Ankle Strapping: Purpose, Step-by-Step Guide, and Considerations

How do you strap an ankle joint?

Strapping an ankle joint involves applying athletic tape in a specific pattern to provide external support, limit excessive motion, and enhance proprioception, commonly used for injury prevention, recovery from sprains, or managing chronic instability.

Understanding Ankle Strapping: Purpose and Benefits

Ankle strapping, often referred to as "taping," is a common technique utilized in sports medicine, rehabilitation, and general fitness. Its primary aims are biomechanical support and neuromuscular facilitation.

• Support and Stability: The rigid application of tape acts as an external ligament, providing mechanical support to the ankle joint. This helps to restrict movements that could lead to injury (e.g., excessive inversion or eversion) or protect healing tissues from further strain.
• Injury Prevention: For athletes participating in high-risk sports (e.g., basketball, soccer, trail running), prophylactic taping can reduce the incidence and severity of ankle sprains, particularly for individuals with a history of instability.
• Pain Management: By limiting painful ranges of motion and providing compression, strapping can help manage pain associated with acute or chronic ankle injuries, allowing for more comfortable movement during recovery or activity.
• Proprioceptive Enhancement: The tape provides constant sensory input to the skin and underlying tissues. This increased afferent feedback helps to improve the body's awareness of the ankle's position in space (proprioception), potentially leading to quicker muscle activation and better dynamic stability.

Anatomy of the Ankle Joint: A Brief Overview

A basic understanding of ankle anatomy is crucial for effective and safe strapping. The ankle is a complex hinge joint primarily formed by three bones, supported by numerous ligaments and tendons.

• Bones:
  • Tibia (shin bone): The larger, weight-bearing bone of the lower leg.
  • Fibula: The smaller bone of the lower leg, forming the lateral malleolus (outer ankle bone).
  • Talus: The bone that articulates with the tibia and fibula, forming the main ankle joint.
• Ligaments: These strong, fibrous bands connect bones to bones, providing stability. Key ligaments involved in ankle sprains and targeted by strapping include:
  • Lateral Ligaments: Anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), posterior talofibular ligament (PTFL) – most commonly injured in inversion sprains.
  • Medial Ligament (Deltoid Ligament): A strong, fan-shaped ligament on the inner side of the ankle, less commonly injured.
• Tendons: These connect muscles to bones, facilitating movement. While not directly supported by tape in the same way as ligaments, they are important to consider to avoid compression.

When to Strap an Ankle

Ankle strapping is indicated in several scenarios, primarily related to injury management and prevention.

• Acute Ankle Sprains (after initial RICE protocol): Once swelling has subsided and a fracture has been ruled out, strapping can provide support during the early stages of rehabilitation, protecting the healing ligaments.
• Chronic Ankle Instability: Individuals who frequently "roll" their ankles or feel their ankle "giving way" can benefit from strapping during activity to enhance stability and confidence.
• Return to Sport/Activity: Following an ankle injury, strapping can offer an important layer of protection as an individual gradually returns to higher-impact or agility-based activities.
• Preventative Measures: Athletes in sports requiring frequent changes of direction, jumping, or landing may choose to tape their ankles prophylactically, especially if they have a history of ankle injuries.

When NOT to Strap an Ankle (Contraindications)

While beneficial, ankle strapping is not always appropriate and can even be harmful in certain situations.

• Suspected Fracture or Dislocation: Never tape an ankle if a fracture or dislocation is suspected. Immediate medical evaluation is necessary.
• Severe Swelling or Open Wounds: Taping over significant swelling can restrict circulation. Taping over open wounds or blisters can lead to infection or further skin damage.
• Circulatory Impairment or Nerve Damage: Individuals with pre-existing conditions affecting circulation (e.g., peripheral artery disease) or nerve function should avoid strapping, as it can exacerbate these issues.
• Unknown Diagnosis: If the cause of ankle pain or instability is undiagnosed, do not tape. A medical professional should assess the injury first.

Materials Needed for Ankle Strapping

Proper materials are essential for effective and comfortable strapping.

• Adhesive Athletic Tape: Typically 1.5 inches (3.8 cm) wide, non-elastic, and strong. Ensure it is medical-grade.
• Pre-Wrap/Underwrap: A thin, foam-like material applied directly to the skin to protect it from irritation and make tape removal easier.
• Adhesive Spray (Optional): Can be applied to the skin before pre-wrap to improve tape adhesion, especially for sweaty individuals.
• Scissors: For cutting tape, though most athletic tapes can be torn by hand with practice.

Step-by-Step Guide: The Basketweave Ankle Strapping Technique

The basketweave (or stirrup and horseshoe) technique is a common and effective method for providing lateral and medial ankle support. This guide assumes you are taping the right ankle.

1. Preparation:

   • Ensure the skin is clean, dry, and free of lotions or oils. Shave any excessive hair to prevent pain during removal and improve adhesion.
   • Apply pre-wrap smoothly from just above the malleoli (ankle bones) up to the lower calf, overlapping by about half its width. Avoid wrinkles, as these can cause blistering.
   • (Optional) Apply adhesive spray to the skin before pre-wrap.

2. Anchors:

   • Apply two anchor strips of tape around the lower calf, just above the pre-wrap. These strips are not meant to be tight but provide a secure base for subsequent strips. Overlap slightly.

3. Stirrups (Vertical Strips): These strips provide medial-lateral stability.

   • First Stirrup: Start on the medial (inner) side of the anchor strip, run the tape down the inner calf, under the heel, and up the lateral (outer) side of the ankle to the anchor strip. Apply tension as you pull up to slightly evert (turn out) the foot, counteracting inversion.
   • Second Stirrup: Begin approximately mid-way between the first stirrup and the front of the ankle on the anchor. Run down, under the heel, and up to the anchor.
   • Third Stirrup: Begin closer to the back of the ankle on the anchor. Run down, under the heel, and up to the anchor.
   • Note: Each stirrup should overlap the previous one by about half its width, creating a strong "U" shape under the heel.

4. Horseshoes (Horizontal Strips): These strips provide anterior-posterior stability and secure the stirrups.

   • First Horseshoe: Start on the medial side of the ankle, run the tape around the back of the heel (just below the malleoli), and finish on the lateral side. This strip should cover the ends of the stirrups. Apply moderate tension.
   • Second Horseshoe: Overlap the first horseshoe by about half its width, slightly higher up the ankle.
   • Third Horseshoe: Overlap the second horseshoe, again slightly higher.
   • Note: Alternate applying stirrups and horseshoes (e.g., Stirrup 1, Horseshoe 1, Stirrup 2, Horseshoe 2, etc.) for optimal basketweave effect, ensuring each new strip covers roughly half of the previous one. Aim for 3-4 pairs of stirrups and horseshoes.

5. Figure-of-Eight: This technique locks in the support and adds further stability.

   • Start on the dorsal (top) aspect of the foot (medial side).
   • Run the tape across the top of the foot, under the arch, and around the lateral side of the foot.
   • Bring the tape across the top of the foot again, then angle it up and around the back of the ankle (above the malleoli).
   • Cross the tape over the front of the ankle and return it to the starting point on the dorsal aspect of the foot.
   • Repeat 1-2 times, overlapping.

6. Closure Strips:

   • Apply additional anchor strips around the lower calf to secure all the vertical strips.
   • Apply horizontal strips around the foot, just behind the toes, and around the mid-foot to secure the figure-of-eight and prevent the tape from peeling. Ensure these are not too tight to avoid restricting circulation to the toes.

7. Final Checks:

   • Gently palpate the taped ankle to ensure there are no wrinkles or areas of excessive pressure.
   • Check for comfort and range of motion. The tape should restrict excessive movement but not completely immobilize the ankle.
   • Assess circulation: Check capillary refill in the toes (press a nail bed until it blanches, then release; color should return within 2 seconds). Ask the individual if they feel any numbness, tingling, or coldness in their toes. If any of these symptoms occur, immediately remove the tape and re-tape with less tension.

Important Considerations and Tips

• Skin Preparation: Always use pre-wrap. For sensitive skin, consider a skin barrier spray or milk of magnesia to create a protective layer.
• Positioning: The ankle should be in a neutral (90-degree) or slightly dorsiflexed (toes pulled up) position during strapping, never plantarflexed (toes pointed down). This prevents the tape from becoming too tight when the foot is loaded.
• Tension Control: Apply firm, even tension to the tape, especially for the stirrups and figure-of-eights. However, be mindful not to apply excessive tension, particularly around the Achilles tendon or over bony prominences.
• Mobility Check: After taping, have the individual walk around and perform gentle ankle movements to ensure comfort and appropriate restriction.
• Monitoring: Advise the individual to monitor their toes for color changes, numbness, tingling, or increased pain. The tape should be removed immediately if any of these signs appear.
• Removal: Carefully remove the tape using tape scissors or a tape cutter. Cut along the non-bony areas to avoid nicking the skin. Always cut from distal (foot) to proximal (leg) to avoid cutting towards the Achilles tendon.
• Practice: Taping is a skill that improves with practice. Seek guidance from a certified athletic trainer, physical therapist, or other qualified healthcare professional.

Potential Risks and Pitfalls

Improper strapping can lead to various complications.

• Skin Irritation/Blistering: Caused by excessive friction, tape allergies, or wrinkles in the tape/pre-wrap.
• Circulatory Compromise: Applying tape too tightly can restrict blood flow, leading to numbness, tingling, coldness, or even tissue damage.
• Nerve Compression: Specific nerves (e.g., superficial peroneal nerve) can be compressed if tape is applied too tightly over their course, leading to numbness or pain.
• False Sense of Security: Taping provides external support but does not replace the need for proper rehabilitation, strengthening, and neuromuscular control. Over-reliance on tape can lead to neglect of these crucial aspects.

When to Seek Professional Medical Advice

While strapping can be a valuable tool, it is not a substitute for professional medical assessment and treatment. Consult a healthcare professional (e.g., physician, physical therapist, athletic trainer) if:

• Severe Pain or Inability to Bear Weight: These are red flags for potentially more serious injuries like fractures.
• Significant Swelling or Deformity: Suggests a more severe injury.
• Numbness, Tingling, or Coldness: Indicates potential nerve or circulatory compromise.
• Pain Worsens or Persists: If symptoms do not improve or worsen despite strapping and rest.
• Uncertainty of Injury: Always get a professional diagnosis before self-treating with strapping.