Have DPMs Abandoned Taping In Their Practice?

Patrick DeHeer DPM FACFAS

It is disappointing to hear DPMs say they do not use taping in practice, especially when their reasoning is that they only do surgery. If someone does not use taping, I believe he or she is turning away from podiatric roots, which are based strongly in lower extremity biomechanics. The study of biomechanics and its relationship to pathologies and treatment make podiatric medicine unique.

For me, taping is essential. I have no idea how I would practice without it. When treating patients with heel pain, I may tape two or three times in conjunction with equinus stretching and anti-inflammatories. I use tape to control foot biomechanics in pathologies such as tendonitis. I use it with orthotics to evaluate how a patient will respond to orthoses and also to see if the orthoses need more correction.

The late Richard Lundeen, DPM, taught me my particular style of taping, Dynamic Muscular Relaxation. He learned this taping technique from Jack Glick, DPM, and it apparently originated in California.

One sprays the foot with adhesive and then applies two to three layers of pre-tape wrap circumferentially around the forefoot just proximal to the metatarsal heads. Proceed to apply a 1-inch athletic tape heel lock from the fifth to the first metatarsal head with the foot perpendicular to the leg. Then apply a plantar rest strap with 2-inch athletic tape, which anchors to the 1-inch tape laterally between the fifth metatarsal head and base. Do this with the metatarsal joint supinated and locked while plantarflexing the first ray.

Finally, apply the tape firmly across the plantar aspect of the foot and then continue loosely taping across the dorsal aspect of the foot, returning to the fifth metatarsal area. The pivot point is the medial aspect of the first metatarsal. This is where you change the tension from firm to loose.

Repeat the process for for the heel lock and plantar rest strap as above but slightly offset from the prior strips. For heavier patients, apply three strips of each taping.

The taping is small enough to allow patients to take quick showers without removing the taping. Initial tightness with the taping will loosen with time. The tape can cause a blister at the pivot point but if patients feel any discomfort, they should remove it. Typically, the tape will stay on for five to seven days. The taping is small enough to fit comfortably in shoe gear with orthoses.

Is Turning Away From Taping A Symptom Of A Larger Problem?

Not using tape is just a part of a larger problem. To me, it is an indicator that the podiatric profession is moving away from its roots in biomechanics. I have seen incredible advancement in podiatric medicine over the years but does advancement also mean changing your origin?

I firmly believe that to be a good foot and ankle surgeon, you must have a deep understanding of lower extremity biomechanics. Biomechanics distinguishes us as podiatrists. It makes us the authority on foot and ankle pathologies and their treatment, and should be the basis for most of our practice.

Let us not forget our past and what we learned from the forefathers of podiatric medicine. Let us have more lectures, read more articles and textbooks, and produce more literature showing the significance of biomechanics. If you re-introduce yourself to the study of biomechanics, your practice may be stronger and your patient care will likely be better as a result.

If we continue to watch biomechanics shrink in our review mirror, we will become just like all of the specialties that treat foot and ankle conditions. Bear in mind that these specialties have a much larger number of practitioners than us and strength lies in numbers.

For podiatry to regain supremacy in the care of the foot and ankle, we must expand on our roots of biomechanics and not ignore those roots. Biomechanics is the foundation of podiatric medicine. This foundation will help podiatry further evolve in the future with improved procedures and techniques, making us the unquestioned experts for foot and ankle care. Therefore, colleagues, dust off your Root biomechanics textbook for it is the key to open the bright door of our future.

Comments

Taping plays a large role in our practice, especially with plantar fasciitis. It's pretty amazing to hear a patient say "Doc, I had doubts about the tape but my pain was noticeably different while it was on." As a matter of fact, most patients often say that they try to tape themselves after they have been taped in our office. We use plantar fascial taping as a precursor to orthotic therapy. It offers (at least in my practice) a fairly high clinical predictor that orthotic therapy will be beneficial for long term management of their plantar fasciitis.

Read what Dr Richie wrote about podiatry and biomechanics. It's the province of foot and ankle orthopedists and physical therapists. Not podiatrists anymore. (paraphrase of his opinion)

Robert Bijak is referring to my post on Podiatry Management in response to others who believe that podiatry has turned their back on biomechanics. I believe that other professions such as orthopedics and physical therapy are now doing the best research in lower extremity biomechanics.

I hope to expand upon this in my next blog for Podiatry Today. I also fully agree with Patrick in his opinion that biomechanics should be the foundation of foot and ankle surgery. If you go to our surgical meetings, you will see that this principle has vanished.

Taping plays an integral part in our practice. We tape patients prior to prescribing functional orthoses for patients. Also, when reviewing requests for surgery, we will make sure taping for plantar fasciitis is one of the modalities utilizied prior to authorizing surgical intervention.

With Blue Cross plans only paying about $6.00 for this service, it is very difficult to continue. I have a practice that many patients get taped. I am now limiting this service only due to reimbursement. I cannot afford to tape for only $6.00 per patient.

We are being pushed out of our livelihood by insurance carriers. If Blue Cross can lower taping to this point, it is just a matter of time before everyone else follows suit.

Podiatric surgery without a basic fundamental understanding of the theories proposed about foot and ankle mechanics makes us nothing but technicians.

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