The Navicular Drop Test provides a quantitative measurement of foot pronation, which is defined as the difference in navicular height between weight-bearing and non-weight–bearing positions.1 Excessive changes in navicular height (ie, ≥ 10 mm)2,3 can be caused by congenital conditions (eg, forefoot varus or pes planus) that predispose individuals for arch pain and other lower limb pathologies such as medial tibial stress syndrome and4,5 anterior cruciate ligament tears.6 Additionally, approximately 1 in 10 people experience pathologies that present with pain on the arch of the foot at some point in their life.7 Although changes in navicular height less than 8 mm are considered within normal limits,8 evidence suggests that changes in navicular height as small as 5 mm may pre-dispose runners to plantar fasciitis.9
Medial longitudinal arch taping techniques (MLATTs) are commonly used to relieve symptoms of plantar fasciitis and other foot pathologies. Athletic tape is applied to the skin to relieve tension on the tissues of the foot by temporarily raising navicular height while weight bearing, thus minimizing the change in navicular height while weight bearing that is correlated with injury.5–7,9 One approach to raising navicular height is to use strips that pull upward directly over-top of the navicular bone, which is used in the low-dye MLATT (Figure 1). Another approach is to pull the forefoot and the hindfoot toward one another to raise the midfoot artificially, creating a higher arch, which is used exclusively in the fan-arch support MLATT (Figure 2). Measurement of navicular height is commonly used as a measure of the effectiveness of MLATTs.10,11 A systematic review exploring the biomechanical, neurophysiological, and psychological hypotheses behind arch taping found significant support for the biomechanical effects of arch taping, specifically an increase in navicular height.12
Low-dye medial longitudinal arch taping technique used in the study.
Fan-arch support medial longitudinal arch taping technique used in the study.
In athletic training, MLATTs are commonly applied prior to an athletic practice or competition to reduce pain and improve joint function during activity. These taping techniques allow the tissues of the foot to acclimate to the imposed demands of the sport or activity and provide additional support.13 Research supporting the use of MLATTs in the athletic training setting is limited because numerous studies do not use an exercise protocol as an intervention variable. Although some studies incorporate exercise protocols, in many cases the intensity of the exercise is too low to reflect the type of dynamic motions that are performed during sports activity. For example, previous studies have used a 10-minute walking protocol11 and a 15-minute walking protocol.14
Two MLATTs are commonly used in athletic training. The low-dye MLATT is the most extensively researched MLATT. When compared to a control group, biomechanical gains are achieved initially but diminish through time15 or after an exercise protocol.11,16 Other studies found that variations of the standard low-dye taping, such as the addition of calcaneal slings and reverse sixes, were successful at maintaining navicular height throughout an exercise protocol.14,17,18
In addition to the low-dye MLATT, the fan-arch support MLATT13 is commonly used in athletic training; however, this technique was not extensively researched because no studies investigating the fan-arch support MLATT were found in available databases. Despite the lack of evidence supporting the use of the fan-arch support MLATT, it is still commonly used in clinical practice. Further research of these two MLATTs is necessary to determine their effectiveness in maintaining navicular height throughout exercise. This information is invaluable for athletic trainers who commonly use these techniques in clinical practice.
Therefore, the purposes of this study are to (1) determine if the low-dye or the fan-arch support MLATT elicits an increase in navicular height, (2) determine if the improvements in navicular height are maintained throughout exercise, and (3) determine which MLATT is more effective at maintaining navicular height after an exercise protocol.
Twenty-five National Collegiate Athletic Association (NCAA) Division III athletes between the ages of 18 and 22 years were recruited for this study. Descriptive statistics for the participants are reported in Table 1. To be eligible for participation participants were required to be registered members of at least one sport's team at the university where data collection occurred. Participants were excluded from the study if they had reported an instance of plantar fasciitis, midfoot sprain, or another arch-related pathology in the previous 3 months. Approval for this study was obtained from the university's institutional review board.
Descriptive Statistics for Participants
The low-dye and fan-arch support MLATTs were used in this study. A single taping protocol was assigned at random and applied to both feet. The order of the taping protocol was randomized to minimize any potential practice effects associated with repeated test administration. Participants returned on a separate occasion 2 to 10 days later to repeat the study with the other taping technique. An adhesive (Colorless Tuf Skin; Cramer Products, Inc., Gardner, KS) was sprayed on the plantar aspect of the foot and around the calcaneal tuberosity before the direct application of athletic tape. The use of Colorless Tuf Skin and omission of pre-wrap was chosen to increase the adherence of the athletic tape to the skin in an attempt to prolong the mechanical advantages attained by the taping techniques.13 The low-dye and fan-arch support MLATTs described by Prentice13 were used for this study. Taping supplies included 1½ inch Johnson & Johnson Coach Athletic Tape, 1-inch Zonas Porous Tape (Johnson & Johnson, Inc., Newark, NJ), and Colorless Tuf Skin. All taping procedures were completed by the primary investigator of this study (TJL). No blinding procedures were used (ie, neither the participants nor the investigator measuring the outcomes were blinded to the condition or tape job being applied).
Navicular height was described as one of the most useful clinical measures of the medial longitudinal arch19 and was assessed using the following protocol. With the participant standing barefoot on a hard-flat surface, a notecard was placed vertically next to the medial aspect of the participant's foot using a wooden block to keep the notecard perpendicular to the floor. A mark was placed on the notecard that corresponded with the height of the most prominent point of the navicular tuberosity identified through palpation. The distance between the base of the notecard and the marking was measured in millimeters and recorded as the navicular height.20 Navicular height was assessed at three time points: (1) prior to tape application (baseline), (2) following tape application (pre-exercise), and (3) immediately following the exercise protocol with the tape still applied (post-exercise) for each tape job (low-dye and fan-arch support MLATT). Because muscle fatigue has been found to have minimal impact on navicular drop,21 a within-subjects design was used. During the baseline assessment, the Navicular Drop Test was used to identify participants with excessive changes in navicular height (≥ 10 mm). Seated navicular height was obtained while the participant was in a non-weight–bearing position (seated on chair) with his or her feet flat on the ground and lower legs perpendicular to the ground. Although data were collected for both the dominant and non-dominant foot, only the dominant foot was included in analyses because of the shared variance between dominant and non-dominant feet of a single participant. Foot dominance was determined as the preferred foot for kicking a football or soccer ball.
This crossover design used an exercise protocol that better imitates the motions used in collegiate athletics than studies in the literature that used only a walking protocol.11,14 Participants completed a 20-minute run-walk exercise protocol alternating running and walking laps on a 200 m indoor track. No significant differences were identified in the number of laps completed during exercise sessions for participants (t24 = 1.287; P = .21; average laps completed: trial 1 = 13.76 ± 1.62; trial 2 = 13.36 ± 1.43). Participants were instructed to complete the running laps at a speed faster than a jog but slower than a full sprint and to complete the walking laps at a brisk but comfortable pace. This protocol was designed to be a standardized physical activity protocol that is similar to the warm-up period a collegiate athlete would complete at the beginning of a practice or competition.
To evaluate the effectiveness of the MLATTs, a 2 × 3 repeated measures analysis of variance (ANOVA) was used to compare navicular heights for each MLATT (low-dye and fan-arch support) across the three time points (baseline, pre-exercise, and post-exercise) on the dominant limb using SPSS Statistics for Windows (version 24.0; IBM Corporation, Armonk, NY). Alpha level was set at 0.05. Significant interaction effects between MLATTs and time points were evaluated using separate one-way within-subjects repeated measures ANOVAs for each MLATT. Follow-up dependent t tests were used to compare differences in navicular height for each time point. To account for multiple comparisons, the Bonferroni procedure was used to control the type I error rate. A familywise alpha of 0.025 (alpha = 0.05/2) and 0.0167 (alpha = 0.05/3) was used for the separate one-way within-subject repeated measures ANOVAs and dependent t tests, respectively. To ensure there were no differences in the amount of exercise performed between the two visits, a dependent samples t test was used.
Descriptive statistics for both tape jobs at each time point are provided in Table 2. A significant interaction effect was identified between tape job and time points (F2,23 = 4.772; P = .018). Separate one-way within-subjects repeated measures ANOVAs were computed for each MLATT. Significant within-subjects effects were found for both the low-dye MLATT (F2,23 = 15.288; P < .001) and the fan-arch support MLATT (F2,23 = 19.426; P < .001). Post-hoc analyses indicated that navicular height increased pre-exercise when compared to baseline for both the low-dye MLATT (t23 = −4.799; P < .001) and the fan-arch support MLATT (t23 = −4.623; P < .001). Compared with pre-exercise navicular height there was a significant decrease in post-exercise navicular height for both the low-dye MLATT (t23 = 3.031; P = .006) and the fan-arch support MLATT (t23 = 5.878; P < .001). Post-exercise navicular height was significantly increased from baseline navicular height for the low-dye MLATT (t23 = −3.019; P = .006) but not for the fan-arch support MLATT (t23 = −0.187; P = .853). No significant differences were identified in the number of laps completed during the 20-minute exercise protocol for either MLATT (t24 = −1.287; P = .211).
Comparison of Navicular Height
Additional follow-up post-hoc analyses indicate that there were no significant differences between either MLATT at baseline (t24 = −0.441; P = 0.663) or pre-exercise (t24 = 1.469; P = .155). However, significant differences were found between each MLATT post-exercise (t24 = 3.817; P = .001). The relationships between the two MLATTs at each of the three time points have been illustrated in Figure 3.
Comparison of navicular height for the low-dye and fan-arch support medial longitudinal arch taping techniques at baseline, pre-exercise, and post-exercise.
In the athletic training setting, MLATTs continue to be a common intervention for arch-related pathologies because they are recommended in the management of pes planus, longitudinal arch strains, and plantar fasciitis.22 In the current study, the low-dye MLATT was superior to the fan-arch support MLATT. Although both taping techniques elicited similar increases in navicular height pre-exercise, only the low-dye MLATT was able to maintain increases through a 20-minute exercise protocol. Navicular height post-exercise was on average 2.32 mm higher than baseline.
The findings in the current study are in contrast to Yoho et al.,15 who found no significant increase in navicular height after 48 hours of daily living activities using the low-dye MLATT. This discrepancy may be due to the longer testing period of the latter study. In addition, the findings of the current study are contrary to another study11 that found no significant difference after a 10-minute walking protocol using the low-dye MLATT. Holmes et al.11 used a subtalar joint neutral position for comparison rather than the relaxed stance that was used in the current study, which could account for the differing results.
One possible explanation for the differences observed in this study is the placement of the individual strips of tape. Both MLATTs feature strips that originate at the forefoot and wrap around the calcaneal tuberosity. These strips pull the proximal and distal parts of the foot together in an attempt to increase the medial longitudinal arch. However, only the low-dye MLATT uses strips that pull upward on the arch directly over the navicular bone. This observation offers a possible explanation for the results observed in the current study. Studies that modify the low-dye MLATT tend to add additional strips that cross directly over the navicular bone and pull upward, like calcaneal slings and reverse sixes.12,18,23,24 One study reduced the heel pain caused by plantar fasciitis with calcaneal taping, which uses a similar strip that pulls upward directly over the navicular bone.25 The type of strip that pulls directly upward on the navicular bone may be the reason why the lowdye MLATT was superior at sustaining navicular height throughout a 20-minute exercise protocol.
Although this study indicated statistically significant differences in navicular height between baseline and post-exercise for the low-dye MLATT, the clinical significance of an approximately 2 mm change may be questionable. Changes of navicular height are considered to be within normal limits if the change is less than 8 mm.8 Although the average change in navicular height was greater from baseline to pre-exercise (4.9 ± 5.1 mm), a reduction in navicular height from pre-exercise to post-exercise was observed for both MLATTs.
Decreased effectiveness of tape jobs after exercise is a common problem and attributed to the tape loosening from foot movements and forces stressing the integrity of the tape or from the breakdown of the tape's adhesion to the skin. One drawback to athletic tape is that it tends to loosen shortly after exercise is initiated. In the case of ankle taping techniques, this observation has led to an increased use of ankle braces in place of the closed basket weave for ankle sprains and instability.26 Similarly, MLATTs elicit gains in navicular height initially, but when the tape loosens with exercise, navicular height decreases. Colorless Tuf Skin was used to limit the tape from loosening, but a reduction in navicular height was still observed using both MLATTs.
The goal of an MLATT is to reduce pain to increase performance, so the ultimate validation of any MLATT would be determined by its ability to reduce pain in symptomatic individuals. Because the participants in this study were all asymptomatic, we were unable to evaluate the pain reduction associated with an MLATT application. Moreover, the literature is not conclusive that an increase in navicular height is the mechanism for eliminating pain.
A suggested alternative mechanism for reduced pain is that deformation of the skin secondary to athletic tape may provide biofeedback that improves proprioception enough to alter the biomechanics that compensate for injury. This proprioceptive mechanism may potentially be more effective at preventing injury as opposed to limiting excessive motion.27
A second proposed mechanism is that the tape alters plantar pressure. One study used plantar pressure as an evaluative measure for MLATTs. Although the low-dye MLATT failed to sustain an increase of navicular height through 5 minutes of treadmill running, Newell et al.16 found that the plantar pressure was shifted laterally. Future studies should investigate other mechanisms that MLATTs may offer for related pathologies.
The current study offers advantages over previous studies. Colorless Tuf Skin was sprayed on the foot before tape application and pre-wrap was omitted. The adhesive may have helped the tape adhere to the skin and prevented the tape from loosening due to sweat or skin deformation. Another advantage of the current study is the use of athletes, which is more representative of the target population than participants from the general population. Because foot anatomy varies throughout different stages of life,28 the population of interest should be studied. The participants in the current study were athletes aged 18 to 22 years, which is a representative sample of patients typically observed in the collegiate athletic training.
This study has limitations. First, only three participants in the current study had a navicular drop of 10 mm or greater, which is considered excessive.2,3 Excessive navicular drop has been correlated with injury,4,6,9 so MLATTs may be more effective for participants with excessive navicular drop. Participants with excessive navicular drop may be more representative of pathological individuals.14,29 The small number of participants with excessive navicular drop identified in this study did not allow for a comparison between pathological and non-pathological participants.
Unfortunately, no data are available for height or body weight of the individuals because this study was originally intended to be an undergraduate class project. Excessive body fatness has been demonstrated to influence lower extremity muscle force production during walking, which could lead to an increased risk of injury.30 Clinicians should be cautioned when generalizing the results of this study due to the lack of demographic data. However, it is worth mentioning that the participants included in this study were Division III collegiate athletes, who are likely to have relatively normal, healthy weights. Furthermore, individual sports may require distinctive body movements that result in biomechanical variations. Consequently, the forces placed on the foot and on the applied tape differ between types of athletes. Future studies may aim to isolate athletes of a single sport to see if a certain MLATT is more affective for a specific set of body movements.
Alternative methods to evaluate the effectiveness of MLATTs may prove to be insightful. For example, an in-shoe sensor that a participant can wear on the foot could provide real-time navicular height data.31–33 Plantar pressure may be an additional evaluative measure worth investigation. Future studies should aim to investigate the reduction of pain and functional outcomes of MLATTs in individuals with arch-related pathologies.
Implications for Clinical Practice
Both the low-dye and fan-arch support MLATT provide similar increases in navicular height following tape application. After a 20-minute exercise protocol, both MLATTs provided diminished effectiveness at maintaining arch height. Although the low-dye MLATT was statistically superior to the fan-arch support MLATT in this study, the average increase in navicular height post-exercise was approximately 2 mm, which may not be clinically relevant. Athletic trainers should consider using alternative methods of increasing navicular height to minimize the risk of injury during exercise in athletes with excessive changes in navicular height as indicated by the Navicular Drop Test.
- Starkey C, Brown SD. Foot and toe pathologies. In: Starkey C, Brown SD, eds. Examination of Orthopedic & Athletic Injuries, 4th ed. Philadelphia: F.A. Davis Company; 2015:171–236.
- Brody D. Techniques in the evaluation and treatment of the injured runner. Orthop Clin North Am. 1982;13:541–558.
- Mueller M, Host J, Norton BJ. Navicular drop as a composite measure of excessive pronation. J Am Podiatr Med Assoc. 1993;83:198–202. doi:10.7547/87507315-83-4-198 [CrossRef]
- Hamstra-Wright KL, Bliven KCH, Bay C. Risk factors for medial tibial stress syndrome in physically active individuals such as runners and military personnel: a systematic review and meta-analysis. Br J Sports Med. 2015;49:362–369. doi:10.1136/bjsports-2014-093462 [CrossRef]
- Neal BS, Griffiths IB, Dowling GJ, et al. Foot posture as a risk factor for lower limb overuse injury: a systematic review and meta-analysis. J Foot Ankle Res. 2014;7:55. doi:10.1186/s13047-014-0055-4 [CrossRef]
- Allen MK, Glasoe WM. Metrecom measurement of navicular drop in subjects with anterior cruciate ligament injury. J Athl Train. 2000;35:403–406.
- Hossain M, Makwana N. “Not Plantar Fasciitis”: the differential diagnosis and management of heel pain syndrome. Orthop Trauma. 2011;25:198–206. doi:10.1016/j.mporth.2011.02.003 [CrossRef]
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- Carvalho ACA, Hespanhol LC Jr, Costa LOP, Lopes AD. The association between runners' lower limb alignment with running-related injuries: a systematic review. Br J Sports Med. 2011;45:339–339. doi:10.1136/bjsm.2011.084038.83 [CrossRef]
- Vicenzino B, Griffiths SR, Griffiths LA, Hadley A. Effect of anti-pronation tape and temporary orthotic on vertical navicular height before and after exercise. J Orthop Sports Phys Ther. 2000;30:333–339. doi:10.2519/jospt.2000.30.6.333 [CrossRef]
- Holmes CF, Wilcox D, Fletcher JP. Effect of a modified, low-dye medial longitudinal arch taping procedure on the subtalar joint neutral position before and after light exercise. J Orthop Sports Phys Ther. 2002;32:194–201. doi:10.2519/jospt.2002.32.5.194 [CrossRef]
- Franettovich M, Chapman A, Blanch P, Vicenzino B. A physiological and psychological basis for anti-pronation taping from a critical review of the literature. Sports Med. 2008;38:617–631. doi:10.2165/00007256-200838080-00001 [CrossRef]
- Prentice W. Wrapping and taping. In: Prentice W, Arnheim D, eds. Principles of Athletic Training: A Competency-Based Approach, 15th ed. New York: McGraw-Hill Higher Education; 2013:211–241.
- Prusak KM, Prusak KA, Hunter I, Seeley MK, Hopkins JT. Comparison of two taping techniques on navicular drop and center-of-pressure measurements during stance. Athletic Training & Sports Health Care. 2014;6:252–260. doi:10.3928/19425864-20141125-13 [CrossRef]
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- Vicenzino B, Franettovich M, McPoil T, Russell T, Skardoon G. Initial effects of anti-pronation tape on the medial longitudinal arch during walking and running. Br J Sports Med. 2005;39:939–943. doi:10.1136/bjsm.2005.019158 [CrossRef]
- Franettovich M, Chapman A, Blanch P, Vicenzino B. Continual use of augmented low-dye taping increases arch height in standing but does not influence neuromotor control of gait. Gait Posture. 2010;31:247–250. doi:10.1016/j.gaitpost.2009.10.015 [CrossRef]
- Hyland MR, Webber-Gaffney A, Cohen L, Lichtman PT. Randomized controlled trial of calcaneal taping, sham taping, and plantar fascia stretching for the short-term management of plantar heel pain. J Orthop Sports Phys Ther. 2006;36:364–371. doi:10.2519/jospt.2006.2078 [CrossRef]
- Kadakia AR, Haddad SL. The role of ankle bracing and taping in the secondary prevention of ankle sprains in athletes. Int Sportmed J. 2003;4:1–10.
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Descriptive Statistics for Participants
|Variables||N||Percent||Age (y), Mean ± SD|
| Male||13||52||20.20 ± 0.79|
| Female||12||48||19.42 ± 1.00|
Comparison of Navicular Heighta
|Variables||Mean ± SD|
| Baseline||44.68 ± 7.62|
| Pre-exercise||49.58 ± 7.39|
| Post-exercise||47.00 ± 7.66|
|Fan arch support|
| Baseline||44.98 ± 8.24|
| Pre-exercise||48.30 ± 7.53|
| Post-exercise||45.08 ± 7.30|