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Discussion in 'Biomechanics, Sports and Foot orthoses' started by studywithfury, Sep 22, 2012.

  1. studywithfury

    studywithfury Member

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    During my biomechanics course we are taught about sub-talar neutral position, Neutral calcaneal stance position, and relaxed calcaneal stance position. Sometimes we are asked to calculate NCSP and RCSP as well.

    I have to ask but are these terms outdated? I feel like the field of biomechanics is far more complex than NCSP, RCSP, etc.

    Do practicing podiatrists actually use these measurements when treating a patient?

    Thank you

  2. markjohconley

    markjohconley Well-Known Member

    SWF, there were certain threads in Podiatry-Arena that were must reads for students. Not sure how you access them nowadays. Admin (or clone) hopefully will help out.
    If not do a member search on Kevin Kirby, efuller, simon spooner, Ian G, Craig Payne (they're the main ones) for their posts, you'll get a much better education from them.
  3. efuller

    efuller MVP

    Making measurments that use a heel bisection line are inheirently inaccurate.

    The results of a measurement or test should change your treatment. Ask your instructors how these measurements change your orthtoic prescription.

    I don't use those measurements, but I do use some of the concepts that those measurements can teach you about. An uncompensated varus (there is not really any difference between forefoot varus and rearfoot varus as far as the STj is concerned) is an important concept to understand anatomically. See Kevin Kirby's rotational equilibrium paper.

  4. Jeff Root

    Jeff Root Well-Known Member

    Background: Forefoot varus malalignment is clinically defined as a nonweightbearing inversion of the metatarsal heads relative to a vertical bisection of the calcaneus in subtalar joint neutral. Although often targeted for treatment with foot orthoses, the etiology of forefoot varus malalignment has been debated and may involve an unalterable bony torsion of the talus.


    According to the above post by admin you can see that these terms are still in use and therefore are not outdated if one wishes to communicate about certain structural and positional osseous relationships of the foot.
  5. Hi Jeff, hope you are well.

    Devil's advocate: what the paper in the thread you linked to demonstrates is that certain structural and positional osseous relationships of the foot cannot be determined from clinical observation- don't you agree?

    That is, if forefoot varus were due to torsion within the talus, we need a clinical assessment technique which correlates with that talar torsion. The techniques employed within this study nor the previous study of McPoil were capable of doing that. Can you suggest another technique which might?
  6. I look at peoples feet when they are standing (walking, running etc.). As for calculating relaxed calcaneal stance position , I don't know why you would do that, when you can look at them standing. As for calculating neutral calcaneal stance position, I don't know why you would do that because (and I'm guessing) if you are employing a 2:1 ratio within that calculation it is fundamentally flawed.
  7. Jeff Root

    Jeff Root Well-Known Member

    Yes Simon, I agree. What Root and Weed attempted to teach was that the ff/rf could be inverted, everted or perpendicular. For example a FF varus is an inverted ff condition (ie deformity, but this really isn’t a good term) but an inverted ff condition isn’t necessarily ff varus since ff supinatus, a plantar flexed 5th, plantar flexed 4th and 5th, plantarflexed 4th, or an elevated 1st or an elevated 1st and second can all result in an inverted ff/rf relationship. Conversely, ff valgus is an everted ff/rf but not all everted ff/rf is ff valgus since a plantar flexed 1st ray, a plantar flexed 2nd, a plantar flexed 1st and 2nd, or an elevated 5th, or an elevated 4th and 5th can all result in an everted ff/rf relationship.

    Dr Root said we do not necessarily know that causes a “true” forefoot varus or valgus and we can’t determine it clinically but we can differentiate it from some of the other condition that result in an inverted or everted ff/rf relationship. Likewise we can’t necessarily differentiate the cause of rearfoot varus or rearfoot valgus but he speculated it could be stj rom (ie a true rf varus or valgus due to stj rom) or it could be the result of a twist in the body of the calcaneus (calcaneal varus or valgus torsion). So it is not necessarily possible to clinically differentiate some of these conditions.

    Let’s not forget that stj frontal plane motion/position is not a true measure of stj motion/position, it is only the frontal plane component of stj motion/position. Therefore, we need to realize that differences in the orientation of the stj axis will influence our perception of stj motion and position. For example a low axis stj will demonstrate a great ratio of inversion/eversion than a high axis stj because we are seeing more motion relative to the frontal plane.

    I believe it is important to recognize both the benefit and limitation of stj and ff/rf measurements. The reason I posted the link is because like it or not, these techniques and terms are still used and there is significant reference to them, so it is important to understand them as best possible.

  8. RobinP

    RobinP Well-Known Member

    This is just my opinion - see answers below in blue

    Good luck and don't believe everything I(or anyone else) tells you. Read it and decide for yourself
  9. SWF (Your real name where you are attending podiatry school is appreciated for more complete answers to your questions):

    I mark heel bisections on all my patients receiving orthoses and measure the relaxed calcaneal stance position (RCSP). I also use the maximum pronation test to see how close the rotational positon of the subtalar joint is the the maximally pronated position during relaxed bipedal stance (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.).

    However, I haven't measured neutral calcaneal stance position for the last 20 years. John Weed, DPM, had us calculating NCSP back in the early 1980s as second year podiatry students....hasn't podiatric biomechanics progressed over the last three decades at your podiatry school?
  10. alwinliew

    alwinliew Member

    Measurements of NCSP and RCSP are a waste of time in a real clinical setting. Not accurate at all!
  11. Jeff Root

    Jeff Root Well-Known Member

    You’re certainly entitled to your opinion. In my opinion, RCSP can be an important indicator of foot function in a closed kinetic chain condition. For example, an inverted RCSP in an individual with a history of inversion ankle sprains would be of interest to many clinicians. A significantly everted, unilateral RCSP might be consistent with a peroneal spasm or adult acquired flatfoot. You might even have to put the stj through an open chain examination of the ROM to detect a peroneal spasm, but some clinicians feel that an open chain stj ROM examination is also a waste of time.

    Disregarding one piece of the puzzle creates an incomplete picture. Depending on the size of the puzzle piece, you may be missing critical information. I fail to see why some people try to make too much or too little of simple clinical techniques.
  12. alwinliew

    alwinliew Member

    I agree with you Jeff.:good: I should probably elaborate what I meant by 'measurements'. I would still get a patient to stand on RCSP to observe whether the calcaneus is inverted/ everted. Then proceed to S.R.T and Jack's and then supine exam (checking STJ axis location, RoM etc)

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