Ankle Taping and Bracing

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Ankle sprains are the most common sports-related injuries in the United States, accounting for an estimated 2 million injuries per year. ^{[1, 2]}  This results in significant time away from games and practices. A practical method of decreasing the number and severity of these injuries would obviously be of great benefit. For this reason, the concept of prophylactic ankle wrapping was introduced more than 60 years ago. ^[3]  The purpose of this article is to review the mechanics of ankle taping and to discuss ankle bracing.

Ankle taping and bracing are fixtures of both athletic training and sports medicine. ^{[4, 5]}  Although studies regarding effectiveness and technique are not all in agreement, it seems clear that bracing or taping of the ankle will continue to be a mainstay in the prepractice and precompetition routine.

The sports medicine physician should understand the concepts and techniques of ankle bracing and taping so that advice and guidance can be offered to athletes and athletic training staff.

For patient education information, see the Foot, Ankle, Knee, and Hip Center and Sprains and Strains – First Aid and Emergency Center, as well as Ankle Sprain and Sprains and Strains.

Ankle bracing and taping are used for the prevention of ankle injuries, especially in athletes with a past history of ankle sprains. ^[2]  The brace or tape is applied before practice or competition.

Ankle bracing and taping should not be used in place of aggressive rehabilitation, including strengthening and proprioceptive exercises. Rather, both should be used in conjunction with rehabilitation in terms of injury prevention.

Ankle sprains occur in nearly all types of sporting events. To understand ankle sprains, one must first understand ankle anatomy. The ankle (talar) joint has three bones and three groups of stabilizing ligaments. The talus articulates in a hinge fashion with both the tibia and the fibula. The distal tibia and fibula are stabilized by the tibiofibular ligaments (anterior and posterior), also known as the syndesmosis.

The thick deltoid ligament supports the medial aspect of the ankle and helps limit eversion. The medial ankle is inherently more stable than the lateral ankle and is, therefore, the site of fewer injuries.

Most ankle sprains are inversion injuries involving either complete or partial tearing of the lateral ligament complex, which is composed of three distinct ligaments: the anterior talofibular, the calcaneofibular, and the posterior talofibular. These ligaments are usually injured in a sequential fashion from anterior to posterior, depending on the severity of the inversion.

In contrast to previous beliefs, rapid lateral body movement actually accounts for relatively few inversion sprains. Most ankle sprains occur when landing from a jump, with the foot in an inverted, plantarflexed position. ^{[1, 6, 7, 8]}  Several studies support the theory that ankle sprains frequently involve disruption in ankle proprioception that prevents the ankle from protecting itself. Eversion ankle sprains, however, usually are not related to inadequate proprioception but are the result of outside forces (eg, contact with another player).

The concept of ankle bracing evolved from ankle taping. Braces are being used instead of traditional taping by many athletes at all levels of competition; they offer several advantages in that they are self-applied, reusable, and readjustable. In the long run, braces are likely more cost-effective than taping. ^{[1, 4, 9, 10, 11]}  Estimates in the past have shown that ankle taping is approximately three times more expensive than bracing over the course of a competitive season. ^[12]

Disadvantages of bracing include the fact that many athletes feel less comfortable or stable when wearing braces than they do when the ankle is taped. Braces also can become torn or lost and require replacement.

Many studies have compared taping versus bracing of the ankle. ^[13] Prospective studies have met with difficulty in controlling all of the variables associated with ankle injuries (eg, playing surface, shoe wear, individual inherent stability, and intensity of competition on both a team and individual level).

Most of these studies have shown that braces are slightly more effective than taping but that both are better than no support. One study found that simply wearing high-top instead of low-top shoes prevented some ankle injuries and that athletes wearing high-top shoes plus taping had more than 50% fewer injuries than those wearing low-top shoes plus taping.

Studies examining the effectiveness of external ankle stabilization have had conflicting results. Some reports show no change in injury rates, but most have found at least some decrease in inversion sprains. Two studies involving high school basketball and football players showed that the use of lace-up ankle braces (vs unbraced controls) reduced the incidence of acute ankle injuries but did not reduce the severity of these injuries. ^{[14, 15]}

The mechanism for this protection is still somewhat unclear. It seems logical that external devices should increase the structural stability of the ankle (ie, “stiffen the ankle joint”) and make the ankle less susceptible to inversion. Although this is true to some extent, at least one classic study has shown that regular taping can lose most of its supportive effect after only short periods of exercise. ^[16]

How, then, does taping or bracing decrease the incidence and severity of sprains? A possible answer was suggested in a study by Robbins and Waked, which found that taped participants had improved proprioception both before and after exercise compared with untaped control subjects. ^[17]  The authors theorized that the traction or pressure imparted to the skin of the foot and ankle via taping or bracing provided improved sensory input and thus improved proprioception, resulting in fewer ankle sprains.

However, a systematic review and meta-analysis of eight studies by Raymond et al found that the evidence suggested that using an ankle brace or ankle tape had no effect on proprioceptive acuity in participants who had recurrent ankle sprain or functional ankle instability. ^[18]

A study by Long et al that included 24 healthy university students found that those who had above-average proprioceptive performance when not taped had worse scores when taped, whereas those who had below-average proprioceptive performance when not taped had better scores when taped. ^[19]  The investigators suggested that taping might amplify sensory input in a way that enhances the proprioception of poor no-taping performers but causes an input overload that impairs proprioception in good performers.

A study by Lohrer et al comparing the neuromuscular properties of taped versus untaped ankles introduced a measure known as the proprioceptive amplification ratio (PAR). ^[20]  This number incorporates neuromuscular properties such as proprioception and degree of mechanical stress. These results indicated that taping did provide increased ankle protection.

A common concern is that prolonged taping or bracing of the ankle may result in weak ankles that are actually more prone to injury. Should this concern prove well founded, it would obviously make a strong caseagainst the use of ankle taping or bracing. However, a study by Cordova et al suggested that this concern is unfounded. ^[21] These researchers determined that consistent ankle brace use did not change the latency to inversion of the peroneus longus (an important stabilizer of the ankle, particularly against inversion, the most common type of ankle injury).

Kemler et al compared 4 weeks of soft bracing with 4 weeks of taping in 157 patients with acute lateral ankle ligamentous sprains, assessing recurrence and residual symptoms at 1 year. ^[22]  They found the rates of recurrence and the incidence of residual symptoms to be similar in the two groups.

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Pedowitz DI, Reddy S, Parekh SG, Huffman GR, Sennett BJ. Prophylactic bracing decreases ankle injuries in collegiate female volleyball players. Am J Sports Med. 2008 Feb. 36(2):324-7. [Medline].

Mickel TJ, Bottoni CR, Tsuji G, Chang K, Baum L, Tokushige KA. Prophylactic bracing versus taping for the prevention of ankle sprains in high school athletes: a prospective, randomized trial. J Foot Ankle Surg. 2006 Nov-Dec. 45(6):360-5. [Medline].

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Cooke MW, Marsh JL, Clark M, et al. Treatment of severe ankle sprain: a pragmatic randomised controlled trial comparing the clinical effectiveness and cost-effectiveness of three types of mechanical ankle support with tubular bandage. The CAST trial. Health Technol Assess. 2009 Feb. 13(13):iii, ix-x, 1-121. [Medline].

McGuine TA, Brooks A, Hetzel S. The effect of lace-up ankle braces on injury rates in high school basketball players. Am J Sports Med. 2011 Sep. 39(9):1840-8. [Medline]. [Full Text].

McGuine TA, Hetzel S, Wilson J, Brooks A. The effect of lace-up ankle braces on injury rates in high school football players. Am J Sports Med. 2012 Jan. 40(1):49-57. [Medline].

Rarick GL, Bigley G, Karst R, Malina RM. The measurable support of the ankle joint by conventional methods of taping. J Bone Joint Surg Am. 1962 Sep. 44-A:1183-90. [Medline].

Robbins S, Waked E. Factors associated with ankle injuries. Preventive measures. Sports Med. 1998 Jan. 25(1):63-72. [Medline].

Raymond J, Nicholson LL, Hiller CE, Refshauge KM. The effect of ankle taping or bracing on proprioception in functional ankle instability: a systematic review and meta-analysis. J Sci Med Sport. 2012 Sep. 15 (5):386-92. [Medline].

Long Z, Wang R, Han J, Waddington G, Adams R, Anson J. Optimizing ankle performance when taped: Effects of kinesiology and athletic taping on proprioception in full weight-bearing stance. J Sci Med Sport. 2017 Mar. 20 (3):236-240. [Medline].

Lohrer H, Alt W, Gollhofer A. Neuromuscular properties and functional aspects of taped ankles. Am J Sports Med. 1999 Jan-Feb. 27(1):69-75. [Medline].

Cordova ML, Cardona CV, Ingersoll CD, Sandrey MA. Long-term ankle brace use does not affect peroneus longus muscle latency during sudden inversion in normal subjects. J Athl Train. 2000 Oct. 35(4):407-11. [Medline]. [Full Text].

Kemler E, van de Port I, Schmikli S, Huisstede B, Hoes A, Backx F. Effects of soft bracing or taping on a lateral ankle sprain: a non-randomised controlled trial evaluating recurrence rates and residual symptoms at one year. J Foot Ankle Res. 2015. 8:13. [Medline].

Douglas A Reeves, Jr, MD Team Physician, Clemson University

Douglas A Reeves, Jr, MD is a member of the following medical societies: American Medical Society for Sports Medicine, American Academy of Family Physicians

Disclosure: Nothing to disclose.

T Jeff Emel, MD Director, Department of Sports Medicine, Eastern Oklahoma Orthopedic Center

T Jeff Emel, MD is a member of the following medical societies: American College of Sports Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Sherwin SW Ho, MD Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago Division of the Biological Sciences, The Pritzker School of Medicine

Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Arthroscopy Association of North America, Herodicus Society, American Orthopaedic Society for Sports Medicine

Disclosure: Received consulting fee from Biomet, Inc. for speaking and teaching; Received grant/research funds from Smith and Nephew for fellowship funding; Received grant/research funds from DJ Ortho for course funding; Received grant/research funds from Athletico Physical Therapy for course, research funding; Received royalty from Biomet, Inc. for consulting.

David T Bernhardt, MD Director of Adolescent and Sports Medicine Fellowship, Associate Professor, Department of Pediatrics/Ortho and Rehab, Division of Sports Medicine, University of Wisconsin School of Medicine and Public Health

David T Bernhardt, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Sports Medicine, American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.

Ankle Taping and Bracing

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