Effect of Anti-Pronation Athletic Tape Types: A Randomized Crossover Trial on Ankle Strength, Gait Parameters, and Balance Control Ability in Women with Flexible Flat Feet

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

This research main question addresses the possible effects of elastic and inelastic taping on ankle strength, gait parameters and balance control in females with flexible flat feet. I consider the topic as original. Furthermore, it is applicable to the field of PT because the authors used taping as an intervention and used simple outcome measures (step length, stride length, ankle movements range of motion, sway length, limits of stability, ankle dorsi flexion strength), which can be used in every clinical setting.   The improved strength of ankle dorsiflexion after elastic taping measured via hand held dynamometer.  The authors gives two possible explanations for their findings (Discussion – second paragraph): 1. greater proprioception facilitation and enhanced neuromuscular control, 2. a greater degree of ankle dynamic movement. The authors should add references to the second paragraph of the Discussion in order to validate their explanations of the study findings. The tables are clear.

 

I suggest adding the use of an Isokinetic muscle strength (ankle dorsiflexors) to "Research limitations" and "Future studies".

In addition, as the outcome measures were only measured as "Short term", measuring this outcomes after a physical activity is of great importance (Future study). 

Author Response

Comments:

We are grateful for the insightful suggestions, which have helped us strengthen the manuscript.

• Comment 1: Add references to validate the explanations in the second paragraph of the Discussion.
• Response: Thank you for this important point. As suggested, we have now added relevant references to support our explanations regarding proprioception and neuromuscular control (Discussion, second paragraph).
• Comment 2: Include "isokinetic muscle strength" measurement as a limitation and suggest it for future studies.
• Response: We agree that this is a valuable point. We have revised the Limitations section to acknowledge the absence of isokinetic muscle strength measurement and have suggested its inclusion in future research.
• Comment 3: Emphasize the importance of measuring outcomes after physical activity for future research.
• Response: We have incorporated this suggestion into the manuscript by highlighting the need for future studies to measure outcomes following physical activity. This has been added to the Limitations section.

Reviewer 2 Report

Comments and Suggestions for Authors

Dear authors, 

Thank you for your submission. Below, I will specify some relevant aspects to consider point by point:

 

- Line 26: Replace "Taping" with "Athletic Tape" to ensure all keywords align with MeSH terms.

- Line 76: This is the first mention of the "navicular drop test." Include the abbreviation (NDT) immediately after the term.

- Line 99: Add “of SUNMOON University” as done in line 303 for consistency.

- Figure 1: Introduce the flow diagram with an appropriate reference before the figure's appearance. Ensure the figure adheres to the structure of a flow diagram for a crossover study, clearly distinguishing the four arms. Provide a more detailed title for this figure.

- Line 114: Add “under the same circumstances” or a similar phrase to clarify the context.

- Figure 2: Correct the title to “Figure 2” instead of “Figure 1.” Provide a more descriptive title for this figure. If feasible, swap images (d) and (e) to avoid confusion.

- Line 158: Replace “s” with “seconds” for clarity.

- Table 2: Include the unit of measurement (kg) after each movement label. For example: "Dorsiflexion (kg)."

- Tables 2, 3, and 4: Instead of only stating "elastic" or "inelastic" for taping type, provide the full name or use abbreviations explained in a footnote. For instance, “A-PESE" abbreviation for “Anti-Pronation Spiral Taping Elastic” and “A-PESI" abbreviation for “Anti-Pronation Spiral Taping Inelastic”.

- Lines 242 and 252: Replace one instance of “findings” with “results” or a similar synonym to avoid repetition.

- Line 245: Replace the repetitive phrase “With regard to” (also in line 235) with alternatives like “Concerning...” or “In terms of...”.

- Lines 248 and 265: Cite an appropriate source (article, website, or other resource) to substantiate each idea.

- Line 272: Start the paragraph with “In addition…” or a similar phrase to ensure smooth continuity with the preceding paragraph.

- Line 280: Remove the abbreviation (CAI) if it appears only once in the manuscript.

- Abbreviations: Verify that all abbreviations are defined upon their first use and are used consistently throughout the text and tables. Add “LOS: Limits Of Stability” to the list of abbreviations.

- References: Ensure compliance with reference formatting guidelines, checking for any typographical errors. If possible, include the volume for each article, not just the issue number.

 

Based on this information, I recommend that the manuscript be revised and rewritten.

 

Best wishes.

Author Response

Comments:

• Replace "Taping" with "Athletic Tape".
• Include abbreviation "NDT" at its first mention.
• Add "of SUNMOON University".
• Improve Figure 1 clarity (clear crossover structure and detailed title).
• Clarify "under the same circumstances".
• Correct figure numbering (Figure 2), swap images (d) and (e).
• Replace "s" with "seconds".
• Clearly include measurement units (kg) in Table 2.
• Clearly explain abbreviations in Tables 2, 3, and 4.
• Replace repetitive terms ("findings," "With regard to").
• Cite sources clearly.
• Start the paragraph with "In addition...".
• Remove abbreviation "CAI".
• Clearly define abbreviations, including LOS.
• Check reference formatting and volume issues.

Response:

We appreciate your detailed and precise feedback. We have thoroughly revised the manuscript as follows:

• "Taping" to "Athletic Tape": As suggested, "Taping" has been consistently replaced with "Athletic Tape" throughout the manuscript.
• Abbreviation "NDT": The abbreviation "NDT" has been defined at its first use.
• University Name: The name "SUNMOON University" has been added for consistency.
• Figure 1: We have revised Figure 1 to better illustrate the crossover design and have provided a more detailed title and legend.
• Phrase Clarification: The experimental conditions have been clarified.
• Figure Numbering & Images: Figure numbering has been corrected, and the images have been rearranged as requested.
• "s" to "seconds": The abbreviation "s" has been replaced with the full word "seconds" for clarity.
• Units in Table 2: Measurement units (kg) are now specified in Table 2.
• Abbreviations in Tables: All abbreviations used in Tables 2, 3, and 4 are now fully explained in the table footnotes.
• Repetitive Terms: We have revised the text to replace repetitive phrases like "With regard to" to improve readability.
• Citations & "In addition...": Necessary citations have been added, and the relevant paragraph now begins with "In addition..." for better flow.
• Abbreviation "CAI": The abbreviation has been removed as it was used only once.
• Abbreviation List (LOS): "LOS" and all other abbreviations have been defined in the list of abbreviations.
• References: We have meticulously checked and formatted all references according to the journal's guidelines, including volume numbers where available.

Reviewer 3 Report

Comments and Suggestions for Authors

Please find attached

 

Comments for author File: Comments.pdf

Author Response

Comments:

• Provide NDT results per participant or include this as a limitation.
• Provide a rationale for conducting only one trial for strength tests.
• Specify the number of trials for gait and balance clearly.
• Include visual representation of test sequence.
• Clarify consistency in timing of tests.
• Explain exclusion of separate supination and pronation tests clearly.

Response:

Thank you for your constructive feedback. We have clarified the following clearly:

• Individual NDT Results: We acknowledge the value of this data. However, due to participant privacy, individual results have not been included. We have addressed this by adding a statement to the Limitations section.
• Rationale for Single Strength Trial: A rationale for conducting a single trial for strength tests, consistent with protocols for immediate-effect studies, has been added to the Methods section.
• Number of Trials: We have now specified that three trials were performed for gait and balance assessments to ensure reliability.
• Test Sequence Diagram: The study's procedural flow is illustrated in the participant flowchart (Figure 1).
• Timing Consistency: We have added a statement to the Methods section clarifying that all test sessions for each participant were conducted during the same time block of the day (morning or afternoon).
• Exclusion of Supination/Pronation Tests: We have clarified in the Methods section that these multiplanar movements were captured during the inversion and eversion strength tests.

Reviewer 4 Report

Comments and Suggestions for Authors

Title: ok
Abstract:
What would be the low pigmentation and antipronation bandage mentioned?
The type of study was not mentioned.
The conclusion does not directly respond to the objective, review.

Introduction
It does not refer to the lateral longitudinal arch, which is also very important in plantar statics and dynamics.
It is important to mention that the lack of structuring of the arches leads to spurs and plantar faceitis.
It does not mention taping to raise the lateral arch.

Methods:
How was the sample selected? Convenience?
Type of study?
Age range of 39, there may already be women in menopause.
No history of lower limb injury in women over 30 years old? It is difficult to be sure of this, it is better to include a recent history (2 years without injury).
Who performed the assessment of navicular mobility? How was it done?
Explain the randomization in Excel better.
The figures are disorganized, put arrows in the figures in the direction of tension, since this is the main factor of the bandage.
Introduce the brand and model of the bandage. each tape
Were the devices calibrated?

Results
What is F in the table?
Improve the presentation of the differences, put the differences in the caption instead of lowercase letters in the table

Discussion
In general, this is superficial, it does not present the theoretical justification for the findings. Improve

Conclusion
Why does it say that mainly elastic tape, it seems biased. The results indicate that inelastic tape has similar effects except in one variable
Review the sentences that point out an advantage or suggest that elastic tape has an advantage, without the study having found such findings.

 

ps: There is a study by Bruening et al 2023 that points out the importance of the direction of tension in bandages, I suggest checking it and adding it to the study

Author Response

Comments:

• Clearly mention lateral longitudinal arch (LLA) in the introduction.
• Clearly specify recent injury history (within two years).
• Clarify sample selection and menopausal age considerations.
• Clearly describe who performed navicular mobility assessments and how.
• Clearly explain randomization method (Excel).
• Improve figures with arrows indicating tape tension direction.
• Clearly introduce tape brand and model.
• Confirm device calibration.
• Clearly explain "F" in tables.
• Improve table presentation of differences.
• Provide stronger theoretical justification.
• Review conclusion for neutrality.
• Consider mentioning Bruening et al. (2023).

Response:

Your comprehensive suggestions greatly enhanced the manuscript. All comments were clearly addressed:

• LLA Mention: The "lateral longitudinal arch (LLA)" is now explicitly mentioned in the Introduction.
• Injury History: The exclusion criteria now specify "recent injury history within two years."
• Sample Selection: We have clarified the sample selection criteria and rationale in the Participants section.
• Assessment Protocol: We have added details specifying that a single trained examiner performed the navicular mobility assessments using calibrated instruments. The randomization method using Excel has also been further described.
• Figure & Tape Details: The figures have been revised. The brand and model of the tape used are now stated in the Interventions section.
• Device Calibration: We have added a statement confirming the calibration of all measurement devices.
• "F" in Tables: The F-statistic is now defined in the table footnotes.
• Table Presentation & Justification: The presentation of the tables has been improved for clarity, and stronger theoretical justifications have been integrated into the Discussion.
• Conclusion Neutrality: The conclusion has been carefully revised to present a more balanced interpretation of the results from both elastic and inelastic taping.
• Bruening et al. (2023): The suggested reference has been incorporated into the Discussion.

Reviewer 5 Report

Comments and Suggestions for Authors

This study examined the effects of different types of anti-pronation taping on ankle strength, gait parameters, and balance control in women with flexible flat feet. As the researchers noted, taping is widely used due to its cost-effectiveness and accessibility, and numerous studies have been conducted on this topic. The detailed review comments for this study are as follows:

Introduction

The rationale for the study is not clearly presented. This is primarily due to the lack of specific examples or findings from previous studies, which makes it difficult to highlight the novelty of the current research. To address this, the authors should provide more concrete comparisons with prior research findings and better emphasize the need for this study.

Results

To further validate the results beyond basic statistical significance, the authors should report effect size values for the main outcomes.

Please indicate the unit of measurement for ankle strength in Table 2.

Discussion

The authors should clarify what this study newly discovered compared to previous research in lines 266–270.

The discussion should provide a clearer explanation of how the findings could be applied in clinical settings, supported by relevant evidence.

Comments on the Quality of English Language

I am not a native English speaker, so I cannot accurately judge the quality of the English.

Author Response

Comments:

• Clearly present the rationale and examples from previous studies.
• Clearly report effect sizes in results.
• Clearly indicate measurement units (kg) in Table 2.
• Clarify clearly new findings compared to previous research.
• Clearly explain clinical implications.

Response:

We addressed all your recommendations explicitly and clearly:

• Study Rationale: The Introduction has been revised to better contextualize the study with findings from previous research.
• Effect Sizes: Effect sizes (Cohen's d) have been calculated and are now reported in the results tables.
• Units in Table 2: Measurement units (kg) have been added to Table 2.
• Novelty of Findings: The Discussion now more clearly articulates the new findings of our study in comparison to previous research.
• Clinical Implications: We have expanded the Discussion to better explain the potential clinical implications of our findings.

Reviewer 6 Report

Comments and Suggestions for Authors

I thank the authors for the opportunity to review their research on the effects of different types of taping in women with flexible flatfoot, as their results could contribute to improving the efficiency when considering one intervention or another for this population.
I would kindly like to make some contributions to their manuscript.
- Title: It seems interesting to add the design of your study to the title (randomized crossover trial?).
- Abstract: You could include the design, methods, results, and conclusions of your study in a structured manner.
- Introduction: It would be advisable to conduct a rational review of scientific background that reflects the current state of the art to justify the need for your trial, but it appears you used references more than five years old for your research. Below are some studies, for which I declare no conflicts of interest, in case they might help you update your background on the topic. Likewise, it would be appropriate, in addition to including the general and specific objectives in this section, to also add your study hypothesis:
- Effects of taping techniques on arch deformation in adults with pes planus: A meta-analysis https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0253567
- Adhesive elastic tape modifies forefoot motion in young women with flatfoot https://www.researchgate.net/profile/Darlan-Ribeiro/publication/379345964_Adhesive_elastic_tape_modifies_forefoot_motion_in_young_women_with_flatfoot/links/66057c7710ca8679872554ab/Adhesive-elastic-tape-modifies-forefoot-motion-in-young-women-with-flatfoot.pdf
- Comparing the effects of Kinesio and dynamic tapes on plantar pressure and postural Stability in the pre- and post-fatigue phases: The case of men with pes planus https://www.sciencedirect.com/science/article/abs/pii/S0966636225001079
- Acute effects of athletic taping on arch deformity and plantar pressure in young female adults with flexible flatfoot https://www.sciencedirect.com/science/article/abs/pii/S0966636223015175
- It also seems necessary to include a gender perspective in health to justify your sample selection criteria.
- Methods:
You must clearly describe the characteristics of your study design and its justification.
Likewise, you must include how you determined the sample calculation.
I consider it necessary to describe the non-destructive testing mentioned in section 2.2 of the experimental procedure.

Likewise, the recruitment process, participant selection, and how it was carried out, as well as who performed these and other interventions and the time periods over which they took place, are also lacking.
Evidence supporting both the outcome measures and the interventions to which participants were subjected is lacking.
References justifying the basis for considering that three days may be the appropriate washout period between interventions, as well as the immediate effect of the different types of bandages, are also lacking.
- Results: I am struggling to identify if there is a primary outcome. Participant flow and clinical and sociodemographic characteristics should appear in this section.
- Discussion: I understand there was no blinding; it would be interesting to add this to the limitations.
- Other data: If the trial protocol is available, it should be included.

Author Response

Comments:

• Clearly specify study design (Randomized Crossover Trial) in the title.
• Clearly structure abstract.
• Update background clearly with recent literature.
• Clearly state hypothesis.
• Clearly describe sample size calculation.
• Clearly describe NDT and Feiss line test clearly.
• Clearly describe recruitment and interventions.
• Clearly state washout period rationale.
• Clearly identify primary outcomes.
• Clearly state absence of blinding in limitations.

Response:

We clearly addressed your valuable suggestions thoroughly:

• Title & Abstract: The title now includes the study design ("A Randomized Crossover Trial"), and the abstract has been restructured.
• Background & Hypothesis: The scientific background has been updated with more recent literature, and the research hypothesis is now explicitly stated in the Introduction.
• Gender Perspective: We have added a sentence in the Introduction section to provide a rationale for focusing on a female population, citing the higher prevalence of the condition in women.
• Sample Size & Screening: A detailed description of the sample size calculation using G*Power has been added. The screening methods (NDT and Feiss line test) and recruitment process are also further detailed.
• Washout Period: Thank you for this comment. We have clarified the rationale in the manuscript. As the goal of this study was to observe the immediate, one-time effects of taping, we determined that a 3-day interval would be sufficient to minimize any carryover effects from the previous intervention while assessing the acute impact of each new taping condition on the same participants.
• Primary Outcomes: The study's primary outcomes are now more clearly identified in the Results section.
• Blinding: We have acknowledged the absence of blinding as a limitation in the Discussion section.

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

Dear authors,

Thank you for resubmitting your article. The manuscript shows significant improvement, and all the previous comments have been addressed satisfactorily. Please ensure careful editing of the text, particularly in the tables and throughout the manuscript.

Once these final adjustments are made, I am confident the manuscript will be ready for publication.

Best regards.

Author Response

Comments:

Dear authors,

Thank you for resubmitting your article. The manuscript shows significant improvement, and all the previous comments have been addressed satisfactorily. Please ensure careful editing of the text, particularly in the tables and throughout the manuscript.

Once these final adjustments are made, I am confident the manuscript will be ready for publication.

Best regards.

Response:

Dear Reviewer,

Thank you very much for your kind and encouraging feedback. We truly appreciate your recognition of the improvements made to the manuscript.

As per your final recommendation, we have carefully reviewed the entire manuscript again, paying special attention to the tables and textual clarity throughout. Minor formatting issues and typographical inconsistencies have been corrected to ensure readability and consistency.

We sincerely thank you for your valuable insights throughout the review process, which have significantly enhanced the quality of our work.

Best regards,

Reviewer 3 Report

Comments and Suggestions for Authors

Thanks for addressing the comments! In lines 199, 200, and 201, it is mentioned that the peak force value is reported in kilograms. I am guessing this is only for the strength tests, since the gait and balance parameters in the results tables have different units of measurement. So, I would rewrite these sentences to reflect the units for each test more precisely. 

Author Response

Comment: Thanks for addressing the comments! In lines 199, 200, and 201, it is mentioned that the peak force value is reported in kilograms. I am guessing this is only for the strength tests, since the gait and balance parameters in the results tables have different units of measurement. So, I would rewrite these sentences to reflect the units for each test more precisely.

Response: We are grateful to the reviewer for this important observation regarding the lack of clarity in our description of measurement units. The reviewer's assumption was correct. To address this, we have significantly restructured the Methods section to enhance precision and clarity.

Specifically, the sentence that confusingly combined different measurements has been removed. The text in lines 209-211 now reads more logically: "Isokinetic strength testing was not performed, which is a limitation and recommended for future studies. All the tests were conducted by the same trained evaluator to ensure reliability."

Furthermore, the information on repeated trials has been moved to the appropriate subsections:

• The procedure of measuring three times for gait parameters is now clarified in Section 2.5.1 (lines 171-172).
• The same clarification for balance control ability is now located in Section 2.5.2 (lines 183-184).

We are confident that these revisions make our methodology much clearer and easier to follow.

Reviewer 5 Report

Comments and Suggestions for Authors

The current response to my review comments is insufficient and unprofessional.
You failed to indicate the specific line numbers where revisions were made, making it difficult to verify the changes.
Furthermore, the Methods section lacks a proper citation for the calculation of effect sizes.

Comments on the Quality of English Language

The current response to my review comments is insufficient and unprofessional.
You failed to indicate the specific line numbers where revisions were made, making it difficult to verify the changes.
Furthermore, the Methods section lacks a proper citation for the calculation of effect sizes.

Author Response

Comments: The current response to my review comments is insufficient and unprofessional. You failed to indicate the specific line numbers where revisions were made, making it difficult to verify the changes. Furthermore, the Methods section lacks a proper citation for the calculation of effect sizes.

Response: We sincerely apologize for our previous insufficient response and thank the reviewer for pointing out these critical issues. We appreciate the feedback on the need to indicate specific line numbers and the omission of a key citation.

To address the reviewer's concern, we have now added a sentence to the Section 2.6. Statistical analysis that clarifies the calculation of effect sizes using partial eta squared (η²), along with an appropriate citation. This revision can be found in lines 221-222 of the revised manuscript.

We have taken your feedback seriously and hope that this revised response and the detailed, point-by-point format meet the expected standards of professionalism and clarity.

Reviewer 6 Report

Comments and Suggestions for Authors

Thank you very much for your kind consideration of my contributions.
As a general recommendation, in responding to reviewers' comments, it would be helpful to indicate the line of the manuscript where the changes appear.
I believe you did not respond to the comment I made in the first review about providing evidence of the use of outcome measurement instruments used for this pathology, whether they are standardized and validated, and including a bibliographic reference for each one.
Thank you very much.

Author Response

Comments: As a general recommendation, in responding to reviewers' comments, it would be helpful to indicate the line of the manuscript where the changes appear. I believe you did not respond to the comment I made in the first review about providing evidence of the use of outcome measurement instruments used for this pathology, whether they are standardized and validated, and including a bibliographic reference for each one.

Response: We thank the reviewer for this crucial feedback and sincerely apologize for overlooking the previous comment regarding the validation of our measurement instruments. This was a significant omission, and addressing it has substantially strengthened our manuscript.

As requested, we have now incorporated bibliographic references that provide evidence for the validity and reliability of each outcome measurement instrument used in our study. The specific additions are as follows:

• For the Navicular Drop Test (NDT): A supporting citation has been added in Section 2.3 (lines 134-135).
• For the video-based gait analysis: A reference has been added in Section 2.5.1 (lines 161-162).
• For the balance assessment via force platform: A citation supporting its use has been included in Section 2.5.2 (lines 176-178).
• For the handheld dynamometer (HHD): A reference justifying its validity for strength measurement has been added in Section 2.5.3 (lines 196-198).

We believe these additions now fully address the reviewer's concerns and provide the necessary justification for our methodological choices.