Taping is becoming a lost art. With all of our graduating residents getting virtually no office exposure throughout their three-year stints in training, it is a reality that we have to face and reverse.
When I was in school (back in the dark ages, I know), one of our esteemed professors, Kendrick Whitney, DPM, would tell us that we were losing the art of “orthodigita” (remember that?) and that we should revisit it as it is a useful modality to prevent surgical intervention and make our patients feel better. At the time, I had no idea what he meant as all I saw were visions of triple arthrodeses and Kidner procedures in my future. Fifteen years later, I finally get it.
My undergraduate degree was in exercise science and I was lucky enough to be able to take a semester-long course in athletic therapy with one of the greats in Montreal, David Paris, PhD, MA, BA(Hons). Although I did not take the subspecialty of athletic therapy at the university, his lessons in strapping and taping were truly invaluable, and I still use the principles he taught even today.
What was really great was that throughout the course, we had hands-on labs, where he would show various taping techniques and expect us to practice. He had us shave our legs (partially) so we could practice these tapings. At the end of the course, we not only had a written exam but a practical exam in which he would have us do various tapings and evaluate them. Then our skills would become part of our final grade. It was awesome. Interestingly, some of my colleagues at the university ended up with me at Temple and I think they could also attest to Dr. Paris’ expertise and importance.
So why don’t we learn these tapings more? I am not sure. We had some of this in podiatry school but it was brief and was not really shown with much direction on application in clinical practice. I was certainly more proficient at these tapings when leaving the university than if I had just had those few workshops in podiatry school.
We can do so much with a good taping. The simple low-Dye is not the end-all, be-all. Not even close. Ask any professional athletes. They will tell you that their trainers can put them on the field, ice or in the ring with so much foot and ankle support with a taping they wonder how they would do without it. We can do this for our patients. Best of all, it does not take much time and based on the time spent, material needed and reimbursement ratio, it actually pays quite well.
As a primer, most offices only have one kind of tape and maybe some moleskin for padding. That’s not everything you need to really offer the various tapings that can prove to your patients that support is what they need. Also, by performing serial tapings and showing the benefits of offering more support, custom orthotics will become a no brainer to your patients.
Here is what you need:
• Good athletic tape, not the cheap brown stuff
• Pro athlete grade white athletic tape
• Kinesio tape, which is a stretchy type athletic tape (available on Amazon.com in big rolls that you can cut to length)
• Pre-cut arch pad moleskin
• Pre-cut sub-metatarsal pads (which we also use as heel pads)
• Pre-tape foam
• Some good Elastoplast tape
This is everything that is in a NFL trainer’s taping kit.
Now here are the techniques. Low-Dye and Gibney’s boot basics are the order of the day. The rest is up to each individual’s pathology. Posterior tibial tendon dysfunction? More medial support and a light Gibney boot. Achilles tendonitis? Mild heel lift with a Kinesio Tape posterior strapping to prevent aggressive plantarflexion. The list goes on and on. It is only limited by your imagination.
If you do a Pubmed search for “low-Dye strapping,” there is not much out there but it is there and the results are mostly positive. For the Gibney boot, sadly, there is not much for the evidence-based medicine guys to sink their teeth into. Our patients love it and we see them back sometimes twice a week for re-taping. After a few weeks, they are so happy, they are very ready for their new pair of custom orthotics.
Taping is a proven technique in professional and amateur athletics. I would love for our new colleagues out of residency to be much more proficient at this important aspect of clinical practice. A little expertise in this can go a long way in establishing your patient base and proving to patients that not only are you not cut-happy, you are truly a well rounded foot and ankle expert.
If anyone out there is interested in learning these techniques (especially in the Philadelphia area), let me know. I would be happy to get together and start the process to taping excellence and superiority.