Approach Considerations
Before embarking on ankle taping, it is important to know how to tear the tape properly. This can be difficult and frustrating at first, but with practice, tearing tape becomes quite simple. Hold the tape between the thumb and index finger of each hand, with little to no gap between the thumbs. Quickly pull the hands in opposite directions to complete the tear.
Avoid tape wrinkles, which can lead to blisters and discomfort. First, smooth the tape while it is being applied; it cannot be smoothed afterward. Second, learn to use the angles naturally supplied by the body part (see the image below). Forcing the tape in a direction it does not want to go only serves to increase wrinkles and makes the taping less effective.
Ankle taping and bracing. Anchor strips. Note the placement of tape along natural angles of the calf to avoid wrinkles.
In general, tape strips should overlie each other by about one half the width of the tape. Each area should be covered by two layers of tape. Uncovered areas within the taped ankle lead to blisters. In addition, do not use excessive force when applying tape. Constriction of blood flow is possible when tape is applied too tightly.
There are several variations on a standard tape application for the ankle. One of the more commonly used techniques taught to undergraduate athletic trainers is discussed below.
Application of Tape to Ankle
Anchor strips
Place two or three anchor strips approximately one third of the way up the lower leg below the bellies of the distal aspect of the gastrocnemius. This is the proximal tape anchor. Place a distal anchor around the midfoot. These anchors may be partially taped directly to the skin to provide increased adherence (see the image below).
Ankle taping and bracing. Anchor strips. Note the placement of tape along natural angles of the calf to avoid wrinkles.
First stirrup
Now, apply the first stirrup (see the image below). Start this strip at the medial side of the upper anchors, go down over the medial malleolus, cross under the foot, come up over the lateral malleolus, and end on the lateral side of the anchors. The theory behind this process is to tape the foot more in eversion than inversion so that one does not predispose an athlete to injury.
Ankle taping and bracing. First stirrup. Note the medial-to-lateral direction of placement.
Horseshoe
Next, apply a horseshoe by taping from the inside of the midfoot anchor, back across the Achilles tendon, and ending on the outside of the anchor (see the image below).
Repeat the stirrup and horseshoe two more times each, moving the position of each by one half the width of the tape; this should produce a basket-weave appearance. The first stirrup covers the posterior half of the malleoli, the second covers the middle of the malleoli, and the third covers the anterior half.
Closure strips
Place five or six closure strips. Start at the malleoli and work up. An additional one or two strips may be needed to enclose the midfoot. After this step, no areas within the body of the tape job should be uncovered except for the posterior portion of the heel, which is not to be taped.
Figure-eight
The so-called figure-eight strapping is started at the dorsum of the ankle. Imagine the numeral 8 bent about 60º in the middle (see the image below). Go medially around the bottom of the foot and back up to the dorsum. Proceed around the back of the leg and finish at the starting point.
Heel lock
Heel lock application techniques are varied. The following is an example of a commonly accepted approach.
Lateral heel lock taping is started with the tape anterior to the lateral malleolus. Go medially across the dorsum of the foot, aiming for the longitudinal arch. Proceed across the plantar aspect of the foot to just posterior to the base of the fifth metatarsal. Now, go upward and posteriorly on the lateral side of the calcaneus, across the Achilles tendon and its insertion on the calcaneus. Go around to the medial side of the ankle, partially overlapping the malleolus. Finish on the anterior aspect of the ankle, and tear the tape (see the images below).
Medial heel lock taping is the most difficult part of the procedure and often takes practice to master. Start anterior to the medial malleolus. Go downward on the lateral side to where the other strip is coming up to go posteriorly around the calcaneus. Proceed straight across the plantar aspect of the foot to the longitudinal arch. Go upward and posteriorly on the medial side of the calcaneus, across the Achilles tendon and its insertion on the calcaneus. Next, go around the lateral side of the ankle, partially covering the malleolus. Finish on the anterior aspect of the ankle, and tear the tape.
Repeat both lateral and medial heel lock taping one more time each.
Final closure strips
Apply final circular closure strips around the foot and lower leg as needed to tidy up the tape job and to ensure that no open spaces or weak spots are present (see the image below).
Technical Variations
The standard tape job described has many variations. To discuss them all would go beyond the scope of this article; therefore, only a few of the simpler changes are mentioned.
Power tape
Many athletic trainers have begun to use a tape known as power tape in their ankle applications. Power tape has a higher tensile strength and is more water-resistant than traditional white tape. It would be used in place of the white tape for the standard ankle taping as described above. It has the disadvantage of being harder to tear and more prone to wrinkling.
Elastic tape
Elastic tape may be used for the heel locks, or it may be used to reinforce the normal heel locks. Athletes often report that this tape is more comfortable or gives them a sense of greater stability.
Moleskin strips
Another variation uses 1.5-in. (3.8-cm) moleskin strips for stirrups and is referred to as power-strapping. This is often used on previously injured ankles.
Outside taping
Another taping variation that should be mentioned is that of ankle "spatting," in which tape is placed on the outside of the sock and shoe. Although this may provide minimal external support, it does not have the same efficacy as regular ankle taping or bracing and therefore is not recommended for use by itself.
Flex tape
Yet another variation in ankle taping is to replace prewrap with "flex" tape. Flex tape is more durable than prewrap and resembles elastic tape, but it is adherent only to itself and not to skin. In some training rooms, this type of tape is being incorporated more and more into the ankle application itself, with less use of white athletic tape.
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Ankle taping and bracing. Correct position: Note the foot at 90º with athlete seated comfortably.
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Ankle taping and bracing. Lateral view of correct position. In this picture, heel and lace pads are already in place.
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Ankle taping and bracing. Anchor strips. Note the placement of tape along natural angles of the calf to avoid wrinkles.
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Ankle taping and bracing. First stirrup. Note the medial-to-lateral direction of placement.
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Ankle taping and bracing. First horseshoe.
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Ankle taping and bracing. Figure of 8.
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Ankle taping and bracing. First step of lateral heel lock.
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Ankle taping and bracing. Second step of lateral heel lock.
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Ankle taping and bracing. Final step of lateral heel lock.
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Ankle taping and bracing. Completed tape job.
