Taping is a critical art as well as a science when it comes to the treatment and prevention of athletic injuries. Taping takes practice, creativity and adaptability. It is a very important part of a sports medicine practice. Not only is taping therapeutic, it can also be diagnostic in the evaluation and treatment of injuries in athletes since the athlete’s response to taping can indicate the effectiveness of orthotics in controlling biomechanical issues. While taping is not a substitute for a comprehensive rehabilitation program, it is a key element in allowing an athlete to return to activity and prevent further injury. We utilize taping for injury care and protection. It allows functional movement while limiting excessive motion. Taping stabilizes and supports the injured area and prevents additional injury. Taping also provides proprioceptive feedback. Improper application of tape can lead to blisters, skin irritation and abnormal stress on the affected area as well as an increased risk of injury. A Guide To The Different Types Of Tape Athletic tape can be porous or nonporous. Porous tape allows for heat and moisture to pass through and help keep the skin cool and dry. Nonporous tape is more occlusive and increases the potential for skin damage and irritation from friction and heat. An added benefit of porous tape occurs if the tape has to be left on for an extended period of time. For example, a high school athlete who does not have access to an athletic trainer on a daily basis can shower and dry it off with a hair dryer. Sometimes one may use elastic tape, which allows for muscles to contract without impeding circulation or neurological function. One should stretch the elastic tape one-third to one-half of its elastic capabilities before applying it. If it is too tight, the tape can restrict the function of the body part and lead to discomfort. No matter what kind of tape one uses, always emphasize monitoring of the taped area for tingling, numbness or impairment of circulation at all times. Spray tape adherent helps the tape adhere better to the skin and also offers a layer of protection. Be sure to use the spray in a well-ventilated area. While areas such as the Achilles tendon or the dorsum of the foot and ankle may be sensitive to friction, one can protect these areas by adding a pad with lubricant such as petroleum jelly. Clinicians should cover any areas of blisters or open wounds prior to taping. How To Safeguard Against Skin Irritation And Allergic Reactions Remind patients that it is best to remove the tape immediately after the sport activity in order to minimize skin irritation. It is important for clinicians to inspect the skin regularly for any signs of irritation or allergic reaction when taping an athlete on a regular basis. When dealing with an athlete who is sensitive to tape, is taped on a daily basis or is allergic to tape, it is important to use a foam underwrap or prewrap. One should apply underwrap over the skin in a single layer as several layers will increase sweating and moisture retention under the tape. Always ask the athlete about any history of tape irritation or allergies, and beware of the fair skinned athletes. Nine Key Principles Of Taping Here are some additional principles of taping that clinicians should keep in mind when working with athletes. 1. Place the foot and ankle in the position it is to be stabilized. Any movement while taping will cause wrinkles and uneven application to the tape. 2. Select the appropriate type of tape for the area and overlap tape at least half the width of the tape below to help prevent irritating the skin from skin separation. 3. To prevent constriction of the area to be taped, be sure to avoid continuous taping whenever possible (or use elastic tape). 4. Always attempt to keep the roll of tape in hand while taping. 5. While applying the tape to the skin, smooth and mold it (I use my thumbnail) to avoid wrinkles or excessive pressure over prominent areas. 6. Apply the tape firmly and with a purpose. Don’t just lay it on the skin but fit the contour of the skin with the pull in the desired direction in order to control the motion in that area. 7. Begin taping with an anchor piece, which will serve as a substrate to attach strips to, and finish with a lock strap to secure the tape job. 8. Tape directly to the skin in order to give the maximum amount of support and protection. 9. In order to minimize strain, one must be in the proper position for applying tape at a comfortable height. Otherwise, it can be tough on the back and wrists. A Primer On Basic Taping Skills One must develop proper taping techniques by extensive practice (see “Nine Key Principles Of Taping” above). The chosen tape width depends on the area one is covering. More narrow tape is required for more acute angles in order to fit the contours of the area to be taped. Commonly, one would use 1/2- to 1-inch tape on the foot and 1.5-inch tape on the ankle. Tearing tape is an important skill to master as learning to tear tape effectively from different positions is essential for speed and efficiency. To tear tape, hold it in the preferred hand with the index finger hooked through the center of the tape roll and the thumb pressing the tape roll’s outer edge (pinched). Then grasp the loose end between the thumb and index finger with the other hand. With both hands, make a quick, scissors-like action to tear the tape. One should also emphasize careful tape removal. It is best to remove tape immediately after the sports activity by using either tape cutters (great for ankle tape jobs) or tape scissors, gently lifting tape away from the skin and advancing along the body’s natural contours. One must stabilize the skin while pulling the tape in the direction of hair growth. Avoid tearing the tape off rapidly as this could damage the skin and cause an abrasion or “skin burn.” Try to avoid using chemical solvents as well. Step-By-Step Pointers For Taping Common Injuries The following basic tape jobs are applicable to common foot and ankle injuries. Hallux spica. One can use this for turf toe or soccer toe injuries. This taping will support and limit motion at the first metatarsophalangeal joint (MPJ) in the direction that one applies the taping. One can use 1-inch or 1/2-inch tape for this technique. The tape job starts on the superior medial aspect of the first MPJ and encircles the hallux. One would finish the strap over the starting point, forming a spica over the joint. Repeat this several times, overlapping the previous spica. To finish off the taping, lock it with an anchor around the hallux distally and the midfoot proximally with care not to put medial to lateral compression across the metatarsal heads. Arch strapping (low dye). This technique commonly treats plantar fasciitis, posterior tibial tendonitis and medial tibial stress syndrome. One can use several variations. Hold the foot in a neutral position and it is helpful to plantarflex the first ray slightly. Using 1-inch tape, place an anchor from proximal to the first MPJ to the fifth MPJ, forming a “U” behind the heel. Be careful about placing the anchor. If one places the anchor too high, it can irritate the back of the heel/Achilles area. If you place the anchor too low, it will pull on the plantar aspect. Then apply a series of 2-inch tape straps going lateral to medial in order to “lift the arch.” Overlap the 2-inch tape straps by one half, going proximal to distal. Doing so leaves the heel area open. Repeat this and add another anchor. Subsequently, one should place a strap of tape, sticky side up, on the dorsum of the foot and apply two straps on top. This enables clinicians to secure the tape job without irritating or pulling on the top of the foot. An alternate method is using an “X” crossing on the plantar aspect of the foot. With this approach, the anchor starts proximal to the first metatarsal head, going medially to the heel around the lateral heel and finishing back at the first metatarsal head. Repeat this from the fifth metatarsal head, going laterally to the heel and around the medial heel back to the fifth metatarsal head. This forms an “X” under the arch. Then one would proceed to place several straps lateral to medial over the “X” in the arch. Sever’s disease/heel taping. This tape job helps to reinforce the calcaneus fat pad and support the calcaneal apophysis. First, I apply a low dye strapping and then fill in the heel with anchor strips, which I apply behind and below the heel. Using a basket weave technique, one can apply strips alternately until the heel is covered, using firm pressure with each strip. Apply anchors to lock the tape job. Modified ankle taping for ankle sprains. This consists of a series of stirrups and J straps to restrict inversion or eversion, depending on the injury. Advanced taping would incorporate a heel lock, which is technically much more difficult to master. Place pads with petroleum jelly over the front of the ankle and the heel where the Achilles tendon attaches to provide protection from irritation. One may need to shave the area or apply underwrap to the area. Hold the ankle at 90 degrees. Utilizing 1 and 1/2-inch tape works well for this technique. The modified ankle taping uses an anchor around the lower leg, about a hand width above the malleoli, and an anchor around the midfoot. Then one should apply a series of three stirrups with tension medial to lateral (eversion). Apply a series of two to three J straps. These should run medially down the ankle, under the foot and finish up across the dorsal medial part of the foot, overlapping each J strap by one half. One would apply heel locks at this time. Proceed to apply circular strips to fill in any gaps, overlapping by one half. Achilles tendon taping. With this method, it is best to use elasticon tape. This tape limits excessive dorsiflexion, which reduces the pull on the tendon. With the patient holding the foot in slight plantarflexion, apply an anchor just below the calf muscle where the leg tapers and apply an anchor at the midfoot. Use three strips of 3-inch elasticon, going from distal anchor to the proximal anchor in order to form a check rein. Then proceed to fill in the anchors, leaving the ankle area open. How Does Taping Compare To Bracing? There are several points to consider when weighing taping and bracing. Bracing may be cost effective for an entire season. Braces are easy to apply. Athletes can often apply braces themselves and braces can be easier on the skin. In addition, braces maintain support whereas taping can lose a significant part of its stabilization value after 10 to 15 minutes. Dr. Dutra is a Fellow and President-Elect of the American Academy of Podiatric Sports Medicine. He is a team podiatrist for the University of California at Berkeley and covers all of its sports. Dr. Dutra is a former athletic trainer for California State University East Bay. Dr. Caselli (pictured) is a staff podiatrist at the VA Hudson Valley Health Care System in Montrose, N.Y. He is also an Adjunct Professor at the New York College of Podiatric Medicine and a Fellow of the American College of Sports Medicine.