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STJ neutral

Discussion in 'Biomechanics, Sports and Foot orthoses' started by mme27, Aug 28, 2010.

  1. mme27

    mme27 Welcome New Poster


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    this question might have been answered before somewhere, but i havent been able to find it, so sorry if i am doubling up.

    i have a question about the SJT neutral. I always read that STJ is where the STJ is neither pronated or suppinated. if thats the case, then why is it whenever you exam a patient in STJ neutral, they usually have some sort rearfoot valgus or varus.

    i also hear that STJ neutral means that the talar and calceaneal joint is congruent. does it mean if that joint is congruent, that by definition, there will be no displacement of the talus or calcanues on eachother, meaning either supination or pronation in that joint??

    the only thing i can think of, is that STJ neutral in a normal foot, means that the leg bisection and heel bisection are parallel. If a patient has some type of rearfoot valgus or valgus, it means that when their STJ is in neutral (ie talar and calcaneal joint spaces are congruent), there is no pronation or suppination specifically in or at the STJ, but the calcaneus is still either everted or inverted when compared to the leg (maybe due to ossues or ST factors). is that right?? thanks for your help anyone!!
     
  2. brevis

    brevis Active Member

    STJ neutral is a subjective reference point.... don't beat yourself up over it.
     
  3. mme27

    mme27 Welcome New Poster

    that doesnt really help but okay!
     
  4. Dontcha just love those questions which are superficially simple but on examination are bloody challenging?

    Hopefully someone with more historical knowledge will be along soon mme27 (catchy name) but in the meantime.

    "neither pronated nor supinated" is the original root definition. Unfortunately it is pretty unhelpful because it is entirely tautological.

    Another you may hear is the position 2/3rds of the way from supination end range to pronation end range. This is also unhelpful because by this a foot with a tiny range in massive inversion, like a paed clubfoot, is in neutral. Its between its max pronated and supinated range after all.

    The talar head congruence method came after root. I forget the name of the person who first described it (perhaps someone can help me out with that, I've been looking for the name for months).

    But as brevis says, you can pretty much forget about bisecting anything as a guide. Its hellishly unrepeatable, and the bisection of the posterior surface of the calc is not perpendicular to its plantar surface anyway. Its more a rhombus than a triangle. So there is no real reason why a foot in neutral SHOULD have a straight bisection from leg to calc even if you COULD measure it reliably. Which you cannot.

    Stop thinking in lines and right angles. We're not built that way. And brevis advice, though a bit brevis:rolleyes:, is sound. STN is a reference point, nothing more. Its location or repeatability is IMO quite peripheral to a diagnosis and care plan.
     
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