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The reliability of the neutral measurement of the subtalar joint

Discussion in 'Biomechanics, Sports and Foot orthoses' started by DevosArne, Nov 2, 2015.

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  1. DevosArne

    DevosArne Member


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    Hello,

    I am researching the reliability of the neutral position of the subtalar joint.
    For the moment we measure this at our institution by hand, by palpating the talushead and when we feel him equally medial and lateral then we 'assume' this is the neutral position.

    For the moment i have read the article about the calcaneal marker device in the article: "A Novel Device for Standardizing Marker Placement at the Calcaneus
    Kevin Deschamps, MSc* Philip Roosen, PhD? Ivan Birch, PhD? Bart Dingenen, MSc? Herman Bruyninckx, PhDjj Kaat Desloovere, PhD? Erwin Aertbelien, PhDjj Filip Staes, PhD?"

    In which they speak of a device they develloped to measure more accuratly.
    So my question is of anybody knows where i can get my hands on this device to test it's reliability and it's function in the practice of the podiatrist.

    And my second question is of anybody has any knowledge of other articles i can use for my research and/or your view on this matter.

    Kind regards,
    Devos Arne
     
  2. efuller

    efuller MVP

    Is you purpose to show that it is inaccurate? What would one do with an accurate neutral position? The originator of podiatric neutral position described three different methods for determining neutral position. I heard someone talking about a study that showed the three different methods did not come up with same position. I don't know if that study ever got published.

    There has been much discussion of the validity of neutral position of the STJ on this site. You might want to look through some of that discussion.

    Eric
     
  3. Rob Kidd

    Rob Kidd Well-Known Member

    As always, back to basics. The essential knowledge of tautology is vital here. Neutral at ST is defined something like this: that position in which the joint is neither pronated nor supinated. Then look at the definitions of those two movements - movements away from neutral. Classic tautology - uses itself to define itself. An absolute no-no in science. Maybe, had the originators of this stuff had a proper grounding in science, this sort of nonsense would never had appeared. However, (and in my opinion), just because there is no scientific basis for ST neutral, does not mean that is it not useful clinically. While I am a long time dead clinician, I am still allowed to have an opinion on such matters. Why is neutral so important to you? If you scan back through the plethora of debates on this arena, you will find many - not just me - that have serious issues with it.
     
  4. DevosArne

    DevosArne Member

    The purpose of my investigation is to 'invent' a reliable measuring intstrument to determine the neutral position of the ST joint. As there is allready one on the market i would like to investigate that one. We as podiatrist in Belgium are more and more looking for numbers, for data we can put into a sheet, reliable data, reproduceble data.

    Now most of the things we measure are with 'the wet finger technique' as we say in belgium. Most of our measurements are by hand, and the reliability is not good, e.g. if we measure the pronation of the ST joint and then in our gait analysis we measure the pronation buffer of that patient, then it is important if we measure 6? or 8? if the patient only has a buffer of 8?.
    The purpose of that measurement device will be if you measure it and I measure it, we will have the same X degrees with that patient.

    There was a research (ROBERT A. ELVERU; JULES M. ROTHSTEIN; and ROBERT L. (1988). Goniometric Reliability in a Clinical Setting Subtalar and Ankle Joint Measurements. Journal of the American Phisical Therapy Association. Retrieved April 10, 2015, from http://ptjournal.apta.org/content/68/5/672.full.pdf)
    In wich they placed the bissectrice of the STJ by joung graduates because of the placing error
     
  5. DevosArne

    DevosArne Member

    We use the ST joint to determine how much we can correct the foot in an orthesis sole and if there is enough ROM for the patient to use during his gait. Now the placement of the bissectrice on the ST joint is more of a guessing work because we draw it on the skin but we are looking at the movement of the calcaneum. We also use it for the NCS and the OCS.

    Because of that importance in our school i have to 'invent' a new measuring device to determine a more reliable placement of the bissectrice so that our measurement are more the same and the fault error is practicly none existance.
     


  6. Impossible to the bolded part

    Why not just show people how to find the STJ axis, which Ken and Joris(?) showed to be accurate and had reliable practitioner to practitioner accuracy

    STJ neutral is nothing I would focus on

    here is some reading re STJ axis

    Determination of subtalar joint axis location by restriction of talocrural joint motion Gregory Lewis,
    Kevin Arthur Kirby,Stephen J Piazza


    Subtalar Joint Axis Location and
    Rotational Equilibrium Theory of Foot Function
    Kevin A. Kirby


    The Subtalar Joint Axis Palpation Technique?Part 1
    Validating a Clinical Mechanical Model


    The Subtalar Joint Axis Palpation Technique
    Part 2: Reliability and Validity Results Using Cadaver Feet


    so why go backwards when you can go forward
     
  7. Rob Kidd

    Rob Kidd Well-Known Member

    If I said that you are trying to measure was it not there, that would be one step too far. However, you seem to make assumptions which are not valid, My advice , as always, is back to basics.
     
  8. Rob it that to post about my post ?
     
  9. Rob Kidd

    Rob Kidd Well-Known Member

    No Mike, it is about the validity of ST Neutral itself, I try very hard not to get personal, though my patience is being tested just now in another thread: re creationism. I look forward to your posts and value them, Rob
     

  10. ahh yes :D
     
  11. DevosArne

    DevosArne Member

    I apologise if i am offending you with my question, but this is the subject I have to write my thesis about.

    This was given to me by my institution. I am only a student who has to write a thesis about this subject who came to this forum in search of the knowledge of some more experienced podiatrist and other medical professions.

    I cannot change it and I have to investigate it if i want to graduate as a podiatrist this year.
    the fact is that there is indeed not alot of investigation about this subject and i'll put the article of the measuring device in this post if there is anybody who is interested.
     
  12. Not offending

    But a very serious question would be why were you given this topic? I would ask it to your instructor.

    Looks really good what you have produced though ( in a quick scan)

    But say your device in for arguments point 100% accurate

    What does it help with in a practical sense.

    If you feel like there is a somewhat negative posting feeling , the STJ neutral discussion has been had many times here and usually ends in quite heated discussions.

    I know you will be feeling a bit deflated the article looks great and you may have found a way to get the bi-section line drawn much much more accurately, then we move to the next point practically what does that mean ?
     
  13. DevosArne

    DevosArne Member

    I will have to dissapoint you, sir. I didn't write that article, this is just the main article I use to write the thesis. All the things i have written for the moment are in dutch.
     
  14. ok so you are going to test a similar idea for your thesis

    anyway you could change the thesis to testing STJ Axis palpation would be much better and you would get much more help :D
     
  15. DevosArne

    DevosArne Member

    i'll suggest is to my instructor but i fear that will not be possible, anyways allready thanks for the help and suggestions!
     
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