Clinical UM Guideline

This document addresses the use of strapping, strategically applying overlapping layers of adhesive plaster or tape to a specific area of the body for the purpose of applying pressure and holding that body part in place. Strapping is intended to partially immobilize or restrict movement in order to provide support to the identified body part.

Note: This document does not address elastic therapeutic tape (such as Kinesio^™ taping).

Medically Necessary:

Strapping is considered medically necessary for the treatment of injuries, illness or post-operative care in any of the following indications:

• Hand; or
• Finger; or
• Ankle; or
• Foot; or
• Toe.

Not Medically Necessary:

Strapping is considered not medically necessary for all other indications.

The following codes for treatments and procedures applicable to this guideline are included below for informational purposes. Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement policy. Please refer to the member's contract benefits in effect at the time of service to determine coverage or non-coverage of these services as it applies to an individual member.

When services may be Medically Necessary when criteria are met:

When services are Not Medically Necessary:
For the procedure codes listed above when criteria are not met, and for the following procedures for all indications

Strapping is an established method of partially immobilizing or limiting movement in order to decrease pain or facilitate healing. The terms strapping and taping are frequently used interchangeably; however, the objective of each technique differs. Strapping, according to the National Library of Medicine, is “the application of adhesive plaster in overlapping strips upon or around a part (as a sprained ankle or the chest in pleurisy) to serve as a splint to reduce motion or to hold surgical dressings in place upon a surgical wound.” While some taping is meant to provide support or aid in maintaining alignment without movement, other types of taping, such as kinesio taping, also called elastic therapeutic taping, are used purportedly to improve circulation without restricting movement, and are not synonymous with strapping. Other methods of taping, such as low-dye taping, used to correct the posture of the foot or apply plantar pressure, can be used to treat chronic inflammatory conditions such as plantar fasciitis.

Strapping of the hand, finger or toes

Injuries of the fingers or the toes, such as certain fractures, sprains, strains or dislocations are common injuries in the United States (U.S.). Treatment frequently includes protected mobilization and efforts to reduce symptoms such as pain and swelling. Both immobilization and protected mobilization support soft tissue healing while protecting against further injury. In addition, as protected mobilization allows some movement, stiffness can be prevented and range of motion maintained. Strapping, also known as buddy, neighbor, or functional taping, is one method of providing protected mobilization. The injured digit is taped to an adjacent digit which serves to provide partial immobilization and support while the affected digit is healing. Buddy taping is a standard intervention for the treatment of both non-displaced fractures and displaced fractures following reduction (Hatch, 2003; Jones, 2012; Nellans, 2013). Multiple studies support that the use of strapping for achieving results similar or better outcomes than splinting or other forms of immobilization (Braakman, 1998; Chalmer, 2013; Martínez-Catalán, 2020; Park, 2015; Paschos, 2014; Poolman, 2005; van Aaken, 2007). In addition to injuries, strapping is commonly used as an alternative or adjunctive postoperative treatment to surgery for deformities. For example, strapping may be used to facilitate realignment in minor nonsurgical cases of hammertoe or to maintain correct position during postoperative healing.

Strapping of the foot or ankle

Ankle sprains and strains are a very common injury. An estimated 628,000 foot and ankle sprains occur in individuals in the U.S. each year. The treatment of ankle injuries, such as sprains or strains, varies depending upon the type and severity of the injury. Rest, ice, compression and elevation (RICE) therapy is often recommended for the first 24 to 48 hours following injury. Additional treatment options range from complete immobilization with casting to no supportive devices. Functional treatment or partial immobilization with strapping allows for some movement to maintain range of motion while providing some support. The 2013 American Physical Therapy Association (APTA) Clinical Practice Guidelines on Ankle Ligament Sprains recommends individuals use some type of external support in the acute phase along with progressive weight-bearing. The type of support should be based upon the severity of the injury. The evidence cited supporting strapping verses complete immobilization is based upon one cohort study and one cadaver study.

There is some debate regarding the best treatment for ankle injuries, however strapping remains a standard of care as a functional treatment option. Functional treatment allows individuals to quickly regain function and restore flexibility and strength as compared to complete immobilization with casting (Ardèvol, 2002; Kannus, 1991; Seah, 2010; Sommer, 1989). Due to the ability of strapping to temporarily support and restrict movement, it may be used for other types of foot or ankle injuries such as plantar fasciitis or tendinitis, or post-operatively.

Strapping of the thorax

There is no evidence supporting the use of chest or thorax strapping for any conditions, including back or neck pain. Chest wall strapping results in breathing in lower lung volumes and mimics the effects of restrictive lung diseases. While chest strapping can limit pain associated with fractured ribs, the risk of adverse pulmonary outcomes and alternative treatments for pain recommend against chest immobilization (Lazcano, 1989; Quick, 1990).

Strapping for other conditions

There is little clinical evidence in the form of published medical literature or clinical practice guidelines which support the use of strapping the elbow, wrist, shoulder, hip or knee. In addition, there is no indication that strapping is a standard of care for any conditions in these areas. The American Heart Association/ American Stroke Association 2016 guidelines for adult stroke rehabilitation and recovery note “Currently, there is insufficient evidence to support or refute the efficacy of shoulder strapping (taping) for the prevention of hemiplegic shoulder pain.”

Displaced fracture: When a bone has fractured (broken) and there is separation between the pieces.

Nondisplaced fracture: When a bone has fractured but has not separated.

Phalanges: Long bones located in the fingers or toes.

Sprain: Injury to the strong flexible fibers (ligaments) which surround a joint.

Strain: Injury to a muscle or the tissue which connects the muscle to the bone (tendon).

Strapping: The application of adhesive plaster or tape in overlapping strips for the purpose of restricting movement or immobilizing a body part.

Taping: The application of tape for the purpose of reducing pain and improving function, by supporting joints and facilitating normal muscle tone and proprioception. The level of support provided is proportional to the rigidity of the tape used.

Peer Reviewed Publications:

1. Andermahr J, Helling HJ, Maintz D, et al. The injury of the calcaneocuboid ligaments. Foot Ankle Int. 2000; 21(5):379-384.
2. Ardèvol J, Bolíbar I, Belda V, Argilaga S. Treatment of complete rupture of the lateral ligaments of the ankle: a randomized clinical trial comparing cast immobilization with functional treatment. Knee Surg Sports Traumatol Arthrosc. 2002; 10(6):371-377.
3. Arnold BL, Docherty CL. Bracing and rehabilitation--what's new. Clin Sports Med. 2004; 23(1):83-95.
4. Barouk P, Bohay DR, Trnka HJ, et al. Lesser metatarsal surgery. Foot Ankle Spec. 2010; 3(6):356-360.
5. Braakman M, Oderwald EE, Haentjens MH. Functional taping of fractures of the 5th metacarpal results in a quicker recovery. Injury. 1998; 29(1):5-9.
6. Carcia CR, Martin RL, Houck J, Wukich DK; Orthopaedic Section of the American Physical Therapy Association. Achilles pain, stiffness, and muscle power deficits: achilles tendinitis. J Orthop Sports Phys Ther. 2010; 40(9):A1-A26.
7. Fernández-Palazzi F, Rivas S, Mujica P. Achilles tendinitis in ballet dancers. Clin Orthop Relat Res. 1990; (257):257-261.
8. Hatch RL, Hacking S. Evaluation and management of toe fractures. Am Fam Physician. 2003; 68(12):2413-2418.
9. Jones NF, Jupiter JB, Lalonde DH. Common fractures and dislocations of the hand. Plast Reconstr Surg. 2012; 130(5):722e-736e.
10. Kannus P, Renström P. Treatment for acute tears of the lateral ligaments of the ankle. Operation, cast, or early controlled mobilization. J Bone Joint Surg Am. 1991; 73(2):305-312.
11. Kemler E, van de Port I, Backx F, et al. A systematic review on the treatment of acute ankle sprain: brace versus other functional treatment types. Sports Med. 2011; 41(3):185-197.
12. Lardenoye S, Theunissen E, Cleffken B, et al. The effect of taping versus semi-rigid bracing on patient outcome and satisfaction in ankle sprains: a prospective, randomized controlled trial. BMC Musculoskelet Disord. 2012; 13:81.
13. Lazcano A, Dougherty JM, Kruger M. Use of rib belts in acute rib fractures. Am J Emerg Med. 1989; 7(1):97-100.
14. Martínez-Catalán N, Pajares S, Llanos L, et al. A prospective randomized trial comparing the functional results of buddy taping versus closed reduction and cast immobilization in patients with fifth metacarpal neck fractures. J Hand Surg Am. 2020; 45(12):1134-1140.
15. Nellans KW, Chung KC. Pediatric hand fractures. Hand Clinics. 2013; 29(4):569-578.
16. Park C, Lee S, Kim S, Hwangbo G. The effects of the application of low-dye taping on paretic side plantar pressure among patients with plantar fasciitis. J Phys Ther Sci. 2015; 27(11):3555-3557.
17. Park KB, Lee KJ, Kwak YH. Comparison between buddy taping with a short-arm splint and operative treatment for phalangeal neck fractures in children. J Pediatr Orthop. 2016; 3 6(7):736-742.
18. Paschos NK, Abuhemoud K, Gantsos A, et al. Management of proximal interphalangeal joint hyperextension injuries: a randomized controlled trial. J Hand Surg Am. 2014; 39(3):449-454.
19. Podolsky R, Kalichman L. Taping for plantar fasciitis. J Back Musculoskelet Rehabil. 2015;28(1):1-6.
20. Quick G. A randomized clinical trial of rib belts for simple fractures. Am J Emerg Med. 1990; 8(4):277-281.
21. Seah R, Mani-Babu S. Managing ankle sprains in primary care: what is best practice? A systematic review of the last 10 years of evidence. Br Med Bull. 2011; 97:105-135.
22. Sommer HM, Arza D. Functional treatment of recent ruptures of the fibular ligament of the ankle. Int Orthop. 1989; 13(2):157-160.
23. Talusan PG, Milewski MD, Reach JS Jr. Fifth toe deformities: overlapping and underlapping toe. Foot Ankle Spec. 2013; 6(2):145-149.
24. van Aaken J, Kämpfen S, Berli M, et al. Outcome of boxer's fractures treated by a soft wrap and buddy taping: a prospective study. Hand (N Y). 2007; 2(4):212-217.
25. Vanti C, Bertozzi L, Gardenghi I, et al. Effect of taping on spinal pain and disability: systematic review and meta-analysis of randomized trials. Phys Ther. 2015; 95(4):493-506.
26. Waterman BR, Owens BD, Davey S, et al. The epidemiology of ankle sprains in the United States. J Bone Joint Surg Am. 2010; 92(13):2279-2284.
27. Williamson DM, Cole WG. Treatment of selected extension supracondylar fractures of the humerus by manipulation and strapping in flexion. Injury. 1993; 24(4):249-252.
28. Won SH, Lee S, Chung CY, et al. Buddy taping: is it a safe method for treatment of finger and toe injuries? Clin Orthop Surg. 2014; 6(1):26-31.

Government Agency, Medical Society, and Other Authoritative Publications:

1. Centers for Medicare and Medicaid Services. Local Coverage Determination (LCD): Outpatient Physical and Occupational Therapy Services. Available at: https://www.cms.gov/medicare-coverage-database/search.aspx?redirect=Y. Accessed on September 24, 2023.
2. Chalmer J, Blakeway M, Adams Z, Milan SJ. Conservative interventions for treating hyperextension injuries of the proximal interphalangeal joints of the fingers. Cochrane Database Syst Rev. 2013;(2):CD009030.
3. Martin RL, Davenport TE, Paulseth S, et al; Orthopaedic Section American Physical Therapy Association. Ankle stability and movement coordination impairments: ankle ligament sprains. J Orthop Sports Phys Ther. 2013; 43(9):A1-A40.
4. Poolman RW, Goslings JC, Lee JB, et al. Conservative treatment for closed fifth (small finger) metacarpal neck fractures. Cochrane Database Syst Rev. 2005;(3):CD003210.
5. Winstein CJ, Stein J, Arena R, et al; American Heart Association Stroke Council, Council on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology, and Council on Quality of Care and Outcomes Research. Guidelines for Adult Stroke Rehabilitation and Recovery: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2016; 47(6):e98-e169.

1. American Academy of Orthopaedic Surgeons (AAOS). Finger Fractures. Last Reviewed: June 2022. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00257. Accessed on September 24, 2023.
2. American Academy of Orthopaedic Surgeons (AAOS). Toe and Forefoot Fractures. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00165. Last Reviewed: November 2021. Accessed on September 24, 2023.
3. American Orthopaedic Foot & Ankle Society (AOFAS). Glossary of Foot and Ankle Terms. Available at: https://www.footcaremd.org/resources/glossary. Accessed on September 24, 2023.
4. National Institute of Health (NIH): National Institute of Arthritis and Musculoskeletal and Skin Disease. Sports Injuries. Available at: https://www.niams.nih.gov/health-topics/sprains-and-strains. Accessed on September 24, 2023.

Buddy taping

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Federal and State law, as well as contract language including definitions and specific coverage provisions/exclusions, and Medical Policy take precedence over Clinical UM Guidelines and must be considered first in determining eligibility for coverage. The member's contract benefits in effect on the date that services are rendered must be used. Clinical UM Guidelines, which address medical efficacy, should be considered before utilizing medical opinion in adjudication. Medical technology is constantly evolving, and we reserve the right to review and update Clinical UM Guidelines periodically. Clinical UM guidelines are used when the plan performs utilization review for the subject. Due to variances in utilization patterns, each plan may choose whether or not to adopt a particular Clinical UM Guideline. To determine if review is required for this Clinical UM Guideline, please contact the customer service number on the back of the member's card.

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