Reliability of STJ Axis Palpation Technique

NewsBot · Mar 29, 2012

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Intratest Reliability in Determining the Subtalar Joint Axis Using the Palpation Technique Described by K. Kirby
Joris De Schepper, Ken Van Alsenoy, Johan Rijckaert, Sophie De Mits, Tom Lootens, Philip Roosen
JAPMA March/April 2012 vol. 102 no. 2 122-129

Background: Exact determination and classification of the spatial position of the subtalar joint axis could be a predictive clinical variable in biomechanical analysis and a valuable tool in the design of functional foot orthoses.

Methods: Three clinicians with different levels of experience determined and classified the subtalar joint axis location, three times, on 52 individuals, using the clinical palpation, allocation and interpretation technique, as described by K. Kirby.

Results: High intratester precision (ICC 0.72 to 0.93) was found for determining the axis location (SEM, 3.72° for angle/0.27 cm for X-axis); however, classification of the spatial position of the axis has large intertester variation (κ = 0.243 to 0.494)

Conclusions: The clinical palpation technique itself is reliable; the consistent attribution of a classification, in other words, interpretation, is weak.
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efuller · Mar 29, 2012

Conclusions: The clinical palpation technique itself is reliable; the consistent attribution of a classification, in other words, interpretation, is weak.
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That an absolute value was repeatable within a tester is really good news. An absolute value across individual testers is not as important as the different testers ranking from most medially deviated to most laterally deviated. If the ranking is the same is across testers then the test will be helpful in that the most medially positioned STJ axis feet will get medial heel skives and the average position axis feet will not.

Eric

Simon Spooner · Mar 29, 2012

What is more important, yet not reported here, is that the researchers carried out a validation study. Why they chose to report the reliability study rather than the validation study is beyond me... but there you go.

Ken, why did you report the reliability study rather than the validation study?

Kenva · Mar 31, 2012

Simon Spooner said: ↑

Ken, why did you report the reliability study rather than the validation study?
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This had everything to do with the project funding and timing. We got a one year project where we had to choose between validity testing and reliability testing. We also wanted to build a supination resistance testing device. The idea was to be able to get an extension the year after to work on the validation. This got bounced, so I took this one up in my Master dissertation Project at QMU. Things could have gone much faster, but the research was basically to fundamental according to the university college guidelines. I'm working now to get my MSc study published so we can get a report on the validity as well as the reliability. The validation I did now was an exploratory study using 3 cadaver specimens.

Have a look at the presentation I gave last week at the Belgian Podiatry conference. this is what i'm trying to get submitted at JAPMA in the upcoming weeks.

Kenva · Sep 22, 2016

Kenva said: ↑

Have a look at the presentation I gave last week at the Belgian Podiatry conference. this is what i'm trying to get submitted at JAPMA in the upcoming weeks.
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Here are the You Tube shots from the research project.

phil · Apr 2, 2012

I'm glad you guys do this stuff. Seeing that cadaver is very disturbing!

Phil

NewsBot · Jun 6, 2014

The Subtalar Joint Axis Palpation Technique—Part 1.
Ken K. Van Alsenoy, Joris De Schepper, Derek Santos, Evie E. Vereecke, and Kristiaan D'Août
Journal of the American Podiatric Medical Association: May 2014, Vol. 104, No. 3, pp. 238-246.

Background: Locating the position of the subtalar joint axis can be a predictive clinical variable in biomechanical analysis and a valuable tool in the design of functional foot orthoses. Before testing Kirby's palpation technique to locate the subtalar joint axis in cadavers, it was important to develop and test the experimental methods in a mechanical model in which the exact location of the hinge joint can be controlled.

Methods: Four testers determined the hinge joint location and moved it through its range of motion, capturing the movement of the joint axis using a kinematic model. The joint axis location was determined and validated by comparing the actual hinge joint location on the mechanical model with the location determined by the palpation technique described by Kirby in 1987 and the location determined by the helical joint axis method using three-dimensional kinematic data.

Results: The overall angles result in mean slopes and intersections of 87° and 92 mm, 86° and 97 mm, 85° and 92 mm, and 88° and 91 mm for testers 1, 2, 3, and 4, respectively. Testers 1 and 3 were able to determine the location to 1° and 1 mm accuracy, tester 2 to 0° and 4 mm, and tester 4 to 2° and 2 mm compared with the kinematic data.

Conclusions: The technique of determining the points of no rotation as described by Kirby could be validated by using a three-dimensional kinematic model to determine the helical axis.
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Kevin Kirby · Jun 6, 2014

Ken, Joris, Derek, Evie and Kristiaan:

Thank you very much for such a fine paper.:drinks:drinks:drinks

NewsBot · Jun 28, 2014

The Subtalar Joint Axis Palpation Technique: Part 2 - Results on reliability and validity using cadaver feet.
Ken K. Van Alsenoy, Krisiaan D'Août, Evie Vereecke, Joris De Schepper, and Derek Santos
Journal of the American Podiatric Medical Association In-Press.

Background
Clinically locating the point of no rotation to determine the subtalar joint axis (STJA) location by applying pressure on the plantar surface of the foot, was described by Kirby in 1987, but never validated. The purpose of this study is to extend a previously validated mechanical model to cadaver feet and to examine the intra-intertester reliability.

Methods
Four testers, with different levels of experience, determined the STJA location and moved the STJ through its range of motion capturing the movement using kinematic analysis. The comparison of the spatial STJA location determined by palpation between and within testers determined the inter- and intratester reliability. The helical axis method was performed to validate the model.

Results
The intrarater reliability varies from high (α = 0.96) to low (α = 0.26) for the slope and is in general high (α between α= 0.78 and α=0.95) for the intersection. The interrater reliability scores moderate to high, depending on the specific cadaver specimen. Concerning the exact location of the subtalar joint axis, no significant difference was found between the results determined by different testers and the helical axis method.

Conclusion
The palpation technique as part of the Subtalar Axis Location and Rotational Equilibrium Theory proposed by Kirby is a reliable and valid clinical tool. Experience in performing the palpation technique has a positive influence on the accuracy of the results. In the context of evidence based practice, this technique could be a standard tool in the examination of patients with lower limb related pathology.
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Kenva · Jun 28, 2014

Kevin Kirby said: ↑

Ken, Joris, Derek, Evie and Kristiaan:

Thank you very much for such a fine paper.:drinks:drinks:drinks
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You are very welcome!
One question remaining in this line for me is how this determined line via palpation is related to gait/the stand phase. Assuming it would be the location around midstance …

Cheers
Ken

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