Abstract
Background
Plantar fasciitis is a common sports injury with long-term chronic pain in the heel as the main symptom, and athletic taping has achieved certain therapeutic effects to improve it, but the clinical efficacy of the problem is still controversial, which was evaluated by Meta-analysis to evaluate the clinical efficacy of the athletic taping technique on patients with plantar fasciitis.
Methods
The Cochrane Library, Embase, PubMed, Web of Science, CNKI, Wanfang, and Vip databases were searched by computer for randomized controlled trial on the clinical efficacy of exercise taping in patients with PF from the time of construction to 1 September 2024, and the PRISMA 2020 checklist was strictly followed. Quality was assessed using the cochrane 2.0 randomized controlled trials scale by two independent reviewers. Endings were meta-analysis using RevMan 5.4.1 analysis software to analyse the data.
Results
Eleven randomized controlled trial with a total of 395 patients were included. On VAS scores, KT effectively reduced VAS pain scores (MD=-0.79,95 % CI −1.10,-0.48, P < 0.00001); on AOFAS scores, KT improved AOFAS function scores (MD=6.58, 95 % CI 5.03,8.13, P < 0.00001) and the results remained consistent across intervention durations; on plantar fascia thickness measurements, KT significantly reduced plantar fascia thickness (MD=-0.33, 95 % CI −0.56,-0.10, P = 0.005); on BBS scores, KT significantly improved BBS scores [MD= 4.75, 95 % CI (3.17, 6.32), P < 0.00001]; on FFI-FPS scores, KT effectively improved FFI-FPS scores [MD =-2.59, 95 % CI (-3.50, −1.69), P < 0.00001]; on FFI-FDS scores, there was a significant improvement on FFI-FDS scores; on FFI-ALS scores, KT had a significant improvement on the FFI-ALS score had a significant effect [MD=-11.03, 95 % CI (-14.79, −7.27), P < 0.00001]; and on VAS scores after follow-up, the pain relief effect was sustained (MD=-1.03, 95 % CI −1.21, −0.85, P < 0.00001).
Conclusion
Based on the available evidence, preliminary analyses suggest that KT combined with conventional rehabilitation may have some advantages in improving pain, ankle-hindfoot function, and plantar fascia thickness in patients with plantar fasciitis, and some of the efficacy is short-term sustained. However, due to the heterogeneity and sample size of the included studies, the above conclusions need to be further validated by more high-quality studies.
1
Introduction
Plantar fasciitis (PF) is a common sports injury characterized by long-term chronic pain in the heel due to degenerative changes and biomechanical alterations in the proximal plantar fascia, associated with obesity, prolonged weight-bearing exercise, and limited ankle mobility . In adults, plantar fasciitis is the most common cause of heel pain, attending 15 % and 80 % of all foot disorders and heel pain syndromes, respectively , . Due to the high prevalence and detrimental effects of PF, it causes significant stress and economic burden to society and individuals , . When PF is present, the use of reasonable rehabilitation measures is crucial for the recovery of patient-related functions. Currently, conventional rehabilitation treatments are mainly based on conservative treatments such as stretching exercises, shockwave therapy, manipulative therapy, ionic introduction, and traditional therapy, but the efficacy of these treatments varies, and most of them are now based on combined treatment modalities . However, most treatment options are only for short-term pain symptom relief, and for patients with chronic plantar fasciitis, correcting the poor biomechanics of the foot is the key to preventing and treating the disease.
For patients refractory to conservative treatment, surgical treatment is usually required, which will result in longer rest and delayed participation in physical activities . Conventional rehabilitation, although clinically effective, is often not significant in relieving pain, reducing swelling, strengthening proprioception, and promoting overall motor function of the foot and ankle . According to the American Physical Therapy Association (APTA) Clinical Practice Guidelines , foot orthotics and athletic taping (AT) are interventions that use mechanical principles. Foot orthotics and taping techniques have a strong level of evidence grade for reducing pain and improving function in patients with PF. However, customized foot orthoses are technically demanding, time-consuming, and costly, making it difficult to popularise their use in clinical practice. Athletic Taping, a technique of wrapping or supporting certain parts of the body with special tape, is commonly used to prevent sports injuries, reduce pain, stabilize joints, and promote rehabilitation. Kinesio Taping (KT) was created by Dr Kenso Kase in 1973 as a common method in athletic taping and is widely used in the rehabilitation of musculoskeletal disorders . It is based on the principle of applying a thin adhesive elastic band that can be stretched to 55–60 % of its original length to the skin surface to provide constant tension and transfer it to the skeletal myofascial, resulting in beneficial effects including spatial restoration, physical and kinematic corrections, fascial laxity, tendon and ligament support, lymphatic fluid circulation, and proprioceptive stimulation ,, . In recent years, athletic taping has received extensive attention from a large number of researchers, but some of them have concluded that the efficacy of athletic taping is not significant, and the issue of its clinical efficacy in maintaining the musculoskeletal health and function of the body is still controversial . There are few randomized controlled trials (RCTs) of athletic taping in the adjunct treatment of plantar fasciitis and the sample sizes of the available studies are small. In light of this, the issue of the clinical efficacy of athletic taping in PF remains controversial . Therefore, we conducted this study, which will be the first randomized systematic investigation with Meta-analysis to determine the efficacy of summary athletic taping in the adjunctive treatment of plantar fasciitis in order to provide a reliable evidence-based foundation.
2
Materials and methods
2.1
Registration
This study followed the preferred reporting items for systematic reviews and meta-analysis (PRISMA), registration number:CRD42024595590. https://www.york.ac.uk/inst/crd .
2.2
Search strategy
The system searched four English databases, PubMed, Cochrane Library, EMBASE, and Web of Science, and three Chinese databases, CNKI, Wanfang, and Vip, from the time of database construction to 1 September 2024. Primary literature searches were conducted in all fields (seven databases) by applying MeSH and Emtree terms and keywords: ‘athletic taping’ OR ‘athletic patches’ OR ‘athletic taping technique ‘OR ‘sports taping’ OR ‘kinesio taping’ OR ‘metatarsal fasciitis’ OR ‘plantar fasciitis ‘OR ‘chronic plantar fasciitis’. Due to the small number of documents, no filters were used, the search was limited to full text and no linguistic or geographical restrictions were imposed on the search. In order to avoid missing documents as much as possible, the references were checked in detail when reading the documents.
2.3
Selection criteria
2.3.1
Inclusion criteria
Literature included in the Meta-analysis had to meet all of the following inclusion criteria in the PICOS Principles : 1) Population: patients with a clinical diagnosis of plantar fasciitis; 2) Intervention: the test group was patients who had the addition of athletic taping to the control group’s intervention; 3) Comparison of interventions: the control group was patients who were treated with either physical assistance only or with the addition of 4) Outcome indicators: at least one of the following outcome indicators was reported: VAS score, AOFAS score, plantar fascia thickness, BBS score (Berg Balance Scale item 7 for balance movement in the back stance) and FFI index (FPS pain score, FDS function score and ALS activity limitation score); 5) Study design: published RCT.
2.3.2
Exclusion criteria
Exclusion criteria: 1) not related to athletic taping combined with physical assistance interventions; 2) articles that did not assess the above outcome metrics or did not set up comparisons between groups; 3) did not state when the assessment was performed; 4) duplicate publication; 5) combination with out-of-study therapies; 6) combination with other injuries; and 7) incomplete raw data.
2.4
Data extraction
In the included studies, two researchers (WS and QH) independently extracted data information from the same studies, then met to review their results and cross-check them, and any disagreements should be resolved by consensus. If consensus could not be reached, a third scholar (ZJ) provided advice on missing information in the text by contacting the original authors by email. After careful study of the title and abstract and elimination of irrelevant literature, literature that passes the initial screening should be reviewed in depth in the full text to clarify whether it is necessary to include it. Information was extracted from the literature screened above, including authors, publication date, sample size, age and sex ratio of patients, specific interventions in the intervention group, and outcome indicators.
2.5
Assessment of risk of bias
Randomized controlled trials (RCTs) were assessed by evaluating the methodological quality of the included literature according to the Cochrane 2.0 assessment tool . It consists of 7 dimensions (including randomization, allocation concealment, blinding of participants, blinding of outcome assessment, incomplete outcome data, selective reporting, and other risks of bias), and the quality of the literature is graded as A if each literature is at low risk of bias for all 7 dimensions; the quality of literature is graded as B if it is partly at low risk of bias, and partly at uncertain risk; and the quality of literature is graded as C if 1 or more of the evaluated indicators are at high.Publication bias and small sample bias were assessed by visual measures of funnel plots.
2.6
Statistical analysis
The study used Review Manager (RevMan) 5.4.1 for Meta-analysis of data and R4.3.3 for Meta-regression. Heterogeneity was analysed using the Q test and I 2 values.The I 2 statistic is an important indicator of heterogeneity, with values of 25 %, 50 % and 75 % representing low, medium and high heterogeneity, respectively. If P > 0.05 and I 2 < 50 %, it indicates that there is no significant heterogeneity between the results of the studies, which can be analysed using a fixed-effects model; Conversely, if heterogeneity is large, a random effects model is required, with sensitivity analyses, subgroup analyses and Meta-regression analyses of the sources of heterogeneity and factors affecting the posterior value of the combined effect size. Sensitivity tests were used to determine whether analytical heterogeneity affects the stability of the results, incorporating the lesser literature comparing random-effects models and fixed-effects models for the analysis. We performed subgroup analyses for studies in the literature with excessive heterogeneity of experimental data, where the combined effect sizes were susceptible to samples with insignificant experimental data due to too few samples. In this study, the outcome indicators were continuous variable information, so the mean difference (MD) was used for continuous variables and 95 % confidence intervals (CI) were calculated, and Q-tests were used to analyse the samples. Funnel plots were produced for sample experimental data to detect publication bias in the included literature. Small sample size and low research precision are distributed at the bottom of the funnel plot and dispersed around; large sample size and high research precision are distributed at the top of the funnel plot and concentrated in the middle.
2.7
GRADE quality of evidence evaluation
The GRADE system was used to evaluate the quality of evidence for the outcome indicators, and the RevMan 5.4.1 results were imported into the GRADEpro software for quality of evidence evaluation. As the literature included in this study was all RCTs, the quality of evidence level started as high and was downgraded according to five factors: risk of bias, inconsistency, indirectness, imprecision, and publication bias, and the evidence was classified into four levels (high, medium, low, and very low).
3
Results
3.1
Literature search results
The literature screening process is shown in Fig. 1 . After an initial screening of 180 documents by searching various databases, 128 documents remained after removing duplicates. By reading the abstracts and titles, 30 literatures were excluded, and ultimately the remaining 20 needed to be read in full to assess for inclusion. Among them, 6 literatures had experimental designs that did not meet the criteria or the articles were not completed, 2 literatures had duplicate patients, 1 was a non-RCT trial, and 11 ,,,,,,,,,, randomised controlled trial studies that met the inclusion criteria were eligible for data extraction and quantitative analysis ( Fig. 1 ).
Flow chart of literature retrieval.
3.2
Basic characteristics of included studies
A total of 11 studies were included, which were published between 2010 and 2023. In total, the studies involved 395 patients with plantar fasciitis. The age range was from 20 to 55 years, the intervention period was from 1 to 5 weeks, and the assessment time was from 1 to 5 weeks. The athletic taping intervention group consisted of patients who had athletic taping added to the control intervention; the control group consisted of patients who had physical assistance only or physical assistance added to the conventional treatment. Seven studies used “I” and “claw” type patches, three studies used “Y” type patches, one of which used “X” type patches, one study utilized support and decompression tape type patches, and one study used other types of patches.(Commonly used KT taping shapes are shown in Fig. 2 ) The outcome indexes were VAS score, AOFAS score, plantar fascia thickness, BBS score (Berg Balance Scale item 7 of the posterior standing balance motor ability score), and FFI index (FPS pain score, FDS function score, and ALS activity limitation score) ( Table 1 ).
Commonly used Kinesio taping shapes.
Table 1
The basic information of the included literatures.
| Author | Sex： M/F | Age： (M±SD)/year | Intervention period | Assessment period | AT Intervention Group | Control group | Outcomes |
|---|---|---|---|---|---|---|---|
| Zhao et al. |
T:10/12
C:10/13 |
T;52.5 ± 6.1
C:52.3 ± 4.6 |
4 weeks | Baseline, 4 weeks | KT(“I-shape” tape+“palm shape” tape)+ESWT+stretching exercise | ESWT+stretching exercise | ①②③ |
| Yeliz et al. |
T:15
C:15 |
T:50.1 ± 6.7
C:53.6 ± 11.3 |
5weeks | Baseline, 5weeks | KT(6 PATCHES)+ESWT | ESWT | ①⑤⑥⑦ |
| Kim et al. |
T:11/12
C:11/12 |
T:42.3 ± 11.62
C:42.1 ± 10.00 |
4 weeks | Baseline, 4 weeks | KT(“I-shape” tape+“palm shape” tape)+Ultrasound therapy+ESWT | electric hot pack +Ultrasound therapy+ESWT | ①⑤⑥⑦ |
| Rahane et al. |
T:20
C:20 |
T:21.8 ± 2.11
C:21.8 ± 2.11 |
2 weeks | Baseline, 2 weeks | KT+Ultrasound therapy+water bath+stretching exercise+Metatarsophalangeal Joint Strengthening Exercise | Ultrasound therapy+waterbath+stretching-exercise+Metatarsophalangeal Joint Strengthening Exercise | ①⑤⑥ |
| Pinrattana et al. |
T:10
C:10 |
T:24.6 ± 5.42
C:22.0 ± 1.25 |
1weeks | Baseline, 1weeks | KT（“I-shape”tape+ “palm shape”tape+Y-shape tape)+stretching exercise | stretching exercise | ① |
| Tsai et al. |
T:10
C:10 |
T:52.67 ± 28.75
C:30.50 ± 13.14 |
1 weeks | Baseline, 1weeks | KT（“Y-shape“tape+ “palm shape” tape)+ultrasound therapy+low-frequency electrotherapy | ultrasound therapy +low-frequency electrotherapy | ③ |
| Jin et al. |
T:18/10
C:17/11 |
T:51.43 ± 7.54
C:50.52 ± 6.91 |
4 weeks | Baseline, 1 week, 4 weeks, 12 weeks | KT（‘’X-shape”tape+ “palm shape” tape+ “I-shape”tape)+ESWT | ESWT | ①② |
| Zhang et al. |
T:9/11
C:11/10 |
T:47.44 ± 5.08
C:46.29 ± 4.60 |
4 weeks | Baseline, 2 weeks, 4 weeks | KT（“I-shape”tape+ “palm shape” tape)+ESWT+stretching exercise | ESWT+stretching exercise | ①②③ |
| Ke et al. |
T:12/20
C:7/28 |
T:52.4 ± 12.06
C:54.8 ± 12.40 |
5 weeks | Baseline, 3 weeks, 5 weeks | Athletic taping（“palm shape” tape+ “I-shape”tape）+ESWT | ESWT | ①② |
| Liao et al. |
T:8/13
C:10/11 |
T:40.29 ± 10.92
C:39.52 ± 9.63 |
2weeks | Baseline, 1 week, 2 weeks | KT（“palm shape”tape+ “I-shape” tape+ “Y-shape”tape）+ESWT+stretching exercise | ESWT+stretching exercise | ①②③ |
| Wu |
T:17/25
C:18/24 |
T:47.91 ± 7.1
C:49.52 ± 5.9 |
4 weeks | Baseline, 4 weeks, 16 weeks | KT（Support and decompression belts）+MET | MET | ①④ |
Note: ① VAS score:visual analogue scale ② AOFAS score:American Orthopedic Foot Ankle Society ③ PFT:plantar fascia thickness ④ BBS score:Berg Balance Scale ⑤ FFI-FPS pain score:Foot Function Index-Foot Pain subscale ⑥ FFI-FDS functional score:Foot Function Index- Foot Disability subscale⑦ FFI-ALS activity limitation score:Foot Function Index-Activity Limitation subscale. T = test group,C=control group;M=male,F=female;ESWT:extracorporeal shock wave therapy;AT:Athletic taping;KT:Kinesio taping;MET:muscle energy technique.
3.3
Risk of bias within studies
Of the Eleven included studies, five used computer randomization, one used simple randomization, one used random number tables, two used procedurally generated random numbers for random sampling, and two referred only to randomization, all of which were assessed to be low-risk in terms of their ‘randomization method’. Eleven studies performed allocation concealment. Nine studies used blinding of implementers and participants, two studies did not mention the evaluation of binding of implementers and participants, and the remaining study did not mention blinding of implementers and participants and evaluated the risk as unclear. Seven of the studies used blinding of outcome assessors, and the remaining four studies did not mention blinding of outcome assessors and assessed the risk as unclear. Eleven studies had complete outcome data and were evaluated as low risk with respect to incomplete outcome data. Seven studies made selective reporting’, while the remaining four did not make any reference to selective reporting and rated the risk as unclear. Two studies were evaluated as having a low risk of other biases’, and the remaining seven studies did not mention other biases and were evaluated as having an unclear risk ( Fig 3 and 4 ).
Risk of bias bar chart.
Risk of bias map of included literature.
3.4
Meta-analysis results
After reading this 11 literature, we extracted the data related to this paper for comparison, which were the outcome pain (VAS score), AOFAS ankle-hindfoot score, plantar fascia thickness, Berg Balance Scale (BBS), and plantar function condition (FDS score vs. ALS score) data. Meta-analysis was performed, and the VAS score, AOFAS ankle-hindfoot score, and plantar fascia thickness were analyzed in subgroups to reveal the reasons for the heterogeneity of the results of different outcome indicators.
3.4.1
VAS score
Ten RCTs were conducted on VAS pain scores ,,,,,,,,, , and the heterogeneity test showed a large heterogeneity (I 2 =72 %,P < 0.0001) ( Fig. 5 ), and a random-effects model was chosen. The results showed that the difference in VAS pain scores between the two groups was significant [MD=-0.79, 95 % CI (-1.10, −0.48), P < 0.00001], suggesting that KT improves VAS scores in patients with FB.
Forest map comparing posttreatment VAS Scores between the two groups.
Subgroup analyses showed no statistically significant differences at 1 week [MD=-0.39, 95 % CI (-1.49, 0.70), P = 0.48] and 2 weeks [MD=-1.13, 95 % CI (-2.39, 0.13), P = 0.08] of intervention, and no statistically significant differences at 4 weeks [MD=-0.70, 95 % CI (-0.89, −0.51), P < 0.00001] and 5 weeks [MD=-0.77, 95 % CI (-1.25, −0.30), P = 0.001] the VAS pain scores of the intervention group were significantly lower than those of the control group. After excluding the literature in the second week subgroup ( Fig. 6 ), I 2 = 28 %, suggesting that heterogeneity may have originated from the literature in the second week. However, the difference between the comparisons of the intervention times was small (P = 0.84), which does not allow us to suggest that the different intervention times were the source of the heterogeneity affecting the VAS scores.
Forest plot comparing VAS scores of the intervention and control groups after excluding the second week for subgroup analysis.
Meta-regression analyses showed no significant effect of intervention time on VAS scores (β=0.0112, p = 0.9969), the model did not account for heterogeneity (I 2 =0 %), and the test for residual heterogeneity was not statistically significant (p = 1.000). The results suggest that time was not a VAS moderating variable, and that neither intercept nor time was a significant predictor (p > 0.05), which may be related to insufficient sample size or high inter-study heterogeneity (see Supplementary file 1 ).
A total of three RCTs followed up the VAS scores of patients with PF after treatment ,, , I 2 = 5 %, with good homogeneity between outcomes, and a fixed-effects model was chosen. The results showed that the difference in VAS scores after follow-up between the two groups was significant [MD =-1.03, 95 % CI (-1.21, −0.85), P < 0.00001], suggesting that KT has good persistence in improving VAS pain scores in FB patients ( Fig. 7 ).
Forest map comparing VAS scores after follow-up between the two groups.
3.4.2
AOFAS functional score
Four RCTs were conducted on AOFAS functional scores ,,, with I 2 = 0 % and good homogeneity between outcomes, and a fixed-effects model was chosen. The results showed that the difference in AOFAS function scores between the two groups was significant [MD= 6.58, 95 % CI (5.03, 8.13), P < 0.00001], suggesting that KT improves AOFAS scores in FB patients.
Subgroup analyses showed that at 1 week [MD= 6.33, 95 % CI (3.65, 9.02), P < 0.00001], 2 weeks [MD= 7.11, 95 % CI (4.24, 9.99), P < 0.00001], and 4 weeks [MD= 6.39, 95 % CI (3.86, 8.92), P < 0.00001] of intervention, the intervention group’s AOFAS function scores were significantly higher than those of the control group ( Fig. 8 ). However, the difference between the comparisons of the intervention times was small (P = 0.91), which does not allow us to suggest that the different intervention times were the source of the heterogeneity of the AOFAS function scores.
Forest map comparing posttreatment AOFAS scores between the two groups.
3.4.3
Plantar fascia thickness
A total of four RCTs analyzed plantar fascia thickness ,,, , with I 2 = 0 % and good homogeneity between outcomes, and a fixed effects model was chosen. The results showed that the difference in plantar fascia thickness between the two groups was significant [MD=-0.33, 95 % CI (-0.56, −0.10), P = 0.005], suggesting that KT improves plantar fascia thickness in patients with FB.
In particular, plantar fascia thickness was significantly lower than that of the control group at 4 weeks of intervention [MD=-0.37, 95 % CI (-0.69, −0.05), P = 0.02], whereas there was no statistically significant difference between the two groups at 1 week of intervention [MD=-0.14, 95 % CI (-0.85, −0.58), P = 0.71] and at 2 weeks [MD=-0.32, 95 % CI (-0.69, −0.05), P = 0.09] there was no statistically significant difference in plantar fascia thickness between the two groups ( Fig. 9 ). However, the difference between the comparisons of the intervention times was small (P = 0.84), which does not allow us to suggest that the different intervention times were the source of the heterogeneity of the plantar fascia thickness.
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