WEBVTT 00:00.000 --> 00:30.000 position:50% align:top line:0 *This machine-generated transcript may have errors. If remediation or a manually-generated transcript is needed, please contact NLM Support at https://support.nlm.nih.gov.* 00:18.790 --> 00:20.219 In this presentation, 00:20.229 --> 00:22.649 I would like to demonstrate the 00:22.739 --> 00:25.610 application of strapping as it relates to 00:25.620 --> 00:28.500 both inversion and E version sprains 00:28.719 --> 00:30.409 and strains of the ankle. 00:33.189 --> 00:34.049 First, 00:34.060 --> 00:36.799 I would like to discuss strains, 00:38.069 --> 00:40.209 strains involve the 00:40.220 --> 00:43.200 tendons which pass over 00:43.209 --> 00:44.000 the ankle. 00:44.009 --> 00:45.049 Traditionally, 00:45.180 --> 00:47.630 the achilles tendon posteriorly, 00:48.119 --> 00:50.080 the peroneal tendons 00:50.110 --> 00:51.860 laterally and the tiballi 00:52.330 --> 00:54.880 anterior tendons are 00:54.889 --> 00:57.680 affected with 00:57.689 --> 00:59.029 ankle strains. 00:59.090 --> 01:01.330 Strains you will remember are an 01:01.340 --> 01:04.300 overstretching of these tendons 01:05.169 --> 01:07.540 which result from ankle 01:07.550 --> 01:10.139 injuries played in various sports 01:11.919 --> 01:12.809 strains. 01:12.819 --> 01:15.559 Treatment essentially 01:15.569 --> 01:17.879 involves in the first phase, 01:18.330 --> 01:20.050 a suitable rest period. 01:20.470 --> 01:23.279 By that 1st 24 to 48 01:23.290 --> 01:24.069 hours, 01:24.080 --> 01:26.440 the person would rest the ankle 01:27.389 --> 01:30.169 and thereby give rest to the affected 01:30.180 --> 01:32.559 tendon restriction of 01:32.569 --> 01:33.209 movement, 01:34.919 --> 01:37.720 stressing the tendon by strapping is 01:37.730 --> 01:38.720 also essential. 01:39.519 --> 01:42.250 So that if the perennial tendons were affected, 01:42.260 --> 01:44.639 one would strap the ankle appropriately to 01:44.650 --> 01:47.410 minimize movement at that particular 01:47.419 --> 01:48.970 portion of the ankle. 01:49.650 --> 01:52.360 A cushion heel may be applied 01:52.849 --> 01:55.379 to the heel of the foot to 01:55.389 --> 01:58.250 reduce shock and forces which 01:58.260 --> 02:01.019 are transmitted through the calcaneus up through 02:01.029 --> 02:03.620 the fibula and the tibia 02:05.129 --> 02:05.860 as well. 02:05.870 --> 02:08.259 The oral administration of anti inflammatory 02:08.270 --> 02:10.699 agents is probably advisable. 02:12.100 --> 02:12.369 Now, 02:12.380 --> 02:15.380 springs are a more 02:15.389 --> 02:18.270 serious form of injury in terms of 02:18.279 --> 02:20.889 the ankle and involve tearing 02:21.039 --> 02:23.699 of the ligaments which bind 02:23.710 --> 02:26.360 the tarsal and meta taal bones 02:26.369 --> 02:27.070 together. 02:27.360 --> 02:30.169 The ligaments most commonly affected are the 02:30.179 --> 02:32.750 lateral ligament uh from the 02:33.160 --> 02:36.139 head of the fibula to 02:36.149 --> 02:39.089 the tailor and the calcaneus 02:39.880 --> 02:42.250 and on the medial side, 02:42.320 --> 02:44.619 from the tibia 02:44.630 --> 02:47.029 portion via the deltoid ligament 02:47.449 --> 02:49.380 to the and the calcaneus. 02:52.490 --> 02:54.910 Because springs are a 02:54.919 --> 02:57.110 tearing of these ligaments through 02:57.119 --> 02:59.539 overstretching sheer or compressive 02:59.550 --> 03:00.309 forces. 03:01.449 --> 03:02.979 Swelling occurs. 03:03.229 --> 03:05.860 There may be a collection of blood 03:06.119 --> 03:08.899 which finds itself trapped around the lateral mali 03:09.250 --> 03:09.830 or the media mole. 03:10.490 --> 03:11.479 In which case, 03:11.490 --> 03:13.880 this would have to be evacuated 03:14.589 --> 03:17.080 um before treatment could 03:17.089 --> 03:17.619 begin, 03:17.860 --> 03:20.750 but essentially treatment begins in the 1st 03:20.759 --> 03:22.559 24 to 48 hours. 03:22.570 --> 03:25.119 With the application of ice. 03:25.130 --> 03:26.050 Traditionally, 03:26.059 --> 03:28.880 one would raise the ankle and leg 03:29.100 --> 03:30.360 in an elevated position, 03:30.369 --> 03:32.399 30 to 45 degrees. 03:32.410 --> 03:35.059 Apply ice in a crushed, 03:36.070 --> 03:38.720 crushed ice in a towel to the 03:38.949 --> 03:41.679 from the dorsum of the foot to one third of the 03:41.690 --> 03:44.440 ankle wrap it very tightly around the ankle 03:45.639 --> 03:48.130 over which you would apply a tensor bandage for 03:48.139 --> 03:50.479 approximately 15 to 20 minutes. 03:50.490 --> 03:53.089 This would occur approximately 03:53.199 --> 03:53.990 23, 03:54.000 --> 03:56.619 maybe four times a day for the 03:56.630 --> 03:59.320 first day or two until the swelling had 03:59.330 --> 04:00.070 subsided. 04:01.820 --> 04:04.820 The advantage with elevation obvious 04:04.830 --> 04:07.210 is obvious in that gravity would assist the flow of 04:07.220 --> 04:10.020 secretions from the foot and ankle and help 04:10.029 --> 04:12.389 restore normal lymphatic 04:12.800 --> 04:14.940 and blood circulatory flow. 04:17.910 --> 04:20.339 Since there is a tearing 04:20.720 --> 04:22.339 of the ankle ligaments, 04:22.350 --> 04:24.709 the lateral or the medial ligaments 04:25.309 --> 04:28.200 following the application of ice. 04:28.209 --> 04:30.829 In that 1st 24 to 48 hours, 04:30.839 --> 04:33.390 the ankle should be bandaged and by 04:33.399 --> 04:33.899 bandaged, 04:33.910 --> 04:36.709 we mean the application of an elastic 04:36.769 --> 04:39.690 crepe bandage tightly 04:39.700 --> 04:41.399 bound around the ankle. 04:41.670 --> 04:43.980 Um in a normal 04:44.239 --> 04:45.290 pattern, 04:45.299 --> 04:48.059 beginning distal and working proximal. 04:48.070 --> 04:50.299 This in turn will help 04:50.309 --> 04:52.019 minimize swelling 04:54.000 --> 04:55.100 at that time. 04:55.109 --> 04:58.049 The patient is instructed in the proper use 04:58.059 --> 05:00.739 of crutches and is told that he 05:00.750 --> 05:03.049 cannot take any weight through that foot. 05:03.059 --> 05:04.410 So this foot in essence, 05:04.420 --> 05:07.390 is being rested because the patient is not allowed 05:07.399 --> 05:09.109 to use it for walking. 05:09.940 --> 05:12.149 Following that 48 hour period, 05:12.160 --> 05:15.149 the acute stage of edema 05:15.239 --> 05:16.290 has subsided. 05:17.399 --> 05:19.170 The application of 05:19.540 --> 05:22.109 support in the form of strapping 05:22.489 --> 05:25.269 is essential at this 05:25.279 --> 05:26.339 point in time, 05:26.489 --> 05:28.950 the treatment is 05:29.079 --> 05:32.029 directed towards supporting the 05:32.040 --> 05:32.470 ankle. 05:33.109 --> 05:35.850 The patient is now allowed to partially weight, 05:35.859 --> 05:38.809 bear and may continue to partially weight 05:38.820 --> 05:41.589 bear for a period of 3 to 4 05:41.600 --> 05:42.209 weeks. 05:42.630 --> 05:45.320 The progression there being from partial weight bearing 05:45.329 --> 05:48.239 initially to a more full weight bearing 05:48.290 --> 05:48.839 state. 05:48.850 --> 05:49.880 Towards the end, 05:49.970 --> 05:52.809 this with the support is allowing the 05:52.820 --> 05:54.000 ligament to heal. 05:56.570 --> 05:57.480 At this point. 05:57.559 --> 05:59.720 I'd like to demonstrate the typical 06:00.089 --> 06:01.940 inversion sprain 06:02.369 --> 06:04.369 involving the lateral 06:05.119 --> 06:07.010 ligaments of the ankle. 06:07.690 --> 06:08.820 In which case, 06:08.829 --> 06:09.760 the patient, 06:09.839 --> 06:12.079 if he were standing upright, 06:12.910 --> 06:15.829 four ft would become twisted, 06:16.230 --> 06:19.130 putting an added strain on these ligaments 06:19.390 --> 06:21.809 as they attach 06:22.850 --> 06:24.339 to the points indicated, 06:26.089 --> 06:28.470 the strain is usually very sharp, 06:28.480 --> 06:30.040 very quick very abrupt, 06:30.049 --> 06:32.959 resulting in tearing of 06:32.970 --> 06:33.869 these fibers. 06:35.000 --> 06:37.809 This particular type of sprain accounts for 06:37.820 --> 06:40.690 90% of all ankle injuries. 06:42.290 --> 06:45.179 The next sprain I would like to demonstrate is the e 06:45.190 --> 06:48.109 version sprain again, 06:48.119 --> 06:51.109 much less common than 06:51.119 --> 06:53.519 the inversions brain but nevertheless 06:53.529 --> 06:56.339 occurs more frequently associated 06:56.350 --> 06:58.989 with uh an individual who 06:59.799 --> 07:02.739 whose feet are planted firmly on the ground and 07:02.750 --> 07:05.750 is struck from the lateral aspect of the of 07:05.760 --> 07:08.309 the of the calf involving 07:08.730 --> 07:10.720 a sudden sheer force, 07:10.730 --> 07:11.910 twisting force, 07:12.059 --> 07:13.390 resulting in a 07:15.200 --> 07:17.739 tearing of the deltoid ligament on the medial 07:17.750 --> 07:19.519 aspect of the ankle. 07:20.929 --> 07:21.980 On the slide. 07:22.260 --> 07:23.230 Before you, 07:23.559 --> 07:26.290 you have demonstrated an E 07:26.380 --> 07:29.220 version sprain showing tearing 07:29.230 --> 07:32.000 of the lateral ligament 07:32.179 --> 07:34.529 as well as the tendons 07:34.859 --> 07:35.980 strains. 07:35.989 --> 07:38.820 Sprains rather need not be 07:38.829 --> 07:40.339 this severe but can be 07:48.309 --> 07:49.899 ligamentous injuries. 07:50.420 --> 07:52.679 In the next slide are classified 07:54.600 --> 07:56.970 and graded by the degree of severity. 07:57.480 --> 08:00.209 A first degree ligamentous injury 08:00.480 --> 08:02.899 is a mild injury where no 08:02.910 --> 08:05.290 instability of the joint 08:05.500 --> 08:06.290 occurs. 08:07.720 --> 08:08.470 In this case, 08:08.480 --> 08:10.739 there would be a minor amount of tearing, 08:11.899 --> 08:14.350 the patient would be treated as indicated 08:14.839 --> 08:17.820 and good results for 08:17.829 --> 08:20.459 normal function would be expected 08:21.049 --> 08:23.279 in a second degree minimal 08:23.290 --> 08:24.750 instability of the 08:25.920 --> 08:28.089 talofibular calcaneal joint 08:28.230 --> 08:31.170 exists and the patient 08:31.179 --> 08:33.619 demonstrates some increased symptomatology 08:35.129 --> 08:37.078 in that he has more severe pain, 08:37.859 --> 08:39.580 more severe swelling, 08:39.590 --> 08:41.900 perhaps some bleeding and so on. 08:43.380 --> 08:44.599 In a third degree, 08:45.070 --> 08:47.520 the complete disruption of the ligament 08:48.619 --> 08:50.950 either from its insertion on the 08:52.429 --> 08:53.539 describe bones, 08:53.549 --> 08:56.159 the fibula or the tibia 08:57.260 --> 08:59.869 and maximal instability occurs 08:59.880 --> 09:02.840 now and the only correction at this 09:02.849 --> 09:05.510 point is through 09:05.520 --> 09:06.130 surgery, 09:08.299 --> 09:10.950 it should be pointed out that treatment of ankle 09:10.960 --> 09:13.919 sprains without support and by 09:13.929 --> 09:14.429 support, 09:14.440 --> 09:17.070 we mean strapping or a plaster boot, 09:18.169 --> 09:20.739 regardless of what other means is used can be 09:20.750 --> 09:23.099 accurately described as non treatment. 09:28.099 --> 09:29.270 I would now like to 09:33.489 --> 09:36.320 consider healing 09:36.330 --> 09:38.070 as it relates to sprains, 09:38.799 --> 09:41.469 prevention of a re sprain which 09:41.479 --> 09:43.979 commonly occurs following the initial 09:43.989 --> 09:46.539 sprain is as 09:46.549 --> 09:49.429 important as the prevention of the ankle sprain. 09:49.440 --> 09:49.989 Initially, 09:51.570 --> 09:54.450 since ligaments do not heal these ligaments on the 09:54.460 --> 09:57.429 lateral aspect of the ankle do not heal by the formation of 09:57.440 --> 09:58.750 new ligamentous tissue, 09:59.059 --> 10:01.460 but rather by fibrous scar tissue, 10:03.469 --> 10:05.239 it is essential that once the 10:06.059 --> 10:07.739 ankle has been sprained, 10:07.950 --> 10:10.450 it is far more susceptible to re sprain 10:11.580 --> 10:14.169 common sense would tell you that if this 10:14.320 --> 10:16.599 ligament has been torn and 10:16.609 --> 10:19.270 stretched and it heals in a 10:19.280 --> 10:21.849 lengthened state that the 10:21.859 --> 10:24.549 tendency towards re sprain becomes 10:24.559 --> 10:25.659 very classical. 10:28.619 --> 10:31.390 This increased susceptibility may be reduced 10:31.400 --> 10:34.219 only by holding the sprained ligaments in a 10:34.229 --> 10:36.210 position of firm support 10:37.130 --> 10:40.049 so that the formation of the scar tissue will be 10:40.059 --> 10:40.659 minimal. 10:41.739 --> 10:44.469 And that insofar as possible, 10:44.479 --> 10:47.150 the fibers of the ligaments will heal in 10:47.159 --> 10:48.950 close proximity to each other. 10:49.710 --> 10:52.090 So that once the strapping has been removed, 10:52.340 --> 10:54.640 although fibrous scar tissue is present, 10:54.929 --> 10:57.609 the ligament is in a shortened healing 10:57.619 --> 10:58.419 state, 10:58.830 --> 11:01.559 thus preventing the prevention of a re 11:01.570 --> 11:04.159 spring providing more stability 11:04.219 --> 11:05.239 for the ankle. 11:10.039 --> 11:11.450 At this point in time, 11:12.239 --> 11:15.010 I should like to demonstrate the 11:15.260 --> 11:17.900 actual strapping process involving the 11:17.909 --> 11:18.429 ankle. 11:18.630 --> 11:19.830 But before we do, 11:19.840 --> 11:22.179 we would like to indicate the types of 11:22.190 --> 11:25.109 materials that are required in order to strap the 11:25.119 --> 11:25.570 ankle. 11:27.479 --> 11:29.090 First of all the 11:30.049 --> 11:33.030 material we are using here is called pro wrap. 11:33.039 --> 11:35.419 It's a very 11:35.429 --> 11:37.039 fine um 11:37.679 --> 11:40.169 polyethylene type of material which is 11:40.179 --> 11:43.109 wrapped over the foot prior to the administration 11:43.119 --> 11:44.010 of the tape. 11:44.219 --> 11:46.750 This is done for basically two reasons. 11:47.020 --> 11:47.840 One, 11:48.099 --> 11:50.619 it will prevent a 11:50.630 --> 11:53.250 reaction between the patient and the 11:53.260 --> 11:56.140 tape because the tape never comes in contact with the 11:56.150 --> 11:56.760 skin. 11:57.080 --> 11:57.820 Uh two, 11:57.830 --> 12:00.070 it will also add 12:00.440 --> 12:03.440 um some support to the next 12:03.450 --> 12:04.700 items which we use, 12:04.710 --> 12:07.159 which are the four by four 12:07.169 --> 12:10.039 gauzes with Vaseline pads in 12:10.049 --> 12:10.340 them. 12:12.390 --> 12:15.080 The next material we use is the 12:15.369 --> 12:18.190 uh quick drawing tape adhesive 12:18.200 --> 12:20.669 um which is used in 12:20.679 --> 12:23.679 conjunction with the pro wrap so that it's sprayed on the 12:23.690 --> 12:24.000 ankle. 12:24.010 --> 12:24.580 First, 12:24.590 --> 12:27.590 the pro wrap is applied and then taping can 12:27.599 --> 12:30.289 begin the tape we use is the 12:30.500 --> 12:32.400 Johnson and Johnson Porus 12:32.710 --> 12:33.520 tape. 12:33.590 --> 12:36.380 This particular role is a three inch roll. 12:37.020 --> 12:39.650 Uh Normally we would recommend a one inch 12:39.659 --> 12:42.309 tape uh for purposes of taping 12:42.320 --> 12:42.969 today. 12:43.409 --> 12:45.940 Uh I have decided to just tear this 12:45.950 --> 12:48.130 tape and uh apply it 12:51.039 --> 12:53.429 in a one inch strip. 12:54.429 --> 12:57.400 Scissors are helpful particularly in 12:57.409 --> 12:59.950 the removal of the strapping. 12:59.960 --> 13:01.440 Once it has been applied 13:03.229 --> 13:03.989 at this point, 13:04.000 --> 13:06.679 I would now like to begin the demonstration 13:06.979 --> 13:09.359 by showing you the 13:09.369 --> 13:12.369 application of the four by four gauze with the 13:12.380 --> 13:15.340 Vaseline pads on the dorsum 13:15.349 --> 13:15.890 of the foot, 13:15.900 --> 13:17.989 you have the flexor retinaculum, 13:18.219 --> 13:20.460 which is a band of 13:20.799 --> 13:23.750 fibers moving transversely across the dorsum 13:23.760 --> 13:26.489 of the foot under which the tendons, 13:26.500 --> 13:29.289 the tibial interior um pass 13:29.719 --> 13:32.590 if you were to apply the tape directly to the skin, 13:32.599 --> 13:34.140 without this gauze. 13:34.369 --> 13:37.340 Um and without the Vaseline irritation at 13:37.349 --> 13:40.239 this point would occur simply because the person's foot 13:40.250 --> 13:42.929 is continually flexing and extend dose, 13:42.940 --> 13:45.809 flexing and and uh and planter 13:45.820 --> 13:46.260 flexion. 13:47.330 --> 13:48.500 So we take the, 13:48.510 --> 13:50.210 the gauze and we simply just 13:52.190 --> 13:55.169 lay it on the flexor retinaculum 13:55.179 --> 13:56.239 on the dorsum of the foot. 13:56.429 --> 13:59.200 It's important in this particular patient 13:59.210 --> 14:01.770 who sustained a an 14:01.780 --> 14:04.609 inversion sprain which is directed 14:04.619 --> 14:05.299 this way, 14:05.690 --> 14:08.640 the ligaments on the lateral aspect of the ankle 14:08.650 --> 14:09.619 were damaged. 14:10.440 --> 14:12.039 And so to 14:12.369 --> 14:15.130 minimize movement and 14:15.140 --> 14:16.460 provide stability, 14:16.520 --> 14:18.770 we simply ask that the patient keep the 14:18.780 --> 14:21.570 foot in the neutral position 14:22.539 --> 14:24.659 or slightly Dorsey flexed. 14:24.669 --> 14:25.609 In this case, 14:25.869 --> 14:28.150 the patient can keep it in the neutral position. 14:29.549 --> 14:32.419 The next gauze pad is applied 14:32.530 --> 14:34.599 posteriorly to the 14:35.890 --> 14:37.020 achilles tendon 14:39.859 --> 14:42.719 to prevent irritation of the tendon as 14:42.729 --> 14:44.909 well as the underlying bursa. 14:47.109 --> 14:48.359 At this point in time, 14:48.369 --> 14:49.989 we take the 14:52.900 --> 14:55.880 ra adhesive spray and spray 14:55.890 --> 14:56.520 the ankle 15:01.020 --> 15:02.450 in essentially two places, 15:02.460 --> 15:05.390 one third of the calf and the dorsum of the foot, 15:06.260 --> 15:08.700 the pro wrap now can be 15:08.710 --> 15:09.539 applied, 15:09.909 --> 15:12.190 it will cling to that adhesive. 15:18.909 --> 15:21.830 And we follow a simple figure of eight 15:22.020 --> 15:24.760 pattern to cover 15:24.770 --> 15:27.500 the gauze 15:27.659 --> 15:30.130 pads sufficiently 15:33.809 --> 15:36.710 and enclosed the heel working our 15:36.719 --> 15:39.500 way up 15:39.510 --> 15:41.940 the caf 15:46.059 --> 15:47.229 having done that, 15:48.200 --> 15:50.849 we are now ready to begin 15:51.330 --> 15:52.590 the actual taping. 15:54.799 --> 15:55.989 In the first case, 15:56.409 --> 15:58.159 two things we would like to 15:58.390 --> 16:00.710 establish are the 16:00.719 --> 16:01.510 anchors. 16:01.880 --> 16:04.719 The first anchor is placed one third of 16:04.729 --> 16:07.679 the calf like so 16:08.359 --> 16:11.090 and it's basically just laid 16:11.099 --> 16:11.450 on. 16:12.210 --> 16:15.090 There's a slight amount of tension on that but very slight. 16:15.340 --> 16:18.299 The second anchor is placed on 16:18.309 --> 16:21.309 the dorsum over the dorsum of the foot 16:21.599 --> 16:24.340 and around the 16:24.349 --> 16:24.880 soul. 16:26.630 --> 16:29.159 It's important here to 16:30.070 --> 16:32.559 tear the tape in such a fashion 16:33.260 --> 16:35.989 so that it does not bind upon 16:36.000 --> 16:36.710 itself. 16:36.719 --> 16:37.409 So in other words, 16:37.419 --> 16:39.869 a gap exists between both sides of the 16:39.880 --> 16:40.450 tape. 16:40.739 --> 16:43.559 And the reason we do this is that when the person is 16:43.570 --> 16:44.489 finally taped, 16:44.599 --> 16:47.030 strapped and stands on that foot, 16:47.219 --> 16:49.929 this gap in the tape here allows 16:49.940 --> 16:52.630 for the meal bones to 16:52.640 --> 16:53.590 splay out. 16:53.809 --> 16:56.479 Thus providing for more 16:56.489 --> 16:57.150 comfort. 16:57.690 --> 17:00.280 Having applied both stirs, 17:01.690 --> 17:03.840 both anchors rather top and bottom. 17:04.510 --> 17:06.439 We would now like to begin the taping, 17:06.780 --> 17:09.479 asking the patient to hold the ankle in the 17:09.489 --> 17:10.589 neutral position. 17:10.979 --> 17:13.699 We begin on the medial side just 17:13.709 --> 17:16.640 posterior to 17:16.650 --> 17:17.099 the. 17:19.040 --> 17:21.400 So it comes down just posterior to that. 17:22.500 --> 17:25.479 And it's basically just laid on at which point 17:25.489 --> 17:26.250 as you come across, 17:26.260 --> 17:29.079 the sole of the foot tension is 17:29.089 --> 17:29.790 applied, 17:30.949 --> 17:33.500 which in turn wants to 17:33.540 --> 17:34.459 avert the foot. 17:34.469 --> 17:37.390 Now remember that this is an inversion sprain involving 17:37.400 --> 17:39.680 the ligaments on the lateral aspect. 17:39.689 --> 17:41.390 So that by pulling at this point, 17:41.400 --> 17:44.280 you are now shortening these ligaments and then 17:44.459 --> 17:47.130 you attach that to the anchor at the 17:47.140 --> 17:47.719 top. 17:49.329 --> 17:51.420 And then it's just a simple case of 17:55.640 --> 17:57.770 placing it down the next 18:00.689 --> 18:02.780 piece of tape which we call the 18:02.790 --> 18:05.660 bisector begins 18:05.670 --> 18:06.099 again, 18:06.109 --> 18:07.880 everything begins on the media aspect. 18:07.890 --> 18:09.109 In this particular case, 18:09.989 --> 18:12.880 on the four ft anchor 18:13.949 --> 18:16.359 proceeds around the back of the heel, 18:16.369 --> 18:19.349 around the side and is 18:19.359 --> 18:22.229 locked into place on the 18:22.680 --> 18:23.439 four ft anchor. 18:23.449 --> 18:24.239 On the other side, 18:24.339 --> 18:27.329 you'll notice very little tension has been applied a slight amount but very 18:27.339 --> 18:28.800 little on this particular case. 18:28.810 --> 18:31.420 This bisector is in turn 18:31.430 --> 18:34.359 locking the first strip in place. 18:35.060 --> 18:37.630 We would now like to apply the second strip 18:38.479 --> 18:40.930 which is going to be applied slightly posterior but 18:40.939 --> 18:43.699 overlapping the first coming again 18:43.709 --> 18:45.579 across the sole of the foot 18:46.640 --> 18:49.119 at which point you now apply tension 18:49.130 --> 18:51.560 again and it now passes 18:51.569 --> 18:53.640 basically over the lateral 18:56.640 --> 18:59.410 and then is firmed down 18:59.420 --> 19:00.250 on the ankle. 19:02.839 --> 19:05.270 This is a rapid petition 19:05.400 --> 19:08.040 pattern in that we now applies the second 19:08.099 --> 19:10.680 bisector covering the 19:10.689 --> 19:12.250 second stir up. 19:18.790 --> 19:21.619 So you can see the pattern stir up one bisector, 19:21.630 --> 19:21.910 one, 19:21.920 --> 19:24.520 stir up two bisector two. 19:24.579 --> 19:27.489 You will also note that everything begins immediately on 19:27.500 --> 19:28.800 the inversion sprain. 19:29.459 --> 19:32.229 If you had an E version sprain involving 19:32.239 --> 19:33.709 the deltoid ligament, 19:35.199 --> 19:37.949 you would begin everything on the lateral aspect 19:38.359 --> 19:38.949 again. 19:38.959 --> 19:41.260 Third strip is slightly 19:41.270 --> 19:43.760 anterior to the first stirrup 19:43.880 --> 19:46.859 comes right over the medium across 19:46.869 --> 19:47.890 the sole of the foot. 19:47.939 --> 19:48.609 Again, 19:48.619 --> 19:51.329 tension is applied at that 19:51.339 --> 19:51.979 point. 19:52.109 --> 19:54.489 And you can see the indentation on the foot here 19:56.140 --> 19:59.109 is allowing for that tension 19:59.119 --> 19:59.729 to take, 20:02.359 --> 20:04.989 take up the slack and the ligament and it comes in just 20:05.000 --> 20:07.839 slightly interior to the first stir. 20:10.209 --> 20:12.939 The pattern from here on in is simply the 20:12.949 --> 20:15.739 application of the bisectors 20:18.109 --> 20:20.910 to close in the 20:20.920 --> 20:22.890 dorsum of the foot. 20:25.069 --> 20:26.900 So you can see the pattern that's emerged. 20:26.910 --> 20:28.140 We have three stirrups, 20:28.150 --> 20:30.949 we have three bisectors and we simply just 20:30.959 --> 20:33.780 continue along now with the application 20:33.920 --> 20:35.500 of more bisectors. 20:38.829 --> 20:41.050 And this firmly locks in the 20:41.060 --> 20:42.839 strips at a higher level. 20:54.890 --> 20:57.869 The next important step in strapping 20:57.880 --> 20:58.540 the ankle 21:00.569 --> 21:02.849 is the heal lock, 21:03.739 --> 21:06.430 probably the most important piece of tape that you will 21:06.439 --> 21:06.979 apply. 21:07.849 --> 21:09.180 When you tape the ankle. 21:12.339 --> 21:14.829 The heel lock is designed to 21:14.839 --> 21:15.900 specifically 21:19.619 --> 21:22.099 counteract any 21:22.930 --> 21:25.260 over stretching of the lateral ligaments. 21:25.400 --> 21:28.270 You may feel that at this point that these 21:28.280 --> 21:29.560 ligaments are well supported. 21:29.569 --> 21:30.790 But in actual fact, 21:31.140 --> 21:32.699 this ankle can be 21:33.709 --> 21:36.000 inverted and averted slightly. 21:38.739 --> 21:40.500 The heel lock 21:41.609 --> 21:43.739 begins on the media aspect 21:44.839 --> 21:45.810 of the ankle, 21:46.229 --> 21:49.089 just like the stirrups comes down 21:50.170 --> 21:53.020 across the sole of the foot and 21:53.030 --> 21:55.400 we'll go very slowly on this so that you pick it up, 21:56.010 --> 21:58.469 it comes across the dorsum of the foot. 21:58.750 --> 22:01.660 So it's down from the media side across the soul. 22:01.890 --> 22:03.780 Now over the dorsum of the foot 22:04.040 --> 22:06.530 around to the 22:06.540 --> 22:07.939 soul and the tape, 22:07.949 --> 22:10.829 basically the direction of the tape at this 22:10.839 --> 22:13.349 point dictates where you must go next. 22:13.359 --> 22:16.180 It has to now go between 22:16.869 --> 22:18.760 behind the lateral, 22:19.729 --> 22:20.359 at this point, 22:20.369 --> 22:21.410 you're applying tension, 22:25.729 --> 22:28.619 it comes across the back of the heel 22:31.520 --> 22:32.000 again, 22:32.010 --> 22:33.829 over the dorsum of the foot 22:36.579 --> 22:38.430 under the soul and again, 22:38.439 --> 22:41.180 the tape dictates direction it is now 22:41.189 --> 22:44.160 behind the me mo so exactly 22:44.170 --> 22:46.750 what we've accomplished and then it 22:46.760 --> 22:49.489 finally ends up on the dorsum of the foot once 22:49.500 --> 22:49.920 more. 22:51.810 --> 22:54.560 Now we'll do that again just so that everyone 22:54.660 --> 22:55.560 catches it. 22:55.719 --> 22:58.410 But what we have in effect accomplished is a 22:58.420 --> 23:00.719 locking mechanism across the 23:00.729 --> 23:03.520 lateral aspect of the heel 23:03.530 --> 23:04.239 first. 23:04.689 --> 23:06.319 And this in turn puts the 23:07.040 --> 23:09.420 lateral ligament in a very 23:09.430 --> 23:10.890 shortened position. 23:11.709 --> 23:14.640 The next step of the same heal lock is to 23:14.650 --> 23:17.619 counteract that by applying tension to the 23:17.630 --> 23:20.300 media aspect of the heel. 23:20.660 --> 23:22.410 And uh at that point, 23:22.469 --> 23:25.060 you have a stabilizing force which 23:25.069 --> 23:27.900 locks that heel into place to 23:27.910 --> 23:28.430 demonstrate. 23:28.439 --> 23:29.130 Once more, 23:29.359 --> 23:31.170 we begin on the media aspect 23:32.270 --> 23:35.069 down across the sole of the 23:35.079 --> 23:37.400 foot over the dorsum 23:40.199 --> 23:41.890 down under the sole again. 23:41.900 --> 23:42.569 And at that point, 23:42.579 --> 23:44.170 you're ready for your first lock, 23:44.939 --> 23:46.589 tear off some extra tape there. 23:47.380 --> 23:48.089 And at that point, 23:48.099 --> 23:49.530 you want to apply the tension, 23:49.670 --> 23:51.800 that's the significant tension point. 23:51.939 --> 23:54.900 And so then you go across the lateral aspect 23:54.910 --> 23:55.550 of the heel, 23:56.959 --> 23:59.800 the tape direction basically tells you you can't come across the 23:59.810 --> 24:00.449 media part, 24:00.459 --> 24:02.770 you've got to come over the dorsum of the foot again 24:03.819 --> 24:06.719 and under the heel and then you're now 24:06.729 --> 24:09.310 ready for the medial heel 24:09.319 --> 24:09.750 lock, 24:10.369 --> 24:12.699 which then in turn brings the tape 24:13.689 --> 24:15.660 right back onto the dorsum of the foot. 24:16.750 --> 24:19.099 Following the application of 24:19.479 --> 24:19.880 one, 24:19.890 --> 24:21.359 perhaps two heel locks. 24:22.189 --> 24:24.920 The simple application of a, 24:28.010 --> 24:29.180 a figure of eight 24:35.109 --> 24:37.829 can be applied to the 24:37.839 --> 24:40.750 ankle to secure 24:40.760 --> 24:43.469 the tape from the heel locks. 24:50.930 --> 24:51.250 Now, 24:51.260 --> 24:51.829 at that point, 24:51.839 --> 24:54.189 we have applied the necessary strips, 24:54.199 --> 24:55.339 three stirrups, 24:55.800 --> 24:57.119 three bisectors, 24:57.130 --> 25:00.099 all overlapping each other and then close the ankle 25:00.109 --> 25:01.979 in with the remaining bisectors. 25:03.020 --> 25:04.839 We then applied our first, 25:04.859 --> 25:07.750 he lock down from the 25:07.760 --> 25:10.160 medial aspect because this is an inversion sprain. 25:10.170 --> 25:12.060 So we want to avert the foot, 25:12.390 --> 25:15.010 keep the ligament in a shortened position down from the medial 25:15.020 --> 25:17.969 aspect across the sole of the foot over the dorsum of 25:17.979 --> 25:20.959 the foot around behind 25:20.969 --> 25:22.500 the posterior lateral 25:23.449 --> 25:26.260 across the back over the dorsum once more 25:27.410 --> 25:29.920 under the sole around behind the 25:32.689 --> 25:35.459 and then back over ending up on the dorsum of the 25:35.469 --> 25:35.859 foot. 25:37.219 --> 25:40.209 One final stage 25:40.219 --> 25:43.020 to this is to apply once 25:43.030 --> 25:43.579 more. 25:44.130 --> 25:47.099 A sealing anchor 25:47.400 --> 25:50.339 to the tape at the top and 25:50.349 --> 25:52.219 bottom of the strapping. 25:52.229 --> 25:54.040 So the first anchor is applied. 25:54.560 --> 25:57.180 Second anchor is applied on the 25:57.189 --> 26:00.170 top over the first anchor and that 26:00.180 --> 26:03.040 seals the basic strips and the 26:03.050 --> 26:03.859 heel lock. 26:03.869 --> 26:05.319 And then at the bottom, 26:05.329 --> 26:06.719 following the same principle, 26:06.729 --> 26:07.180 again, 26:08.689 --> 26:11.660 the tape is applied allowing a gap 26:11.670 --> 26:14.339 in the bottom of the foot all this 26:14.349 --> 26:14.729 time. 26:14.739 --> 26:17.439 It's important that the person keep that foot in a dorse flex 26:17.449 --> 26:20.209 position should problems arise in that 26:20.979 --> 26:23.160 voluntary cooperation of the patient 26:23.849 --> 26:24.900 not be present. 26:25.250 --> 26:27.459 You can take a piece of tape 26:28.359 --> 26:31.260 and circle the lower portion of the 26:31.270 --> 26:33.770 foot like so and 26:34.229 --> 26:37.209 hand the remaining portion of the tape to 26:37.219 --> 26:37.739 the person. 26:37.750 --> 26:39.780 So that in this particular case, 26:39.790 --> 26:40.949 and he pulls on the tape, 26:40.959 --> 26:42.979 he's pulling himself into a Dorsey flexed, 26:43.410 --> 26:44.660 averted position. 26:44.819 --> 26:47.459 Thus allowing for you to tape the 26:47.469 --> 26:50.089 final check on the taping that has been 26:50.099 --> 26:53.060 applied is determined with the patient 26:53.069 --> 26:54.410 in the standing position, 26:54.510 --> 26:57.300 either partial weight bearing or fully weight bearing. 26:57.310 --> 26:57.969 In this case, 26:57.979 --> 27:00.699 the patient is almost fully weight 27:00.709 --> 27:03.530 bearing by asking the 27:03.540 --> 27:06.119 patient in this 27:06.130 --> 27:06.560 stance, 27:06.569 --> 27:09.349 whether or not the tape is too tight on the lateral aspects 27:09.489 --> 27:12.380 is a good indicator as to whether the tape 27:12.680 --> 27:15.589 over a period of the next 12 to 24 27:15.599 --> 27:18.000 hours is going to limit 27:18.010 --> 27:19.630 circulation to the toes. 27:19.790 --> 27:21.660 If the tape is too tight, 27:22.599 --> 27:25.260 then a simple cut 27:25.270 --> 27:27.810 along the lateral aspect about an inch, 27:28.040 --> 27:30.619 inch and a half long or the medial aspect, 27:30.630 --> 27:30.900 an inch, 27:30.910 --> 27:33.150 an inch and a half long may be made. 27:33.260 --> 27:35.410 Such a cut will now be demonstrated 27:40.949 --> 27:42.180 simply going in, 27:42.660 --> 27:43.959 take a small cut, 27:44.180 --> 27:46.479 then ask the patient once more. 27:46.599 --> 27:48.040 How does that feel? 27:48.380 --> 27:49.239 If it, 27:49.250 --> 27:51.310 it is required that you go a little further, 27:51.400 --> 27:52.150 you can, 27:52.290 --> 27:54.880 it's important not to cut too far into the tape. 27:55.010 --> 27:55.680 Otherwise, 27:55.689 --> 27:58.119 you are weakening the strapping 28:00.010 --> 28:01.979 as it is as it is shown 28:03.319 --> 28:05.160 it's important as well to note that 28:06.339 --> 28:07.050 in athletes, 28:07.060 --> 28:09.579 this tape would be applied pre and post 28:10.900 --> 28:11.869 game time. 28:12.150 --> 28:14.869 And in the non athlete such as this patient, 28:15.300 --> 28:18.030 he attends the physiotherapy department daily for the 28:18.040 --> 28:19.189 application of the tape. 28:19.930 --> 28:22.839 The duration again is somewhere between two and 28:22.849 --> 28:23.650 four weeks. 28:24.000 --> 28:26.819 This can be determined by the ongoing assessment 28:27.030 --> 28:29.540 and the stability of the sub tailored joint. 28:31.729 --> 28:32.280 In summary, 28:32.290 --> 28:34.949 the important points to remember in taping the 28:34.959 --> 28:35.829 ankle are.