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In previous threads there has been much discussion regarding the role of the "STJ neutral theory" in modern-day clinical biomechanics (with newer theories such as the Tissue stress model, and SALRE challenging the old teachings). Regardless, most of us still use the STJ neutral measurement in our biomechanical assessments in one way or another.

It has been stated that the very common practice of using talo-navicular congruency as an indicator for STJ neutral position was not an appropriate method for determining STJ neutral position since the talo-navicular joint is not part of the STJ but is rather part of the midtarsal joint.

My question is:
This being the case, what is the appropriate method for determining STJ neutral if not by palpating the head of the talus?
(excuse my ignorance if this has already been covered)

Cheers,
Adam

 

The question I would ask is why determine it in the first place? What is actually done with the information?

Having said that, if I wanted to find STJ neutral, I would just find that position that just feels right - its that position that subtly takes more energy to move away from than it takes to move towards. ..... concidently there is a very high correlation between finding it this way and the talo-navicular congruency method and the curves above/below the lateral malleolus method.

The next problem, it that you can them manipulate/mobilise the STJ and the neutral position changes .... so which is the true STJ neutral - the one before or the one after the manipulation.

 

I think we're mostly agreed that clinically we can only ever find an approximation of STJ-neutral.

The fast way to do this is to have your pt sitting comfortably and maximally dorsiflex the foot by applying pressure to the 4/5th met head. You have a good approximation of STJ neutral when the foot is maximally dorsiflexed, and the ankle is still straight (no medial/lateral bulges).
Don't be suprised if the foot is inverted. They almost always are.
Takes about 5 seconds if you practice a bit.

The reason we do this is to capture the forefoot to rearfoot relationship of the foot when the STJ is in it's approximation of neutral. That way we know to balance the orthoses on the inside (medial) or outside (lateral)

Is it relevant to only use an approximation of STJ-neutral?
Certainly. Your ever-so-accurate orthosis posting becomes an unquantified wedge as soon as the orthosis sinks into the shoe by a mm, and further lost when the pt walks on uneven paving.

The fact is we don't have to be (can't be) accurate in our casting or posting. The orthoses still do their job.


Anyway, works for me :)

Regards,
david