury.3.4.8~11~16*28.37 The treatment of this injury is, however, still disputed.6, 17320323'33.38 Besides the so-called conservative treatment and the surgical method, some authors have also described a mobilizing treatment. In this treatment, periods of immobilization using a bandage are alternated with mobilization and intensive physiotherapy.7,9,10.12.21.22 In each of these treatments a strapping or taping bandage is used at one time or another to support the ankle and to relieve the lateral ligament~.~~-~~ The aim of this study was: 1) to measure the influence of strapping on talar tilt; 2) to measure the influence of taping on talar tilt; 3) to measure the influence of taping on talar tilt after activity program with tape in place; 4) to compare these results. MATERIALS AND METHODS

During a first screening examination the ankle joints of 268 athletes were radiologically tested looking for tibiotalar instability. Varus stress was 'This study was carried out at the Academical Hospital of the Vrije Universiteit Brussel. Brussels, Belgium. NOTE: Reprinted in part with permission from American Journal of Sports Medicine, Vol. 13,

PD 46-50.1985. t'~octorandusat the Laboratory of Motor Revalidation and Kinesitherapy. $ Orthopaedic Surgeons at the Department of Orthopaedics and Traumatology. 5 Professor, Director of the Department of Orthopaedics and Traumat010gy.

therefore applied manually. The radioscopic examination was performed with a CGR OPERIX II (CGR Benelux) apparatus with video monitoring. The ankle joints that showed a rocking of the talus were withheld for further examination. The tested people were active sportsmen, i.e., physical education and physical therapy' students and also competitive sportsmen and women. Ages varied from 18 to 32, with an average of 21. Eighty-four ankle joint cases that showed a talar tilt (TT) were withheld for a second series of tests. Only 51 of them could be tested further on according to the following program since not all of the 84 testees showed up for this second test. Using an original stress apparatus-adapted and rebuilt after Inman18-(Fig. 1) it was possible to reproduce a definite stress varus on the tibiotalar joint. The measurement of TT was done with the lower leg fixed and the foot in 40° plantar flexion.13-'5~18.40 A torque force was placed with a 15-kg weight. The TT was measured on an xray taken in anterioposterior view (Fig. 2) at a distance of 50 cm, perpendicular to the longitudinal axis of the tibia, with the tibiotalar joint space in the center of the x-ray (mass, 32; kilovolts, 55). The following tests were performed: 1) measurement of without support; 2) measurement of TT with an elastic adhesive bandage [TensoplastaD(Smith and Nephew Ltd.) 7 cm]- applied in . . "figuke of eight" (Fig. 3: sp/ka strapping); 3) mea~~rement of TT with a Gibney Basket Weave adaptation inelastic adhesive bandage [Leukotapem (Beiersdorf) 3.75 cm] (Fig. 4: taping); 4)


Fig. 1 . Position of the ankle joint for x-ray in varus stress: weight 15 kg; note foot in 40' plantarflexion.

Fig. 2 . X-rays of a case. A, X-ray of TT produced on stress apparatus; ankle is not suppofled with bandage; 6,x-ray of TT produced on stress apparatus, strapping in place; C, x-ray of TT produced on stress apparatus, taping in place; D, x-ray of TT produced on stress apparatus after activity test with tape in place.

111


Fig. 3. Strapping: technique of "figure of eight" or "spike" with elastic adhesive bandage (7.5 cm).

Fig. 4. Taping: technique of "Gibney Basket Weave" with inelastic bandage.

112

ANKLE STRAPPING AND ANKLE STABILITY

JOSPT November 1985

113

TABLE 1

TABLE 2

Results of TT measurements on x-rav

Mean results and SDs

Instability (TT) in degrees -c 0.5' Case


Without bandage

Strapping Taping

~

Instability (TT) in degrees

:

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51

measurement of TT after a 30-minute activity test with the same taping still in place. The activity test consisted of jumping exercises, zig-zag running, hopping, figure of eight running, direction changing runs.

~

~

~

~

'

Without Tape postbandage Strapping Taping

Mean Mean deviation Standard deviation Variation

INSTABILITY

~

+ 0.5'

13.3 3.4 4.5 19.9

12.1 3.2 4.4 19.0

4.9 2.5 3.1 9.9

6.9 2.6 3.3 1 1 .O

T.T.' S.D. = 4.46'

WITHOUT STRAP- TAPING TAPE BANDAGE PING POST

Fig. 5.Diagram of mean results of instability in degrees of TT and standard deviation.

An EMG biofeedback apparatus [BFS 10 (Medico Electronic, Belgium)] was used to control the relaxation of the lateral muscles of the lower leg during the stressing of the ankle joint in varus. RESULTS

Individual results are reported in Table 1. A mean TT of 13.31' was measured without support of a bandage. Absolute error = 0.08' (Fig. 2A). With application of strapping the mean TT was 12.60' (absolute error = 0.08') (Fig. 2B). With application of taping the mean TT was 4.86' (absolute error = 0.20') (Fig. 2C). After an activity program of 30 minutes with tape in place, the mean TT was 6.90' (absolute error = 0.15) (Fig. 2D). Mean results and standard deviations are reported in Table 2. Diagrams are shown on Fig. 5. Statistical interpretation of the results using the Student t-test showed that the decrease in TT with application of strapping was not significant compared to TT without support of bandage. The decrease of TT with tape, however, was highly significant compared to TT without support of a bandage. After a 30-minute activity program, the decrease in TT was still highly significant when compared with TT produced without support of a

114

VAES ET AL

bandage. After this 30-minute activity program with tape in place, the increase in TT was not significant when compared with TT produced immediately after putting tape on the ankle joint. DISCUSSION AND CONCLUSION


The use of talar tilt as a parameter for measuring ankle joint stability is still dis11.17.19.3om ~he anterior drawer sign, as cussed.~. described by Castaign,' gives more information about one specific ligament, namely, the anterior According to other talofibular ligament.2.31.34-36 authors, TT gives more information about the 32.39 1n this case fibulocalcaneal ligament.5.'8.30, however, position of the foot-in dorsiflexion, In this replantarflexion-is very imp~rtant.'~ search, functional instability was not studied nor discussed. We measured differences in TT only to evaluate the influence of supporting materials. From these results we may conclude that the elastic adhesive bandage (strapping) gives insufficient support to eliminate the talar tilt. Its use as a restraint after acute trauma can, however, still be discussed. We think that this type of bandage is less appropriate to support unstable tibiotalar joints. The use of tape shows, on the other hand (even after a 30-minute activity program), a statistically highly significant reduction of tibiotalar instability, as measured by tibiotalar tilt angle. Although the value of taping of the ankle joint for therapeutic purposes hasn't been proven, we believe that further research would be valuable for clinical practice. A main problem remains: the time-efficiency relation of taping. Clinical research in this field has been initiated. REFERENCES 1. Baumgardner GR: Technique important in ankle X-ray studies. Phys Sportsmed 6:83-87.1976 2. Black H: Roentgenographic considerations:the ankle. Am J Sports Med 5:238-241.1977 3. Blyth CS: When and where players get hurt. Phys Sportsmed 9:45-49. 1974. 4. Bonin JG: Injury to the ligaments of the ankle. J Bone Joint Surg (Br) 47:609-614,1965 5. Brand RL: Natural history of inadequately treated ankle sprain. Am J Sports Med 5:248-253,1977 6. Brostrom L: Sprained ankles. Treatment and prognosis in recent ligament ruptures. Acta Chir Scand 132:539-550, 1960 7. Bullard RM: Taping the athletic ankle. Pod Sports Med 69:727729,1979 8. Castaign J: Instabilites chroniques externes de la cheville. S.O.F.C.D.T. XLIX-ieme Reunion Anuelle 1:167-174,1977 9. Delacerda FG: Effect of underwrap conditions on the supporting effectivenssof ankle strapping with tape. Am J Sports Med 18:7781. 1978

JOSPT Vol. 7,No. 3

10. Drake EC: The case for ankle taping. Am J Sports Med 1:4-5, 1973 11. Elmslie RC: Recurrent subluxation of the ankle joint. Ann Surg 100:364-378,1934 12. Ferguson AB: The case against ankle taping. Am J Sports Med 1:46-47. 1973 13. Freeman MAR: Treatment of ruptures of the lateral ligaments of the ankle. J Bone Joint Surg (Br) 47:661-668. 1965 14. Freeman MAR: Instability of the foot after injuries to the lateral ligaments of the ankle. J Bone Joint Surg (Br) 47:669-677. 1965 15. Freeman MAR, Dean M, Hanham I: The etiology and prevention of functional instability of the foot. J Bone Joint Surg (Br) 47:678685.1965 16. Garrick JC: Frequency of injury, mechanism of injury and epidemiology of ankle sprains. Am J Sports Med 56:240-246. 1977 17. Geesink RGT: Ander zicht op enkelbandletsels. Ned Tijdschrift voor Geneeskunde 121:37-39,1977 18. lnman VT: The Joints of the Ankle. Baltimore: Williams 8 Wilkins, 1976 19. Johnson EE. Keith L, Markalf P: The contribution of anterior talofibular ligament to ankle laxity. J. Bone Joint Surg (Am) 65:8188,1983 20. Judet J: Entorses et ruptures du ligament lateral externe de I'articulation tibio torsienne. Soc Belge Chir Orthop Trauma, Meeting of March 18,667-671, 1972 21. Juverial JP: Effects of ankle taping on vertical jumping ability. Athletic Training 7:146-149, 1972 22. Laughan RG: Three dimensional kinematics of the taped ankle before and after exercise. Am J Sports Med 8:425-431, 1981 23. Leonard MM: Injuries of the lateral ligaments of the ankle: an experimental study. J Bone Joint Surg (Br) 2:373-377, 1979 24. Malina RM: Effects of exercise upon measurable supporting strength of tape. Res Q 34:158-164,1962 25. Mayhew JL: Effects of ankle taping on motor performance. Athletic Training 7:lO-11. 1972 26. McCarter CC: Taping treatment of severe inversion sprains of the ankle. Am J Sports Med 5:24-26, 197P 27. McCluskey JM: Prevention of ankle sprain. Am J Sports Med 4:151-157. 1976 28. Quigley TB: A protective wrapping for ankle. J.A.M.A. 3:924-925. 1976 29. Rarick GL: The measurable support of the ankle joint by conventional methods of taping. J Bone Joint Surg (Am) 14:1183-1187, 1962 30. Rubin G: The talar tilt angle and the fibular collateral ligaments. A method for the determination of talar tilt. J Bone Joint Surg (Am) 42:2-6, 1960 31. Selignon D: Ankle instability: evaluation of the lateral ligaments. Am J Sports Med 8:39-43,1980 32. Staples SO: Ruptures of the fibular collateral ligaments of the ankle. J Bone Joint Surg (Am) 57:359-362. 1975 33. Stover CN: Air stirrup management of ankle injuries in the athlete. Am J Sports Med 8:360-365,1978 34. Thorndike A: Frequency and nature of sports injuries. Am J Surg 981316-31 9, 1959 35. Vaes P, Leduc A: Le taping comme prevention des lbions ligamentaires cons6cutives aux torsions de la cheville. Charleroi. colloque Internationaldes Traumatismes de la cheville et du pied, April 24, 1981 36. Vaes P, Leduc A, van de Broeck R: Radiografische meting van de stabiliserende waarde van enkeltaping op het instabiel tibio-talair gewricht. Geneeskundeen Sport, December 1981 37. van de Brodeck R: Onelastische klevende drukverbanden. Edit. Processiestraat,78, Brussels, 1981 38. Van Moppes FI, Van den Hoogenband CR: Diagnostic and therapeutic aspects of inversion trauma of the ankle joint. Doctor thesis, Free Univ. Amsterdam. 1982 39. Watson-Jones Sir R: Fractures and Joint Injuries, Ed 4, Vol 2, p 813. Edinburgh and London: E8S Livingston Ltd., 1982 40. Weil LS: A biomechanical study of the lateral ankle sprains in basketball. Pod Sports Med 69:687-690,1979