Calcaneal taping decreases patient's pain in the short-term, but does not improve function.

Clinical Bottom Line: The calcaneal taping technique is an easy immediate treatment with very little risk that can be used to alleviate pain for patients with plantar heel pain in the short term. VAS decreased significantly more with calcaneal taping technique than with both the control group (p<.001) and sham-taping group (p<.001). None of the treatment methods demonstrated improvements in the patient specific functional scale (PSFS). There were very few threats to validity in this study, but the utility of the results is limited due to the short-term follow-up, lack of other treatment included and no comparison to other taping methods or orthotics. This study is level 1b evidence with 100% follow-up.

Citation/s: Hyland MR, et al. Randomized Controlled Trial of Calcaneal Taping, Sham Taping, and Plantar Fascia Stretching for the Short-Term Management of Plantar Heel Pain. Journal of Orthopedic and Sports Physical Therapy. 2006; Vol 36-6: 364-371.

Lead author's name and fax: Matthew R. Hyland, Fax unavailable

Three-part Clinical Question: For a 41 year old female with unilateral plantar heel pain will plantar taping provide more relief in the short term than placebo treatment?

Search Terms: Plantar heel pain, plantar fasciitis, taping The Study: Single-blinded concealed randomized controlled trial with intention-to-treat.

The Study Patients: A total of 42 subjects were randomly assigned to one of four groups: stretching alone, calcaneal taping, control group and sham taping. The inclusion criteria was appropriate to target those individuals who would best benefit from the treatment. This criteria included: age between 18-65, pain with first steps upon walking, pain located at the heel or plantar surface of mid-foot and presence of and everted calcaneus greater than or equal to two degrees. The stretching group (N=10, 8 males) had a mean age of 34.1 (5.9). The calcaneal-taping group (N=11, 5 males) had a mean age of 45.5 (12.0). The control group (N=10, 3 males) had a mean age of 37.6 (10.1). The sham-taping group (N=10, 5 males) had a mean age of 40.Descriptivescriptive statistics were provided and their were no significant differences between groups at the start of the study for anything except gender. Control group (N = 10 & 10; 10 & 10 analyzed): The control group (N=10) was provided no treatment for the one week duration of the study. The sham-taping group (N=10) had their heels taped with cover roll and Leukotape but it was applied in a way that did not attempt to control the position of the calcaneous. Subjects in the sham-taping group returned half-way through the week to get their foot retaped. Experimental group (N = 10& 11; 10 & 11 analyzed): There were two different treatment groups: stretching alone and calcaneal taping alone. The stretching group (N=10) received passive stretching of the ankle plantar flexors and fascia on day one, and day 3 or 4 in a physical therapy office. A description of the stretches was included in the article. Subjects in this group were instructed not to perform the stretches at home. The calcaneal taping group (N=11) received calcaneal taping alone. Cover roll was applied to the plantar heel and foot and then covered with Leukotape. The Leukotape layer was applied laterally to medially in an attempt to pull the calcaneus medially. Specific directions and photos were included in the article. Both taping groups were instructed to keep the tape on for 24 hours a day. Subjects in the calcaneal-taping group also returned to get their foot taped again in the milile of the week.

The Evidence:

VAS scores with 95% Confidence Intervals

Pre Mean and SD / Pre 95% CI / Post Mean and SD / Post 95% CI
Stretching Group (n=10) / 6.3 +/-0.8 / 5.73- 6.87 / 4.6 +/-0.7 / 4.8-5.1
Calcaneal-Taping Group (n=11) / 7.0 +/-0.8 / 6.46-7.54 / 2.7 +/-1.8 / 1.49-3.91
Control Group (n=10) / 6.3 +/-1.2 / 5.44-7.16 / 6.2 +/-1.0 / 5.48-6.92
Sham Taping Group (n=10) / 6.4 +/- 1.2 / 5.54-7.26 / 6.0 +/-0.9 / 5.36-6.64

Non-Event Outcomes

Time to outcome/s / Control group / Experimental group / P-value
Change in VAS Score: Calcaneal Taping vs Control / 1 week / 6.2 +/- 1.0 / 2.7 +/- 1.8 / <.001
Change in VAS Score: Calcaneal Taping vs Sham Taping / 1 week / 6.0 +/- 0.9 / 2.7 +/- 1.8 / <.001
Change in PSFS Score: Calcaneal Taping vs Control / 1 week / 4.8 +/- 1.3 / 6.2 +/- 1.8 / =.078

Comments: The results to this study are valid and there are very few threats to validity. The subjects were randomly assigned to one of the four groups and were blinded to their group assignment. The authors did not mention if the individuals doing the statistical analysis were blinded to treatment received. All subjects were accounted for at the conclusion of the study and were analyzed in the groups they were initially assigned to. Groups were treated relatively equal aside from their different treatments. The main difference is that all but the control group had some sort of hands on treatment, either taping or stretching, done in the clinic at two different times. This aliitional time being seen could increase the placebo affect taping and stretching could have. All four groups were homogenous in regards to most of the descriptive statistics at the start of the trial. Groups only varied in the amount of males and females they had in them. For instance the stretching group had 8 males and 2 females while the control group had 3 males and 7 females. The two outcome measures, Visual Analog Scale (VAS) and Patient Self-Reported Functional Scale (PSFS) have been shown to be reliable and capture the results were are interested in for this study.

The statistical analysis done for this study was appropriate. The authors performed Tukey post hoc analysis to account for the multiple groups. There were significant differences both within and between groups at the conclusion of the study. The study found significant improvements for pain in stretching (-1.7 decrease on VAS, CI 4.08-5.1, P<.001), sham-taping (-0.4 decrease on VAS, CI 5.48-6.92, P<.05) and calcaneal taping groups (-4.3 decrease on VAS, CI 1.49-3.91, P<.001) on VAS scale. Calcaneal taping also significantly improved pain compared to sham taping and stretching (p<.05). The change in VAS score for calcaneal taping is clinically significant because if a patient can improve by 50% on the VAS scale they will definitely notice a positive change. The 95% confidence interval of calcaneal taping, which was not recorded by the authors, is larger than preferred, however, the interval does not overlap the Pre VAS CI therefore the results are still of value. An improvement of 1.7 for the stretching group is borderline clinically significant and gives pause to the question of how much improvement could have happened if subjects were told to stretch on their own at home. The confidence interval for stretching is tight and does not overlap pre VAS CI which increases the value of this finding. The sham taping group improved by less than 0.5 which is not clinically significant. No improvements were found in the Patient Self-Reported Functional Scale (PSFS). I agree with the authors' conclusion that the short duration of the study may have contributed to not finding a change on this scale. The authors believe this tool may not have been sensitive enough to pick up changes in the short term even if they had occurred. There were no events recorded and therefore number needed to treat and relative and absolute risk reduction could not be calculated. The authors could have used an increase in subjects' VAS as an event, but it would not have alied much weight to the article.

The patient population used in the trial is very broad and therefore the results can be applied to a large amount of the patients with plantar heel pain that are seen in a normal outpatient PT clinic. Most patient's values and preferences would be satisfied if they were treated with taping, stretching or both. The results of one of those treatments alone, however, would not be sufficient to satisfy patients' desires to return to pre-injury function or resolve pain. Both techniques require patients to return to the clinic at least twice a week for treatment. Some patients may not be able to do this based on their schedule. Both the calcaneal taping technique and the plantar stretching are inexpensive easy techniques to learn and apply to your patients. A downfalls of this study is that they did not give patients in one of the groups both the calcaneal taping and the stretching. This might have shown a larger treatment effect. They also did not have the plantar stretching group do any stretching on their own, which does not resemble what a normal PT treatment regiment would include. This study demonstrated either a simple taping technique or passive stretches twice a week can significantly improve a patient's self reported pain level in the short-term. Although this study has limitations, which the authors acknowledged, the results are significant and the treatments used are simple enough to apply to my patients immediately. The taping technique is especially useful when treating patients in remote locations where orthotics would not be available. Future studies should compare low dye taping to calcaneal taping.

Appraised by: Kara Weigel; Saturday, April 07, 2007 Email: