Difference between revisions of "Taping"

From Fellrnr.com, Running tips
Jump to: navigation, search
User:Fellrnr (User talk:Fellrnr | contribs)
User:Fellrnr (User talk:Fellrnr | contribs)
m
Line 29: Line 29:
 
* Applying a small amount of anti-biotic ointment onto the blister itself can help prevent it getting stuck to the tape and provides a small measure of protection from infection if the blister bursts naturally.
 
* Applying a small amount of anti-biotic ointment onto the blister itself can help prevent it getting stuck to the tape and provides a small measure of protection from infection if the blister bursts naturally.
 
* Dust with powder as a final step so the excess adhesive does not stick to the socks.
 
* Dust with powder as a final step so the excess adhesive does not stick to the socks.
 
 
==Partially blistered toe==
 
==Partially blistered toe==
 
This is quite a common area to blister.
 
This is quite a common area to blister.
Line 44: Line 43:
 
* Dust in powder so the excess adhesive does not stick to the socks.
 
* Dust in powder so the excess adhesive does not stick to the socks.
 
* If Injinji socks are not used, then the tape may rub on the next toe. It may be possible to cover part of the next toe with tape to prevent this, rather than taping every toe.  
 
* If Injinji socks are not used, then the tape may rub on the next toe. It may be possible to cover part of the next toe with tape to prevent this, rather than taping every toe.  
 
 
==Completely blistered toe==
 
==Completely blistered toe==
 
A completely blistered toe is unusual, but is especially problematic as there is no skin left to attach the tape to. Instead, tags of tape must be used to attach the tape to the foot.  
 
A completely blistered toe is unusual, but is especially problematic as there is no skin left to attach the tape to. Instead, tags of tape must be used to attach the tape to the foot.  
Line 60: Line 58:
 
* Dust in powder so the excess adhesive does not stick to the socks.
 
* Dust in powder so the excess adhesive does not stick to the socks.
 
* If Injinji socks are not used, then the tape may rub on the next toe. It may be possible to cover part of the next toe with tape to prevent this, rather than taping every toe.  
 
* If Injinji socks are not used, then the tape may rub on the next toe. It may be possible to cover part of the next toe with tape to prevent this, rather than taping every toe.  
 
 
==Side of the big toe==
 
==Side of the big toe==
 
This is basically the same as the partially blistered toe, but there is a stronger case for cutting open the toe box of the shoe near the blister.  
 
This is basically the same as the partially blistered toe, but there is a stronger case for cutting open the toe box of the shoe near the blister.  
 
 
==Sides of heel ==
 
==Sides of heel ==
 
* [[Blister Prevention#Blisters on the back or sides of the heel|Prevention tips]]
 
* [[Blister Prevention#Blisters on the back or sides of the heel|Prevention tips]]
Line 69: Line 65:
 
* Small blisters could be left intact, but larger blisters will require popping if the athlete is to continue running.  
 
* Small blisters could be left intact, but larger blisters will require popping if the athlete is to continue running.  
 
* Do you have lots of time? Then use the luxury taping approach, otherwise use the rapid approach.  
 
* Do you have lots of time? Then use the luxury taping approach, otherwise use the rapid approach.  
 
 
===Rapid===
 
===Rapid===
 
* Clean the area thoroughly.  
 
* Clean the area thoroughly.  
Line 78: Line 73:
 
* Gently smooth the tape; if there are any creases, pinch them into a few large folds and cut the folds away.  
 
* Gently smooth the tape; if there are any creases, pinch them into a few large folds and cut the folds away.  
 
* Dust in powder so the excess adhesive does not stick to the socks.
 
* Dust in powder so the excess adhesive does not stick to the socks.
 
 
 
===Luxury ===
 
===Luxury ===
 
* Clean the area thoroughly.  
 
* Clean the area thoroughly.  
Line 90: Line 83:
 
* Apply strips of Micropore around the edges of the Kinesio-Text tape.
 
* Apply strips of Micropore around the edges of the Kinesio-Text tape.
 
* Dust in powder so the excess adhesive does not stick to the socks.
 
* Dust in powder so the excess adhesive does not stick to the socks.
 
 
==Side of ball==
 
==Side of ball==
 
The side of the ball of the foot can be treated much like the sides of heel, but there is more movement due to the bending of the foot. Small blisters can use the rapid approach, but for larger areas, the flexibility of the Kinesio-Tex tape may justify the extra effort. Prevention tips - [[Blister Prevention#Blisters on the sides of the forefoot]].
 
The side of the ball of the foot can be treated much like the sides of heel, but there is more movement due to the bending of the foot. Small blisters can use the rapid approach, but for larger areas, the flexibility of the Kinesio-Tex tape may justify the extra effort. Prevention tips - [[Blister Prevention#Blisters on the sides of the forefoot]].
 
 
==Under the ball ==
 
==Under the ball ==
 
This is one of the nastiest places to get a blister, as it is the primary part of the foot used for running.  
 
This is one of the nastiest places to get a blister, as it is the primary part of the foot used for running.  
Line 103: Line 94:
 
* Apply the adhesive promoter to the undamaged skin either side of the blister.
 
* Apply the adhesive promoter to the undamaged skin either side of the blister.
 
* Apply tape over the ball of the foot and up either side, but don't circle the foot entirely as this could constrict blood supply.  
 
* Apply tape over the ball of the foot and up either side, but don't circle the foot entirely as this could constrict blood supply.  
 
 
==Under the heel==
 
==Under the heel==
 
This is similar to the ball of the foot, with the tape applied up either side of the heel. [[Blister Prevention# Blisters under the heel of the foot|Prevention tips]]
 
This is similar to the ball of the foot, with the tape applied up either side of the heel. [[Blister Prevention# Blisters under the heel of the foot|Prevention tips]]
 
 
==Between the toes==
 
==Between the toes==
 
A blister between the toes can be quite painful, and can easily spread under the foot.  
 
A blister between the toes can be quite painful, and can easily spread under the foot.  
Line 120: Line 109:
 
* If time is limited, a simple strip of Kinesio-Tex tape could be used.
 
* If time is limited, a simple strip of Kinesio-Tex tape could be used.
 
* Dust in powder so the excess adhesive does not stick to the socks.
 
* Dust in powder so the excess adhesive does not stick to the socks.
 
 
==Back of the heel and Achilles==
 
==Back of the heel and Achilles==
 
A blister here is almost as nasty as under the ball of the foot. Flexibility is required for normal foot movement and there is pressure from the shoe.  
 
A blister here is almost as nasty as under the ball of the foot. Flexibility is required for normal foot movement and there is pressure from the shoe.  
Line 126: Line 114:
 
* A blister on the back of the heel or Achilles will sometimes require popping if the athlete is to continue running.  
 
* A blister on the back of the heel or Achilles will sometimes require popping if the athlete is to continue running.  
 
* Do you have lots of time? Then use the luxury taping approach, otherwise use the rapid approach.  
 
* Do you have lots of time? Then use the luxury taping approach, otherwise use the rapid approach.  
 
 
===Rapid===
 
===Rapid===
 
* Clean the area thoroughly.  
 
* Clean the area thoroughly.  
Line 135: Line 122:
 
* Gently smooth the tape; if there are any creases, pinch them into a few large folds and cut the folds away.  
 
* Gently smooth the tape; if there are any creases, pinch them into a few large folds and cut the folds away.  
 
* Dust in powder so the excess adhesive does not stick to the socks.
 
* Dust in powder so the excess adhesive does not stick to the socks.
 
 
 
===Luxury ===
 
===Luxury ===
 
* Clean the area thoroughly.  
 
* Clean the area thoroughly.  
Line 147: Line 132:
 
* Apply strips of Micropore around the edges of the Kinesio-Text tape.
 
* Apply strips of Micropore around the edges of the Kinesio-Text tape.
 
* Dust in powder so the excess adhesive does not stick to the socks.
 
* Dust in powder so the excess adhesive does not stick to the socks.
 
 
 
=Pre-Taping=
 
=Pre-Taping=
 
As well is taping a blister that has already occurred, it is possible to take before the race begins. There are advantages and disadvantages to this approach, and if possible, it is far better to avoid the underlying causes of blistering.
 
As well is taping a blister that has already occurred, it is possible to take before the race begins. There are advantages and disadvantages to this approach, and if possible, it is far better to avoid the underlying causes of blistering.
 
 
==Advantages of pre-taping ==
 
==Advantages of pre-taping ==
 
* If you found no way of preventing the blisters then pre-taping may help.
 
* If you found no way of preventing the blisters then pre-taping may help.
Line 158: Line 140:
 
* Some adhesives seem to become stronger after a day or so.
 
* Some adhesives seem to become stronger after a day or so.
 
* Taping a day or two before the race allows you to check the taping fits correctly and is not going to cause a problem.
 
* Taping a day or two before the race allows you to check the taping fits correctly and is not going to cause a problem.
 
 
==Disadvantages of pre-taping ==
 
==Disadvantages of pre-taping ==
 
* It's harder to check if a blister is forming if you've pre-taped your feet. I've seen a number of runners who were convinced they had blisters when in fact it was just a hotspot.
 
* It's harder to check if a blister is forming if you've pre-taped your feet. I've seen a number of runners who were convinced they had blisters when in fact it was just a hotspot.
Line 164: Line 145:
 
* It's possible for the tape to ruck up and actually cause a blister rather than prevent one. I've had tape come loose and migrate to a different part of the foot where it caused a blister that would never otherwise have occurred.
 
* It's possible for the tape to ruck up and actually cause a blister rather than prevent one. I've had tape come loose and migrate to a different part of the foot where it caused a blister that would never otherwise have occurred.
 
* Your feet may swell during the race, and taping can cause constriction. This is especially a problem if you tape around a toe.
 
* Your feet may swell during the race, and taping can cause constriction. This is especially a problem if you tape around a toe.
 
 
==Approaches to pre-taping==
 
==Approaches to pre-taping==
 
There are two approaches to pre-taping; Spot taping and area taping. Spot taping is where you apply tape to a small area that is blister prone. I have found that this can be a useful approach if you have a particular vulnerability. Area taping involves applying tape to a large portion of the foot, creating what amounts to a tape-based sock. The advantages of area taping are that the edges of the tape are well away from the pressure zones. However, area taping is generally trickier to get right.
 
There are two approaches to pre-taping; Spot taping and area taping. Spot taping is where you apply tape to a small area that is blister prone. I have found that this can be a useful approach if you have a particular vulnerability. Area taping involves applying tape to a large portion of the foot, creating what amounts to a tape-based sock. The advantages of area taping are that the edges of the tape are well away from the pressure zones. However, area taping is generally trickier to get right.
 
 
==Tapes for pre-taping==
 
==Tapes for pre-taping==
 
You may find that different takes are appropriate for pre-taping, as there is no blister that requires protection. I generally prefer Micropore for pre-taping, as it is low friction and reduces any stretching forces on the skin.
 
You may find that different takes are appropriate for pre-taping, as there is no blister that requires protection. I generally prefer Micropore for pre-taping, as it is low friction and reduces any stretching forces on the skin.
 
 
=Also See=
 
=Also See=
 
* [[Book Review - Fixing Your Feet|Fixing Your Feet]] is a great book that includes details of taping
 
* [[Book Review - Fixing Your Feet|Fixing Your Feet]] is a great book that includes details of taping

Revision as of 12:53, 19 May 2012

Taping may be required to prevent blisters or if they occur anyway, to help treat them. Different tapes have different properties, and it's best to gain experience with different tapes before using them in a race. Even putting a piece of tape on the edge of your hand will give you an idea of how well it stick and how flexible it is.

1 General Taping Tips

  • Practice taping for your training runs – remember The Golden Rule of Racing
  • Remember your feet may swell so avoid taping too tightly.
  • If you get a blister, taping can prevent it getting worse and can relieve the pain.
  • Taping a blister can create more pressure on the blister if done incorrectly.
  • You can tape a blister with or without popping it. Popping a blister is a bad idea, but sometimes it's necessary if the blister will spread.
  • Taping should be a last resort; try to fix the underlying problem first.

2 Tapes

  • Micropore[1] This is my default tape, partly because I have been using Micropore from my earliest memories due to my skin condition. Micropore is very thin, smooth and inflexible, but not very sticky, so you need to use it with an adhesive promoter. The biggest problem with Micropore is that it is not very durable. I find it will last well enough for a race, but I like to tape a day or two ahead of time to make sure the tape is right, and it can suffer wear in the mean time.
  • Leukotape P [2] This is thicker, slightly rough textured, inflexible tape. It works very well when you need something more robust than Micropore.
  • Elastikon[3] This tape is thicker than any of the others, slightly rough, but flexible and porous.
  • Kinesio-Tex This is a soft tape that stretches in one direction. I find that it does not stick well without an adhesive promoter, though rubbing the tape to warm it before applying will help it stick a little better. I also find the edges tend to fray, so I will often use some Micropore to stick the edges down.
  • Duct Tape I strongly recommend against using duct tape, as it is not breathable, so the skin tends to become saturated underneath. Duct Tape also tends to wrinkle, creating creases that cause further problems. Like many other tapes, you need to use it with an adhesive promoter to get it to stick effectively. Watch the edges, as they tend to catch and then the tape then rolls up. I have used Micropore on the edges, with some success.

3 Adhesive Promoter

  • Friar's Balsam[4] Also known as Tincture of Benzoin, this helps tapes stick much better. I find it important to apply the balsam to the area where the tape is going to be placed; If you miss a spot, then the tape will tend to lift up in that spot. If you over apply it, you can remove the excess with rubbing alcohol or smother it with talcum powder.
  • Mastisol[5] This is seems to work better than Friar's Balsam – it is claimed to be 7-10 times sticker. I'm not sure if that is true, but it does work remarkably well. Easy to apply, but expensive!

4 Adhesive Remover

  • Detachol[6] This adhesive remover works great for removing tape, especially around blisters. You still have to be careful, easing up the edges and applying some of the detachol, but it's quite easy. I use a cotton bud to rub the detachol at the point where the tape meets the skin. It seems to leave no residue or upset the skin in any way.

5 How to tape a blister

I've practiced taping my own blisters, and worked the Umstead 100 aid station, taping many runners feet.

5.1 General Principles

  • Clean the area around the blister. If lubricant has been used, this can be tricky to remove completely. Using alcohol can help; I'd recommend using plenty of rubbing alcohol as it's cheap and a good solvent.
  • Be aware of the passage of time during a race, as it's possible to burn through enough time that meeting the cut offs becomes difficult.
  • Only burst blisters if they are likely to spread.
  • Adhesive promoter is usually a good idea.
  • Avoid duct tape – it's macho, but a poor solution.
  • Applying a small amount of anti-biotic ointment onto the blister itself can help prevent it getting stuck to the tape and provides a small measure of protection from infection if the blister bursts naturally.
  • Dust with powder as a final step so the excess adhesive does not stick to the socks.

5.2 Partially blistered toe

This is quite a common area to blister.

  • Prevention tips
  • Try to clean the area as well as possible.
  • A blister on the toes will sometimes require popping if the athlete is to continue running.
  • Cutting open the toe box may help, but has some risk if this is done in the middle of a race.
  • Mastisol is recommended, but tincture of benzoin will work.
  • Micropore or Leukotape are the best tape choices.
  • Apply the adhesive promoter to the skin of the toe that is unblistered. Applying to the toe nail may be necessary if there is little unblistered skin left, but this will make the tape hard to remove.
  • Wrap the toe in tape; don't make the tape too tight as this could cause constriction. If the blister is not burst, care must be taken that the tape does not force the blister to spread further.
  • Gently smooth the tape over the end of the toe, pinching into a few large folds.
  • Cut the folds away, leaving a smooth covering.
  • Dust in powder so the excess adhesive does not stick to the socks.
  • If Injinji socks are not used, then the tape may rub on the next toe. It may be possible to cover part of the next toe with tape to prevent this, rather than taping every toe.

5.3 Completely blistered toe

A completely blistered toe is unusual, but is especially problematic as there is no skin left to attach the tape to. Instead, tags of tape must be used to attach the tape to the foot.

  • Prevention tips
  • Try to clean the area as well as possible.
  • A complete blistering of a toe will often require popping if the athlete is to continue running.
  • Cutting open the toe box may help, but has some risk if this is done in the middle of a race.
  • Mastisol is necessary; only use tincture of benzoin if Mastisol is not available.
  • Micropore or Leukotape are the best tape choices.
  • Wrap the toe in tape; don't make the tape too tight as this could cause constriction. If the blister is not burst, care must be taken that the tape does not force the blister to spread further.
  • Gently smooth the tape over the end of the toe, pinching into a few large folds.
  • Cut the folds away, leaving a smooth covering.
  • Apply the adhesive promoter to the skin of the foot near the toe and to the tape at the top and bottom of the toe.
  • Apply tape 'bridges' between the tape over the toe and the foot itself.
  • Dust in powder so the excess adhesive does not stick to the socks.
  • If Injinji socks are not used, then the tape may rub on the next toe. It may be possible to cover part of the next toe with tape to prevent this, rather than taping every toe.

5.4 Side of the big toe

This is basically the same as the partially blistered toe, but there is a stronger case for cutting open the toe box of the shoe near the blister.

5.5 Sides of heel

  • Prevention tips
  • A blister on the side of the foot will sometimes require popping if the athlete is to continue running. If the blister is small and just starting to form, it may be okay to leave it depending on the conditions and the length of the race remaining.
  • Small blisters could be left intact, but larger blisters will require popping if the athlete is to continue running.
  • Do you have lots of time? Then use the luxury taping approach, otherwise use the rapid approach.

5.5.1 Rapid

  • Clean the area thoroughly.
  • Tincture of benzoin is recommended, but use Mastisol if the conditions are wet.
  • Micropore or Leukotape are the best tape choices.
  • Apply the adhesive promoter to the skin around the blister, far enough around to ensure it goes beyond the taping.
  • Place a piece of Micropore or Leukotape over the blister, providing at least 0.5 inch/1cm beyond the edge of the blister.
  • Gently smooth the tape; if there are any creases, pinch them into a few large folds and cut the folds away.
  • Dust in powder so the excess adhesive does not stick to the socks.

5.5.2 Luxury

  • Clean the area thoroughly.
  • Tincture of benzoin is required, but use Mastisol if the conditions are wet.
  • Use Kinesio-Tex with Micropore.
  • Apply the adhesive promoter to the skin around the blister, far enough around to ensure it goes beyond the taping.
  • Place a piece of Kinesio-Tex over the blister, providing at least 0.5 inch/1cm beyond the edge of the blister.
  • Gently smooth the tape; if there are any creases, pinch them into a few large folds and cut the folds away.
  • Apply more adhesive promoter to the skin around the Kinesio-Tex tape and to the edges of the tape itself, far enough around to ensure it goes another 0.5 inch/1cm beyond the Kinesio-Tex taping.
  • Apply strips of Micropore around the edges of the Kinesio-Text tape.
  • Dust in powder so the excess adhesive does not stick to the socks.

5.6 Side of ball

The side of the ball of the foot can be treated much like the sides of heel, but there is more movement due to the bending of the foot. Small blisters can use the rapid approach, but for larger areas, the flexibility of the Kinesio-Tex tape may justify the extra effort. Prevention tips - Blister Prevention#Blisters on the sides of the forefoot.

5.7 Under the ball

This is one of the nastiest places to get a blister, as it is the primary part of the foot used for running.

  • Prevention tips
  • Clean the area thoroughly.
  • Popping the blister is normally required if it has not naturally popped under the pressure of running.
  • Tincture of benzoin is recommended, and Mastisol is generally not required as there is normally plenty of skin on the sides and top of the foot to adhere to.
  • The best tape is Leukotape, as you want to stabilize the damaged skin and limit the motion of the blister against the underlying sub-skin. Flexible tape is not going to help
  • Apply the adhesive promoter to the undamaged skin either side of the blister.
  • Apply tape over the ball of the foot and up either side, but don't circle the foot entirely as this could constrict blood supply.

5.8 Under the heel

This is similar to the ball of the foot, with the tape applied up either side of the heel. Prevention tips

5.9 Between the toes

A blister between the toes can be quite painful, and can easily spread under the foot.

  • Prevention tips
  • Clean the area as well as possible, which can be difficult in this area.
  • A blister between the toes will sometimes require popping if the athlete is to continue running.
  • Tincture of benzoin is recommended.
  • A combination of Kinesio-Tex and Micropore or Leukotape is required.
  • Apply the adhesive promoter to the skin of above and below the blister.
  • Cut a butterfly shape out of the Kinesio-Tex tape, so that the narrow section will fit between the toes.
  • Apply the butterfly shape; help will be needed holding the toes apart.
  • Use Micropore or Leukotape to tape the ends of the butterfly down.
  • If time is limited, a simple strip of Kinesio-Tex tape could be used.
  • Dust in powder so the excess adhesive does not stick to the socks.

5.10 Back of the heel and Achilles

A blister here is almost as nasty as under the ball of the foot. Flexibility is required for normal foot movement and there is pressure from the shoe.

  • Prevention tips
  • A blister on the back of the heel or Achilles will sometimes require popping if the athlete is to continue running.
  • Do you have lots of time? Then use the luxury taping approach, otherwise use the rapid approach.

5.10.1 Rapid

  • Clean the area thoroughly.
  • Tincture of benzoin is recommended, but use Mastisol if the conditions are wet.
  • Leukotape is the best tape choice.
  • Apply the adhesive promoter to the skin around the blister, far enough around to ensure it goes beyond the taping.
  • Place a piece of Leukotape over the blister, providing at least 0.5 inch/1cm beyond the edge of the blister.
  • Gently smooth the tape; if there are any creases, pinch them into a few large folds and cut the folds away.
  • Dust in powder so the excess adhesive does not stick to the socks.

5.10.2 Luxury

  • Clean the area thoroughly.
  • Tincture of benzoin is required, but use Mastisol if the conditions are wet.
  • Use Kinesio-Tex with Micropore.
  • Apply the adhesive promoter to the skin around the blister, far enough around to ensure it goes beyond the taping.
  • Place a piece of Kinesio-Tex over the blister, providing at least 0.5 inch/1cm beyond the edge of the blister.
  • Gently smooth the tape; if there are any creases, pinch them into a few large folds and cut the folds away.
  • Apply more adhesive promoter to the skin around the Kinesio-Tex tape and to the edges of the tape itself, far enough around to ensure it goes another 0.5 inch/1cm beyond the Kinesio-Tex taping.
  • Apply strips of Micropore around the edges of the Kinesio-Text tape.
  • Dust in powder so the excess adhesive does not stick to the socks.

6 Pre-Taping

As well is taping a blister that has already occurred, it is possible to take before the race begins. There are advantages and disadvantages to this approach, and if possible, it is far better to avoid the underlying causes of blistering.

6.1 Advantages of pre-taping

  • If you found no way of preventing the blisters then pre-taping may help.
  • Pre-taping is done on dry skin, so generally adhesion is much better.
  • And you can spend a lot more time doing the pre-taping than is possible or practical during the actual race.
  • Some adhesives seem to become stronger after a day or so.
  • Taping a day or two before the race allows you to check the taping fits correctly and is not going to cause a problem.

6.2 Disadvantages of pre-taping

  • It's harder to check if a blister is forming if you've pre-taped your feet. I've seen a number of runners who were convinced they had blisters when in fact it was just a hotspot.
  • The taping has to last for the full length of the race when you pre-tape, which can be a challenge for longer races. Always use an adhesive promoter when pre-taping.
  • It's possible for the tape to ruck up and actually cause a blister rather than prevent one. I've had tape come loose and migrate to a different part of the foot where it caused a blister that would never otherwise have occurred.
  • Your feet may swell during the race, and taping can cause constriction. This is especially a problem if you tape around a toe.

6.3 Approaches to pre-taping

There are two approaches to pre-taping; Spot taping and area taping. Spot taping is where you apply tape to a small area that is blister prone. I have found that this can be a useful approach if you have a particular vulnerability. Area taping involves applying tape to a large portion of the foot, creating what amounts to a tape-based sock. The advantages of area taping are that the edges of the tape are well away from the pressure zones. However, area taping is generally trickier to get right.

6.4 Tapes for pre-taping

You may find that different takes are appropriate for pre-taping, as there is no blister that requires protection. I generally prefer Micropore for pre-taping, as it is low friction and reduces any stretching forces on the skin.

7 Also See

8 References

  1. http://www.zombierunner.com/store/categories/foot_care/tapes/product6.html Micropore at Zombie Runner
  2. http://www.zombierunner.com/store/categories/foot_care/tapes/product967.html Leukotape P at Zombie Runner
  3. http://www.zombierunner.com/store/categories/foot_care/tapes/product1.html
  4. http://www.zombierunner.com/store/categories/foot_care/adhesives/product125.html Friar's Balsam/Tinture of Benzoin at Zombie Runner
  5. http://www.zombierunner.com/store/categories/foot_care/adhesives/product1026.html Mastisol at Zombie Runner
  6. Eloquest Healthcare Detachol http://www.eloquesthealthcare.com/products/detachol.aspx