Photos by Kinesio Group
The Achilles tendon is the largest tendon in the body and is at risk of tendon rupture due to stress from running, jumping, sudden acceleration, and sudden changes in direction. Overuse, vascular disease, nerve damage and rheumatic diseases can also cause tendon degeneration. In this article, we will introduce elastic therapeutic taping for acute pain and taping for rehabilitation, chronic conditions and prevention.
When repetitive stress occurs in the Achilles tendon, microscopic damage and inflammation often occur in the tendon and peritendinous region, and degeneration of the tendon is often observed. In addition, cases related to tendon degeneration, an age-related change, tend to be more common in middle-aged and older citizens, runners, and walkers.
According to an Achilles tendinopathy and tendon rupture research study by Karen L. Maughan, MD, and Blake Reid Boggess, DO, FAAFP1, 80% of tendon ruptures occur during recreational sports. Overuse is often caused by excessive physical activity, inappropriate exercise, and short rest. It also tends to manifest itself as pain and inflammation when the Achilles tendon is strained in an unfamiliar environment.
The tendon joins the gastrocnemius and soleus muscles in the posterior part of the lower leg to form the Achilles tendon in the middle of the posterior part of the lower leg, which is attached to the calcaneus bone.
It is involved in plantar flexion of the ankle joint when the gastrocnemius and soleus muscles contract.
The superficial layer of the Achilles tendon has an epitendinous membrane called the paratenon, and the Achilles tendon is surrounded by blood flow-rich pateranon. The space between the Achilles tendon and the paratenon contains interstitial fluid that reduces friction. In addition, there is a fatty tissue called the Kager’s fat pad at the back of the Achilles tendon that supplies blood flow to the Achilles tendon.
In Achilles tendinitis, repetitive stress on the Achilles tendon can cause inflammation of the paratenons and fatty tissues, which can lead to thickening and adhesions that cause pain.
Client complains of pain in the Achilles tendon area when jumping or walking/running. The pain is strong at the beginning of walking, lessens with time, and returns when the client continues walking. Pain and tension in the Achilles tendon area when getting up or when standing up from a prolonged sitting position.
Symptoms can include swelling and tenderness in the Achilles tendon area. If the pain is severe, just touching the skin may cause severe pain or tension and difficulty moving the tendon.
Assessment and Taping
Assessment for Achilles tendinitis includes:
• Swelling in the area from the calcaneus to the Achilles tendon, which is painful when pressed. (Especially, the area 2-6 cm from the calcaneus is most common.)
• The pain is most severe before or after exercise or when the client begins to move upon waking up, and as the condition progresses, rest pain may also occur. Pain is also increased by dorsiflexion of the ankle joint. In severe cases, the ankle joint becomes less mobile, and a creaking friction sound may be heard in the Achilles tendon when the ankle joint is moved in cases of periarthritis.
Taping for Achilles tendinitis includes:
• Rehabilitative, chronic and preventive taping applications for Achilles tendon pain: Taping No, 1, 2, 3 ,4 (see photos, this article).
• Acute taping applications for Achilles tendon pain: Taping No, 5, 4, 2 (see photos, this article).
Because the Achilles tendon and plantar fascia are one continuous layer of tissue, it is also effective to treat both at the same time for best results. We base our evaluation of a client’s condition on Hydrokinetic theory and the concepts of space, movement and cooling.
Hydrokinetic Theory explains that there is water (interstitial fluid) throughout the body that reaches all the tissues and organs that make up the body (Space) and that this water flows slowly and smoothly (Movement), activating cells and eliminating friction and heat (Cooling). This normal flow of interstitial fluid in the spaces between the various membranes (such as fascia) or organs is considered the basis of the human body’s function.
The screening assessment is then used to determine which areas of the client need to be in a state of space, movement and cooling so that this environment can be maintained at all times, or as a means of locating areas where this environment is disturbed and depending on the client’s condition. Elastic therapeutic taping is used to create a condition in which the client’s natural healing power can work easily. (Prior to taping application, make sure the skin is clean. The skin should be free of oils, lotions and be dry.)
Directions:
Prior to taping application, make sure the skin is clean. The skin should be free of oils, lotions and be dry.
1. 1 Measure and cut 1 I-Cut from the back of the heel to just below the knee.
a. Place anchor at the back of the heel with no tension.
1.2 Dorsiflex the ankle with the hand or foot.
a. Apply 50% of tension off the backing paper and apply the strip over the Achilles tendon and middle of calf muscle halfway up the calf between heel and knee.
b. Roll off the remaining backing paper and apply tape with no tension.
c. Rub the tape to activate the adhesive.
2.1 Measure and cut 1 Y-Cut from the base of the heel to just below the knee.
a. Place anchor under the heel with no tension.
b. Dorsiflex the ankle with the hand or foot.
2.2 Apply the inside tail by peeling away the backing paper and with 10% tension follow the inside of calf muscle curving around and meeting just under the crease of knee.
2.3 Apply the outside tail by peeling away backing paper and with 10% tension follow the outside of calf muscle curving around and meeting just under the crease of the knee.
a. Rub both tails to activate adhesive.
3. Measure and cut one I-Cut from the inside the shin bone to outside of the leg.
a. Tear backing paper in the center and apply 10-15% tension, placing strip directly over area of pain.
b. Rub tape to activate the adhesive.
Plantar Fascia Taping:
4. Prone with the knee flexed to 90 degrees.
a. Apply the anchor of the tape to the posterior aspect of the heel.
b. Passively extend the toes and dorsiflex the ankle to increase tissue tension.
c. Apply the outside (medial and lateral) tails with full (100%) available tension to cover the plantar fascia.
d. Apply the inside (middle) tails equidistant to the other tails.
5.1 Stretch the inflamed area of the Achilles tendon as much as possible.
a. Apply one end of tape to the inside of the Achilles tendon.
b. Apply the tape with the tail toward the outside of the heel with 5-10% tension so that the center of the tape is over the affected area.
5.2 Use your fingertips or tweezers to gently spread the tape starting with the outside working towards the center of the tape. Be careful not to pull the tape too much.
5.3 Apply one end of tape to the outside of the Achilles tendon.
a. Apply the tape with the tail toward the inside of the heel with 5-10% tension so that the center of the tape is over the affected area.
b. Apply using the same procedure as the first tape application.
5.4 Apply one end of the third tape to the calcaneus.
a. Apply the tail with 0-5% tension toward the along of the Achilles tendon so that the center of the tape is over the affected area.
b. Apply using the same procedure as the first tape application.
Rehabilitative, Chronic, Preventive taping applications for Achilles tendon pain: Taping No, 1,2,3,4
Acute taping applications for Achilles tendon pain: Taping No, 5, 4, 2
About the Author
Takayoshi Kawamoto, is the Education & Research Development Manager of the Kinesio Group. In addition to helping create Kinesio University education, he has been working closely and assisting Kenzo Kase, D.C., for over 10 years to develop and advance Kinesio Taping and Kinesio Medical Taping.
Footnote
1. Maughan K, Boggess B. Achilles tendinopathy and tendon rupture. UpToDate. Waltham, MA: UpToDate Inc. https://www.uptodate.com (Accessed on September 21, 2022)