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Measuring and recording Supination Resistance Test Results clinically

Discussion in 'Biomechanics, Sports and Foot orthoses' started by TedJed, Mar 25, 2016.

  1. TedJed

    TedJed Active Member

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    Apologies if this has been discussed/answered elsewhere on PA but I was unable to find a clear answer in my searches...

    My question is:

    How do you measure and record the amount of force required to supinate the foot in your clinical assessment?

    I note that Kevin K advises:

    '...the clinician notes the magnitude of force that is required to supinate the foot from its resting position...'

    How does one do this? A '4 Plus' system? Do you have a 'force measuring' instrument?

    I'm looking for a practical, clinical solution.

    Also, what are the common mistakes rookies make when first starting out with the Supination Resistance test?

    Thank you,
  2. BEN-HUR

    BEN-HUR Well-Known Member

    You may well be interested in the following cited page (if you haven't seen it yet)... The concept of 'Supination Resistance' (http://www.runresearchjunkie.com/the-concept-of-supination-resistance/).

    It is an article from Craig Payne ("Running Research Junkie" blog). It discusses your questions, which are good questions pertaining to the crux of prominent (prevalent) adverse forces & how to assess thereof (which are potentially predictive &/or correlate with certain types of injuries). The article also cites Dr Kirby's views on this test as well as methods measuring such forces (supination resistance) which I've thought about a fair bit as far as your query pertaining to "a practical clinical solution" (i.e. an adequate in-clinic test device/method... reducing the degree of subjectivity with the finger test - albeit, still useful)...


    ... & subsequently marrying such findings in providing optimal orthotic devices supplying adequate functioning to resolve injury i.e. orthosis supplying sufficient external supination moments to the foot (STJ)... to overcome the adverse degree of pronation moments (excess pronatory forces) contributing to such injuries. Force/kinetics over motion/kinematics in predictability for injury (or cause thereof) & for orthotic prescription...

    These issues are important in picking the right orthotic for patients (i.e. off-shelf or less rigid device may benefit low supination resistance force clients... custom or more rigid device should benefit high supination resistance force clients e.g. medial deviated STJ axis cases); right orthotic traits (i.e. medial skive, medial flare, reverse Morton's extension, 1st ray cut-out etc...) & right materials to use (density/hardness of shell material; friction qualities of the top cover). However, with some patients it's pretty obvious what they will benefit from... but it's nice to know the actual (or ballpark) degree of force present within some feet which are contributing to their injury (makes for interesting stats) as well as collating data for the correlation to what orthosis materials are more appropriate (characteristics thereof i.e. load tolerance) which can address/withstand such forces discovered. Yet even then it's not quite that 'simple', it's not just what the materials can withstand... but also the shape/contour/length of the device (i.e. device arch contour) to keep in mind for an optimal outcome (as these traits impact on device flex... & subsequent effectiveness in providing adequate external moments to the foot/STJ).

    Hence for those not-so obvious patients & more challenging humans... this (supination resistance) test is handy to get a practical grip of :rolleyes: ... preferably with something that measures (provides quantitative feedback)...


    I suppose a wooden board (doesn't cost much) to stand on, strong non-flexible strap (wouldn't cost much) attached to the board & the important force gauge (cost ???) would do the job like in image above. Ask patient to stand there (don't do anything - just stand naturally!)... you then resupinate the foot to that infamous neutral position via the strap/gauge apparatus & record the measurement. Could be fairly easy to make... & inexpensive. Maybe Craig could shed some light on this... making & cost thereof?

    Then maybe... in getting real creative & techy... combine the above supination resistance test method with (or within) a digital scanner device to also obtain a digital image of foot... which then also can be used for orthotic fabrication (now that could be an invention [noted here first on 25-3-16] :rolleyes: ).

    Not only is assessing such forces interesting... it adds another notch to the empirical science of orthotic therapy as an optimal form of lower limb treatment ;)

    *** There is also Ian Griffiths blog on the "The Supination Resistance Test" (which is also cited in Craig's article) found here - The Supination Resistance Test (https://sportspodiatryinfo.wordpress.com/2010/03/07/the-supination-resistance-test/).
  3. TedJed

    TedJed Active Member

    Thanks mate,

    You've just made it a 'Good Friday'! ;)
  4. Griff

    Griff Moderator

  5. A little history on the creation of the Supination Resistance Test may be of help here.

    I first started experimenting with the idea of the Supination Resistance Test in 1984-1985 during my Biomechanics Fellowship at the California College of Podiatric Medicine (CCPM). At that time, I was also actively formulating ideas on how medial and lateral subtalar joint (STJ) axis deviation affected how the foot functioned and on how STJ axis deviation affected the mechanical behavior of the extrinsic muscles of the foot during weightbearing activities.

    One must also understand that in 1984-1985, I was the only one interested in determining STJ axis location since everyone else in the CCPM Biomechanics Department was teaching Root STJ Neutral Theory where we were taught by measuring the foot and lower extremity we could then make the best orthotic for the patient. Root STJ Neutral Theory did not teach to alter the orthosis prescription depending on the anatomic location of the presenting complaint, but rather taught that by making a vertically balanced foot orthosis with a 4 degree/4 degree rearfoot post that ended at the metatarsal head and without any topcovers or forefoot extensions for nearly all feet, one could "prevent abnormal compensations", "lock the midtarsal joint" and make the "STJ function in neutral position".

    The reason I invented the Supination Resistance Test and chose the medial navicular as the area I would try pulling up on to do the test was that the medial navicular was the area of insertion for the strongest supinator of the foot, the posterior tibial muscle. I wanted a test where I could "feel the force" that the posterior tibial muscle would need to create at the medial navicular to get the STJ to supinate since I had already noted that doing the standard Root measurements (i.e. FF to RF, RF varus/valgus, RCSP) correlated poorly to pathology and seemed to have very little correlation to gait function.

    By the time I started writing, in 1990, the chapter in DeValentine's book where I first described the Supination Resistance Test, I had already been using the test in my practice for about 5 years and was very confident in its results (Kirby KA, Green DR: Evaluation and Nonoperative Management of Pes Valgus, pp. 295-327, in DeValentine, S.(ed), Foot and Ankle Disorders in Children. Churchill-Livingstone, New York, 1992). I'm glad to see that it has become a valuable test for others also in helping determine the internal forces within the feet of our patients.
  6. Jig that I built and a little data- cost was approaching 1000 sterling. BTW the photo in the top right corner of the first slide was a match for "Simon Spooner" when I googled it a few years back at the time when I was preparing the lecture that these slides belong to- guns, guitar, single bed and thong, what can I say...

    Attached Files:

  7. It seemed so plausible...... https://archive.org/details/funny_or_die_video_2a61aa471c
  8. This is certainly not a personal dig at the authors who made this comment, but can anyone spot the problem with this statement...

    Attached Files:

  9. Craig Payne

    Craig Payne Moderator

    In our reliability study on the manual version, we used a 5 point scale: 0/5 to 5/5 and found it was reliable in those experienced in its use.

    I do know about a handheld device that is about to come on the market that will measure it. Its not my device. It is patented and will be relatively inexpensive. I have emailed the people behind it and will update this thread with a picture and other details if/when they can supply them.
  10. There are many problems with this quote on Simon's slide since it assumes that "over-pronation" or "excessive pronation moments" acting on the foot are the cause of all foot and lower extremity pathologies treated with foot orthoses, which is simply not the case. In addition, the Supination Resistance Test does not quantify the magnitude of STJ pronation moments, it simply allows the examiner to assess how difficult it is to supinate the STJ by pulling up on the medial navicular which is directly affected by STJ spatial location relative to the medial navicular pulling force.

    The Supination Resistance Test is probably best thought of as a good clinical indicator of how hard the posterior tibial muscle will need to contract to produce STJ supination motion in relaxed bipedal stance. In addition, the Supination Resistance Test can be used clinically to compare the differences between the two feet of the same individual or between the feet of different individuals to act as a confirmation of STJ axis spatial location assessment done by other methods.

    However, I doubt the Supination Resistance Test, by itself, can be used reliably to determine the magnitude of internal and external STJ pronation moments acting on the foot during relaxed bipedal stance or during weightbearing activities. In order to accomplish this goal, the exact spatial location of the STJ axis relative to all the external and internal forces acting across the STJ axis would need to be also determined.
  11. All of which is true, but I was thinking more about first principles and Newton's 3rd in particular. That is, the reaction force of the orthosis will always be equal and opposite to the applied force from the foot- physical law.
  12. Craig Payne

    Craig Payne Moderator

    There is an element of simplifying things down to make them understandable by the particular audience that its directed at.
  13. Agreed and like I said Craig, nothing personal. But you cannot change the laws of physics, said Scotty to Kirk ;) Beam me up... https://www.youtube.com/watch?v=dh8oMFM19Kc
  14. Admin2

    Admin2 Administrator Staff Member

  15. BEN-HUR

    BEN-HUR Well-Known Member

    This should be interesting (re. update). Thought I do a google search on Force Gauges (cost thereof)... quite a variety in prices... some of which are quite expensive: https://www.google.com.au/?gws_rd=ssl#q=force gauge&tbm=shop

    Then thought I do a YouTube search on Push/Pull Force Gauges:

    Digital Gauge:

    - SHIMPO FGE-XY: Push/Pull Digital Force Gauge...

    - Shimpo FGE Digital Force Gauge (FGJN): http://shimpoinstruments.com/force_gauges/FGE (cost about $595 USD)

    - Shimpo FGV-XY Digital Force Gauge with USB Output (FGP): http://shimpoinstruments.com/product/FGV-XY (cost about $795 USD)

    Thought digital gauge would be better (mainly for ease of reading/use)... however, the following video states there are functional benefits to mechanical gauges (i.e. more difficult to overload, retain calibration longer)...

    Mechanical Gauge:

    - PS / FB Mechanical Force Gauge...

    - FB Mechanical Force Gauge: http://imada.com/products/fb-mechanical-force-gauge/

    - FB / PS Mechanical Force Gauge: http://www.gaugecity.com/p-38-fb-ps-mechanical-force-gauge.aspx (cost about $430 USD)

    The way I see (thus far) with the push/pull forces gauges: is not only can you measure supination resistance test via the pull function... but one can also measure orthotic shell deformation via the push (compression test) function. Of course it's not just the forces associated with the static supination resistance test to consider, there are other factors at play i.e. body weight... along with & in association with dynamic considerations such as gait (technique), velocity etc... as well as shoe type, ground surface (i.e. stiffness, camber & associated varying GRFs) etc... Such variable factors can be a bit mind boggling... but hey, as long as we can adequately dampen those (potential pathological) forces which are associated with overloading the structure (i.e. tissue, bone) then positive results usually ensue.
    Last edited by a moderator: Sep 22, 2016
  16. I just went into my garage and found the folder containing the original photos and manuscript for our chapter in DeValentine's book where I first described the Supination Resistance Test (Kirby KA, Green DR: Evaluation and Nonoperative Management of Pes Valgus, pp. 295-327, in DeValentine, S.(ed), Foot and Ankle Disorders in Children. Churchill-Livingstone, New York, 1992). The chapter was mailed to the publishers on October 8, 1990.

    The photo of me performing the Supination Resistance Test on one of my pediatric flatfoot patients in my first office, which I shared with three other orthopedic surgeons here in Sacramento, was probably taken in the summer of 1990. I completed the manuscript and figure legends also in the summer of 1990 before I sent it off to Don Green to read over.

    It's hard to believe that this was all from over a quarter of a century ago.
  17. drhunt1

    drhunt1 Well-Known Member

    The real key to this discussion is to take these concepts and actually solve problems with them. In other words, why is the supination moment important, and how does that translate into more normal foot function? And by who's premise does that even occur...is that a part of Root Biomechanics...or is that a concept of TST?
  18. BEN-HUR

    BEN-HUR Well-Known Member

    Being that this thread discussed the clinical recording, use thereof & making a clinical assessment tool pertaining to the Supination Resistance Test... here is a thread recently posted which reveals a measuring tool that now can be purchased for this purpose... https://podiatryarena.com/index.php?pages/keystone/


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