RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES KARNATAKA, BANGALORE

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. NAME AND ADDRESS OF THE : DEEPTI. G. SHASTRY CANDIDATE Department of Physiotherapy M.S.Ramaiah Medical College, M.S.R.I.T Post Bangalore - 560054

2. NAME OF THE INSTITUTION : Department of Physiotherapy M.S.Ramaiah Medical College M.S.R.I.T Post, Bangalore - 54

3. COURSE OF THE STUDY AND SUBJECT : Masters in Physiotherapy (Musculoskeletal Disorders and Sports)

4. DATE OF ADMISSION TO COURSE : 15TH May, 2009

5. TITLE OF THE TOPIC : “Immediate effect of Augmented Low-Dye taping on dynamic balance in subjects with hyperpronated feet”

6. BRIEF RESUME OF THE INTENDED WORK

6.1 Need For The Study :

The ankle and foot complex is the distal most segment on which the whole body is supported. It has a variety of functions to carry out particularly in weight bearing hence most of the activities requiring postural stability during static and dynamic activities are dependent on the ankle and foot 1.

The two commonly seen foot types are the supinated foot and the pronated foot. A normal supination involves calcaneal inversion, talar abduction, talar dorsiflexion and tibiofibular lateral rotation2. When the foot is excessively supinated, the medial longitudinal arch is abnormally high and the foot does not adequately adapt to the ground surface. This increases the demand on the musculoskeletal structures of the foot to maintain stability3.

A normal pronation involves calcaneal eversion, talar adduction, talar plantarflexion and tibiofibular medial rotation2. In hyperpronation, an excessive amount of these motions occur. There is flattening of the medial longitudinal arch causing hypermobility of the midfoot. This changes the foot alignment thereby increasing the soft tissue stress and demand on the postural control also increases. This biomechanically abnormal foot posture affects the normal transitions of the subtalar joint required during dynamic activities1,4,5. The foot therefore loses the ability to maintain a rigid support in full weight bearing and the shock absorption ability is also affected5.

Since most activities an individual participates are dynamic as opposed to static6, dynamic balance is very essential. Subjects with hyperpronated feet have a reduced dynamic reach in a few directions due to the medial deviation of foot and increased foot mobility1. Various interventions have been used to reduce excessive pronation among which the Augmented Low-Dye taping is the most commonly used. Taping has also been used in many other inflammatory conditions like plantar fasciitis, to improve joint proprioception and also in the prevention of ankle sprains7,8. When applied in hyperpronated feet, the low-dye taping creates an external supinating force, helps to raise the medial longitudinal arch, increases the vertical navicular height and reduces the medial contact area in both static and dynamic activities9,10. As dynamic balance is affected in subjects with foot hyperpronation, there exists a need to assess the effect of taping on dynamic balance in those subjects.

Therefore this study aims to use Augmented Low-Dye taping technique to assess its immediate effect on dynamic balance in subjects with hyperpronated feet.

Null Hypothesis :

Augmented Low-Dye taping does not have an effect on dynamic balance in subjects with hyperpronated feet.

Alternate hypothesis :

Augmented Low-Dye taping has an effect on dynamic balance in subjects with hyperpronated feet.

6.2 Review of Literature :

Foot deformities can be symptomatic as well as asymptomatic and both pronated and supinated foot type individuals face certain difficulties in maintaining balance. Karen P. Cote at al., studied the effects of pronated and supinated foot postures on static and dynamic postural stability using the Star Excursion Balance Test and found that there was a significant change in the reach by direction and foot type. The reach distance in pronated foot type subjects was reduced in lateral and posterolateral directions compared to neutral and supinated foot type subjects1. Pronation of foot in runners was found to be a predisposing factor for injuries according to a study done by Hintermann et al.They concluded that though some amount of foot pronation is physiological, excessive pronation is harmful and causes an overloading stress on the foot and knee and may predispose for related injuries of the lower extremity4.

Researchers have hypothesized that correcting the excessive foot pronation by taping improves the foot posture and reduces the related problems associated with hyper pronation of the foot. The most commonly used method is the Low-Dye taping. Bill Vicenzino et al., conducted a study on asymptomatic individuals with hyperpronated feet to investigate if Low-dye taping changes foot posture. They found that there was a significant increase in the Arch Height Ratio following the application of tape and a significant decrease in the contact area occurred in the medial rearfoot during both running and walking tasks10.

Another study conducted by Bill Vicenzino et al investigated the antipronation effect of Low-Dye (L.D) taping and Low-Dye taping with calcaneal slings and reverse sixes (LDCR) on vertical navicular height, after application and 20 minutes of exercise. Asymptomatic subjects with increased pronation of the foot were taken for the study. It was found that LDCR provided a better control of pronation after application and after a period of exercise compared to LD11.

The review of literature suggests that subjects with foot hyperpronation and structural deficits face problem in maintaining postural stability which inturn hampers their functional activities involving dynamic balance. Though the Augmented Low-Dye taping technique has been used as an intervention in subjects with foot hyperpronation, its effect on dynamic balance is not well established. Hence this study is conducted to check the effect of Augmented Low-Dye taping on dynamic balance in subjects with hyperpronated feet. 6.3Objectives of the study :

1. To assess the dynamic balance using the Star Excursion Balance Test in subjects with hyperpronated feet. 2. To assess the dynamic balance immediately after the application of Augmented Low-Dye taping in subjects with hyperpronated feet. 3. To compare the dynamic balance before and immediately after the application of Augmented Low-Dye taping in subjects with hyperpronated feet.

7. MATERIALS AND METHODS :

7.1 Source of collection of data :

Asymptomatic subjects from M.S. Ramaiah Medical Teaching Hospital will be taken up for the study.

7.2 Methods of collection of data :

Sampling procedure: Convenience sampling

Type of study: Interventional study

Sample size : 36

Inclusion criteria:

1.Asymptomatic subjects with hyperpronated feet , having a navicular drop difference of 10 mm or more. 2.Age group : 18 to 40 years.

Exclusion criteria:

1.History of any lower extremity injury within the past 1 year. 2.Any neurological deficits. 3.Pre-existing musculo-skeletal pathology of the lower extremity. 4.Allergy to tape. 5.Limb length discrepancy.

Procedure of data collection:

Subjects of either gender satisfying the inclusion criteria will be taken for the study. An informed consent will be taken before the procedure. Each subject’s height, weight and demographic data will be collected. Subjects will be alternately recruited into test group and control group. The navicular drop will be measured using the Brody’s method. Dynamic balance will be assessed using the Star Excursion Balance Test (SEBT).The subject’s dominant foot will be considered for the procedure. Verbal and visual demonstration of test will be provided to each subject. The Subjects will be asked to perform the test and dynamic balance will be measured based on the maximum reach distance as recorded by the SEBT. Augmented Low-dye taping will then be administered to the test group which maintains the foot in adduction and supination10. Dynamic balance will be measured immediately after the tape application. An average of three readings will be taken. The control group will receive neutral taping and the dynamic balance will be remeasured.

Outcome measure:

Star Excursion Balance Test (SEBT)

Materials required:

1. Millimeter scale 2. Inch Tape 3. Protractor 4. Rigid non elastic tape 5. Marker pen 6. Weighing machine Statistical analysis:

Paired t - test.

7.3 Does the study require any investigation or intervention to be conducted on patients or other human or animals? Yes.

7.4 Has ethical clearance been obtained from the institution?

Yes (A copy of it has been enclosed)

8.LIST OF REFERENCES:

1. Karen P.Cote, Michael E.Brunet, Bruce M.Gansneder, Sandra J.Schultz. Effects of pronated and supinated foot postures on static and dynamic postural stability. Journal of Athl. Training 2005; 40(1): 41-46 2. Cynthia Norkin, Pamela K. Levangi. Joint structure and function. A comprehensive analysis 3. Franco A.H. Pes cavus and Pes planus: Analyses and Treatment. Phys. Ther. 1987; 67: 688-694 4. Hintermann B, Nigg B.M : Pronation in runners: Implications for injuries. Sports Medicine; vol 26, no. 3, 1998: 169-176(8) 5. Tiberio D. Pathomechanics of structural foot deformities. Phys. Ther. 1988; 68: 1840-1849 6. Bernier J.N, Perrin D.H. Effect of coordination training on proprioception of the functionally unstable ankle. JOSPT 1998, 27: 264-275 7. S.Spanos; M.Brunswic; E.Billis. The effect of taping on the proprioception of the ankle in a non weight bearing position amongst injured athletes. Foot. Vol 18, No. 1, March 2008 [page 25-33] 8. P.Firer. Effectiveness of taping for the prevention of ankle ligament sprains. British journal of Sports Medicine, vol.24, No.1 9. Del Rossi G, Fiol Kowski P, Morodyski M.B, Bishop M, Trimble M. For how long do temporary techniques maintain the height of the longitudinal arch? Phys. Ther. Sport 2004; 5:84-89 10.Bill Vicenzino, Thomas G.McPoil, Trevor Russell, Sara Piesker. Antipronation tape changes foot posture but not plantar ground contact during gait. The Foot. 16(2006) : 91-97 11.B.Vicenzino, J.Fielding, R.Howard. R.Moore, S.Smith. An investigation of the antipronation effect of two taping methods after application and exercise. Gait & Posture. 5(1997): 1-5

9. SIGNATURE OF THE CANDIDATE :

10. REMARKS OF THE GUIDE :

11.NAME AND DESIGNATION OF :

11.1.GUIDE: MRS. VEENA KIRAN NAMBIAR ASSOCIATE PROFESSOR DEPARTMENT OF PHYSIOTHERAPY M.S.RAMAIAH MEDICAL COLLEGE

11.2.SIGNATURE : 11.3.CO-GUIDE: MRS. SONI. S ASSOCIATE PROFESSOR DEPARTMENT OF PHYSIOTHERAPY M.S. RAMAIAH MEDICAL COLLEGE

11.4.SIGNATURE:

11.5.HEAD OF THE DEPARTMENT: PROF. SAVITA RAVINDRA PROFESSOR AND HOD DEPARTMENT OF PHYSIOTHERAPY M.S.RAMAIAH MEDICAL COLLEGE

11.6. SIGNATURE:

12. 12.1. REMARKS OF THE CHAIRMAN AND PRINCIPAL:

12.2. SIGNATURE: ANNEXURE – I

INFORMED CONSENT

I have been informed by Ms Deepti.G.Shastry that a project has been undertaken to assess “The Effect of Augmented Low-Dye taping on dynamic balance in subjects with hyperpronated feet.” I understand that this study is purely for academic problem solving purpose. I have been explained the whole procedure and I hereby give my approval to be included in the study.

NAME: DATE:

SIGNATURE: ANNEXURE- II

EVALUATION FORM

DEMOGRAPHIC DATA:

Name: Age: Gender: Occupation: Address:

EXAMINATION:

Navicular Drop difference: Ankle Range Of Motion: Limb Length: Height: Weight: