Functional ankle taping correction on plantar foot ulcer healing in diabetic patients: Randomized controlled trial

1 Introduction

Diabetic foot ulcers (DFUs) are a significant and destructive consequence of diabetes, impacting approximately 26 million individuals globally each year. Individuals with diabetes have a lifetime risk of around 25% of acquiring a foot ulcer, which is significantly higher than those without diabetes [1]. The prevalence of foot ulcers in the diabetic community has been found to range from 4% to 10%. Around half of diabetic foot ulcers (DFUs) develop on the plantar surface of the foot. If not treated properly, these ulcers can become chronic and fail to heal [2]. Diabetic foot ulcers (DFUs) are a well-known condition that increases the likelihood of negative health outcomes, such as major limb amputation. Additionally, DFUs impose a costly burden on the healthcare system due to prolonged healing durations, diminished quality of life, and an elevated death rate [3].

Increased plantar pressure while walking is another indicator of diabetic foot ulceration. Nevertheless, research on the sensitivity and specificity of barefoot plantar pressure in predicting ulceration indicates that while barefoot pressure is significant, it is only a somewhat accurate predictor [4]. This is likely because patients walk barefoot in their daily lives and wear shoes, which create different biomechanical conditions. When walking without shoes, the pressure on the bottom of the foot is usually significantly greater than when wearing protective footwear that patients commonly receive after a plantar foot ulcer has healed [5]. Therefore, persistently wearing such footwear directly impacts the overall mechanical stress on the foot and can significantly influence the chance of ulcer recurrence [6]. Kinesio taping (KT) is a method that involves using conventional taping techniques to imitate the characteristics of human skin. The tape is very thin, similar to the epidermis, and may be stretched longitudinally by 30% to 40% of its original length [7]. Kinesio taping (KT) is an active method that does not immobilize but enhances proprioception to support the musculoskeletal system actively. This can be beneficial for improving posture and movement, even in individuals without symptoms, by optimizing muscle function and correcting misaligned joints [8].

This study aimed to examine the impact of correcting functional ankle taping on healing plantar foot ulcers (PFUs) in diabetic patients.

2 Methods

The study is a controlled, double-blinded, and randomized controlled trial that occurred between August 2023 and February 2024 at the outpatient clinic of the Modern University for Technology and Information Faculty of Physical Therapy. The Ethical Committee for Human Research endorsed the study in line with the principles of the 1975 Declaration of Helsinki at the Cairo University’s Faculty of Physical Therapy in Egypt (Reference number: P.T.REC/012/004688) and was registered with the Clinical Trials.gov (NCT06065488).

3 Results

The study investigated the effectiveness of functional ankle taping correction on plantar foot ulcer healing in diabetic patients in a randomized clinical trial. The trial involved 74 participants who were assessed for eligibility, with two excluded for various reasons (One individual does not fit the criterion for participation), while the other individual has chosen not to participate., leaving 72 randomized into two groups, each receiving a different intervention over eight weeks. Group A received functional ankle taping, medical treatment, and dressing according to their cases. Group B received a placebo taping method that was considered ineffective (not from insertion to the origin of muscles) with the same material without tension; they also received medical treatment and dressing according to their cases. After the 8-week intervention period, the participants were assessed for outcome measures, including the walkway pressure system for plantar pressure assessment, a handheld standard goniometer for active ankle dorsiflexion, wound surface area by the+Wound Desk mobile application, and saline solution for wound volume. The randomized procedure was managed by a licensed physical therapist who was not involved in the study’s protocols. Two participants discontinued Group A during the trial due to skin irritation and were referred to a dermatologist for intervention. The analysis of the trial included a total of 35 participants per group who completed the full intervention (Fig. 1).

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Fig. 1

Flow chart diagram.

4 Discussion

This study aimed to investigate the effectiveness of functional ankle taping correction on plantar foot ulcer healing in diabetic patients. Although there is not a lot of literature on the use of ankle taping for plantar foot ulcer healing, some studies have indicated that this method could be beneficial when used around the wound.

To accomplish this, we used functional ankle KT for plantar ulcers and measured peak plantar pressures, active ankle dorsiflexion, and ulcer healing after eight weeks.

The most important result observed in this study was the change in peak plantar pressure scores. Plantar pressure is not routinely assessed in clinical practice, which reduced the experimental group towards that due to a reduction in the active range of dorsiflexion, which improves plantar ulcer healing. The KT group showed a statistically greater reduction than the sham control group.

Ankle taping is commonly employed to prevent and cure foot and ankle diseases. Research indicates that traditional taping can effectively manage foot movements, particularly excessive pronation, and plantar flexion while walking. Kinesiotaping (KT) is becoming increasingly common [13]. A recent study has investigated the impact of KT on clinical outcomes related to plantar flexion. The findings indicate that the KT group experienced more significant clinical advancements than standard clinical care. However, it is important to note that the lack of a control group constrained the study for comparison purposes [14].

Additionally, Sawkins et al conducted a study that showed a placebo effect of functional taping in individuals with unstable ankles. Participants reported feeling more comfortable and confident, but their biomechanics had no observable change. Also, Luque-Suarez et al. demonstrated the immediate effectiveness of neuromuscular taping and functional taping. They observed significant and clinically meaningful improvements in correcting pronated and supinated hind foot postures when applying placebo neuromuscular tape with no actual stress (sham-tension) [15]. Furthermore, Seo HD et al conducted a study to explore the impact of kinesio tape on ankle mobility function in individuals with and without foot ulcers. The researchers determined that kinesio tape can rapidly reduce foot pressure and enhance human performance. Additionally, it may shift the pressure on the sole, which aids in healing ulcers. Nevertheless, there is an improvement in the patient’s postural stability with PFUs [16].

In addition, Lin CC et al found that the use of an ankle KT enhances the flexibility of the ankle and knee joints, reduces the speed at which force is applied to the joints, and lowers the likelihood of damage during walking. This treatment promotes efficient healing and decreases the likelihood of recurring wounds [17]. Correspondingly, Tobruk MS et al demonstrated that the application of the KT method could effectively improve ankle motion and assess the pressure on the foot’s sole. This method provides valuable insights into foot injuries and significantly impacts walking using Kinesio tape. The positioning of the foot plays a crucial role in redistributing pressure and absorbing shock during walking, particularly for diabetic patients [18].

Besides, Griebert et al. discovered that KT has a substantial effect on reducing plantar pressures. The researchers examined individuals with medial tibial stress syndrome, a common overuse injury among individuals who engage in regular physical activity— the elastic therapeutic tape benefits muscular function by improving muscle efficiency and effectiveness [19]. In a study conducted by Guner S et al it was determined that applying kinesiology tape (KT) to the arch of the foot in healthy individuals does not result in any immediate changes in walking plantar pressures [20]. Further, Cornwall et al. utilized tape with a 100% elongation, but their evaluation of static kinematics did not reveal any enhancement in posture 24 hours following the administration of Kinesio Tape, in comparison to the application of sham Kinesio Tape without stress [21]. Also, Kiseljak et al. Hence, according to his perspective, the KT Functional Correction Technique was deemed superior to the KT Muscle Facilitation Technique [22] regarding diminishing walking plantar pressures.

Alternatively, these changes in the plantar pressures shown in this study are not similar to other walking pressure studies of functional taping in a similar group of participants with plantar foot ulcers which explained by Sullivan et al. demonstrated substantial elevations in plantar pressure in the lateral midfoot region and reductions in the medial forefoot and hindfoot areas. There were no alterations observed in the middle part of the foot or the outside part of the front foot. The pressure investigations conducted on low-dye taping do not indicate that taping leads to a consistent alteration in foot pressures. However, it remains to be seen whether these findings are due to unreliable measurements of plantar pressures or variations in polarography systems [23].

Additionally, García-Madrid et al. demonstrated that the plantar pressure in the big toe and the first, second, third, and fourth metatarsal regions remained unchanged before and after the application of kinesio tape, indicating no significant difference. However, a significant difference was seen in the fifth metatarsus. The results indicate that the heel area experienced the maximum pressure both before and after applying kinesio tape, while the fourth metatarsus experienced the lowest pressure. This reduced the overall time required for ulcer healing compared to utilizing standard treatment alone. Nevertheless, the decrease in pressure is consistently lower [24].

The existing data on the efficacy of functional ankle taping in correcting plantar ulcers and promoting healing has certain limitations. There needs to be more sample numbers, and the lack of follow-up data is among the limitations. In future studies, the scientific community should consider employing bigger sample sizes and collecting follow-up data to evaluate the long-term sustainability of treatment outcomes. Furthermore, further research is required to provide a more comprehensive understanding of the processes via which these treatments operate. Gaining comprehension of their functioning could streamline treatment methods and enhance therapy outcomes.

5 Conclusion

The study found that correcting ankle taping has an impact on various factors including peak plantar pressure, ankle dorsiflexion, wound area, and wound volume. This correction leads to a reduction in peak plantar pressure, wound area, and wound volume, while also boosting active ankle dorsiflexion.

The study indicated that functional ankle taping correction affects peak plantar pressure, ankle dorsiflexion, wound area, and wound volume by reducing peak plantar pressure, wound area, and wound volume and increasing active ankle dorsiflexion.