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Positive Kirby's sign

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Simon Spooner, Jan 25, 2006.


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    I'm seeking some images of lateral weightbearing x-rays showing occlusion of the sinus tarsi in max pronated feet. Don Green refers to this as a positive Kirby's sign- fame in the 21st century :cool:

    Thanks for any help you can give.
  2. Craig Payne

    Craig Payne Moderator

    I caught the title of this thread and thought "this has got to be good" :) ...whats Kevin been up to?? :eek: ...there were several photos taken that night we all out in Las vegas :cool: , but I do not recall Kevin being lateral that night ,... but it was a serious post

    There was this recent paper on alignment:
    Thomas S. Roukis and Kevin A. Kirby: A Simple Intraoperative Technique to Accurately Align the Rearfoot Complex J Am Podiatr Med Assoc 2005 95: 505-507.

    And theses ones:

    KA Kirby Anterior axial projection of the foot J Am Podiatr Med Assoc 1988 78: 380b

    KA Kirby, AJ Loendorf, and R Gregorio Anterior axial projection of the foot
    J Am Podiatr Med Assoc 1988 78: 159-170.

    Maybe what you want is in one of those
    Last edited by a moderator: Jan 26, 2006
  3. Actually, the story behind this is that, during my Biomechanics Fellowship at CCPM in 1985, one of the biomechanics faculty, Jack Morris, DPM, and I were at the x-ray viewing box in the Biomechanics Clinic talking about feet and biomechanics and x-rays. He was telling me about the notch on the cuboid that he thought was important for "locking of the midtarsal joint" that he had never seen written before in the literature so that he was going to call it the "Morris notch". I told him that if he was going to get his name on a bone, then I wanted my name on my discovery that I had never seen written in the literature. I further explained to Jack that my discovery was that I had found that the best way to determine that the subtalar joint was maximally pronated on an x-ray was to take a lateral view and inspect to see if the lateral process of the talus was abutting against the floor of the sinus tarsi. [I discovered this while working on my initial ideas on subtalar joint rotational equilibrium and on the anterior axial radiographic view I had developed during the same time.] I told Jack (with a smile on my face) that this new sign should be called the "Kirby sign", especially if he could call the notch on the cuboid the "Morris notch".

    A few months later that year, when I was at a five day seminar where Mert Root had invited a group of us to help him edit one of his manuscipts for a proposed new book, Don Green and I sat next to each other and talked quite a bit about biomechanics. Since Don and I were about the only two of the approximately 25 individuals there who actually had the guts to disagree with Mert on some of his ideas, we enjoyed sitting next to each other to bolster our confidence against Mert's often dominating personality. It was during this meeting that I remember first telling Don about the "Kirby sign" on the lateral radiograph of the foot. Since then, he has been teaching the "Kirby sign" to all his students and residents in San Diego and also has been teaching it throughout the United States when he lectures at podiatry meetings on x-ray evaluation.

    That's the true story of the origin of the "Kirby sign" on the lateral radiographic projection of the foot.
  4. Here is the night: December 2, 2003, Las Vegas. From left to right: Erin Ward, Simon Spooner, Craig and Mimi Payne, Jay Cocheba and sons, Chris Nester, and yours truly.

    Considering that Craig wasn't feeling up to par that night, he looks pretty darn good.
  5. The Spooner Sign

    Here's Dan Everson, myself and Chris Nester doing the "Spooner Sign" at the after-seminar dinner and drinking festivities at the Las Vegas PFOLA meeting.
  6. I think you'll find that Nester is multi-tasking in that picture; not only a positive Spooner, but also the eponymous "Nester"- what a crowd pleaser.

    Anyway, back to the plot has anyone got an x-ray as requested?
  7. Captions for what the guy in the background is saying?
  8. Trust me, Kirby was lateral that night. Creating havoc with his radio-controlled mouse and tensegrity kit.

    Chicago anyone?
  9. It's going to be cold in Chicago in December. Regardless of the cold weather, I'll be there as usual and Chris Nester tells me he has also been invited to speak. I haven't heard anything else on who has been invited to speak.

    Should be a good meeting, especially after the lectures are over and the real education begins. ;)
  10. admin

    admin Administrator Staff Member

  11. I've decided, for the sake of staying on topic, to move this discussion on radiographic findings of subtalar joint (STJ) rotational position from the The Myth of Growing Pains thread to this old thread from a few years back were we discussed "Kirby's sign" from Dr. Don Green's lectures and articles.

  12. As Simon requested, here are standing lateral radiographs of a couple of my female patients, who will be soon be doing bunion surgery on, that showed a maximally pronated STJ position in relaxed bipedal stance which is evidenced by the lateral process of the talus directly abutting against the floor of the sinus tarsi of the calcaneus.
  13. Here is an illustration from my practice Facebook page that shows the position of the articular facets of the talo-calcaneal joint in the maximally pronated position. As the subtalar joint supinates from the maximally pronated position, the volume of the sinus tarsi space increases due to the lateral process of the talus gliding superior-posteriorly along the posterior facet of the calcaneus. Subtalar joint supination also causes the sign of "bullet-holing" within the sinus tarsi on lateral radiographs of the foot in patients with the most supinated feet.

  14. drhunt1

    drhunt1 Well-Known Member

    Good luck finding that sign on a patient with uncompensated rear foot varus.

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