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subtalar joint

Discussion in 'Biomechanics, Sports and Foot orthoses' started by rabzash, Mar 6, 2010.

  1. rabzash

    rabzash Member

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    I have just recently joined the podiatry arena and being a first year student on a podiatry degree programme I have just recently studied the subtalar joint however I do not get why your meant to look at the subtalar joint or like the emphasis on why you have to use it?

    I would appreciate it if someone could tell me a reason as to why podiatrists look at the subtalar joint.
    Its all soo confusingggggg :(
  2. Griff

    Griff Moderator


    Attached Files:

  3. rabzash

    rabzash Member

    thankss a lott ian!! thiss shouldd help me loadssss!
  4. Griff

    Griff Moderator

    No worries. You might want to invest in a new keyboard - it looks like some of the keys are sticking...
  5. Atlas

    Atlas Well-Known Member

    I think he is looking at more than just Podiatry Arena:eek:
  6. Lab Guy

    Lab Guy Well-Known Member

    ou also think about it, Among other functions, the subtalar joint is also the first joint in the body to absorb the ground reactive forces into the musculoskeletal framework of the human body. With that being said, the STJ is the first domino that initiates a cascading fall of dominos when the STJ is not in proper balance.

    We thus study the STJ due to its important influence on the joints distally as well as its influence on the joints proximally so that we may find better treatment modalities for biomechanical imbalances.

  7. Atlas

    Atlas Well-Known Member

    Steven, but as we move forward (gait), the ankle via sagittal plane motion does a little bit I would have thought. Also, when the heel is not in contact with the ground (% of gait cycle?), the GFRs are bypassing the STJ. (I'm not a physics expert BTW)

    I like your paragraphs here; it is getting me thinking a bit. As good as it is, it also represents my view that podiatrists grossly underestimate the ankle joint.

    Ron Bateman
    Physiotherapist (Masters) & Podiatrist
  8. Ron:

    How do you know that 1) Lab Guy is a podiatrist and 2) that his views are representative of podiatrists as a whole? You are a podiatrist also..do you also grossly underestimate the ankle joint??
  9. Atlas

    Atlas Well-Known Member

    Kevin, I have seen podiatry in Australia from a few vantage points. First referring in, looking from the outside as just a physio. Second, as a pod student and psuedo-foot-ankle-clinician, and now as a qualified pod. You have seen podiatry from a number of vantage points as well; but not from mine.

    Let me unequivocally say, {irrespective of the Lab guy and his profession; irrespective of your views (and I know you are on record here as not rating the lunge test as an essential/helpful measurement and diagnostic tool (yes diagnostic!)}, I have a strong view that podiatrists (in general) underestimate the ankle, or at the very least, have nowhere near comparable knowlege (compared to STJ and distal to it). My favourite self-made quote is "Podiatrists own the foot...but there is a price to pay for the ankle".

    And like the lunge, I can debate it with you until the cows come home.

    I know that there are exceptions to the rule, and that I could name a couple of pods in Melbourne here that are more than proficient. But across-the-board, there is a huge discrepancy of knowledge between the foot and the ankle.

    Ron Bateman
    Physiotherapist (Masters) & Podiatrist
  10. CraigT

    CraigT Well-Known Member

    I think I missed this debate... can you enlighten me?
    I think examining the function of dorsiflexion between the leg and the foot is one of the single most important parts of our assessment- this comprises both ankle and foot movement (and forces) and combinations thereof...
    Is a lack of appreciation of the contribution of the ankle joint during gait what you are alluding to Ron?
  11. Atlas

    Atlas Well-Known Member

    G'day Craig. Look at the thread Lunge Test - Please explain.

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    Originally Posted by Kevin Kirby
    I can see the usefulness of the lunge test for patients involved in running sports where the demands for ankle joint dorsiflexion are the greatest when the knee is flexed. Therefore, the lunge test seems like a good test possibly for soleus and ankle joint equinus.

    However, I can't see how the lunge test helps us, in any way, for those patients that have symptoms related to walking where the demand for ankle joint dorsiflexion is greatest when the knee is extended, and the ankle never comes close to 35 to 38 degrees of dorsiflexion during the stance phase of gait.

    Craig, please explain the mechanical reasons behind always adding a 3 mm heel lift to these patients when they have, for example, 33 degrees on the lunge test but their ankle joint is never dorsiflexed more than about 10 degrees during walking gait and they are not involved in running activities.

    (My response was...)
    Kevin, these same people who don't run, can't avoid inclines (escalators/slopes) and can't avoid descending steps or gutters.
    This undoubtedly quashes the magic '10 degree figure' that many believe and are side-tracked about. The other thing is that why do we assume that the sedentary don't hurry for a few steps during an intermittent but urgent activity (late for a pedestrian crossing; catching bus etc.)

    The whole point of the lunge is not a magic minimum figure/angle. It provides information about (a) symmetry (My advice is not to be too concerned about 10, 12, 33 or 35 degrees. The most important benchmark (in unilateral conditions) is the contra-lateral lunge reading.) and (b) ankle joint health and whether stretching is appropriate or inappropriate.

    I cannot fathom how one can fully understand the ankle joint in terms of complete diagnoses, prognosis and when to refer on, without first understanding and utilizing the lunge test.

    No not really Craig. My issue is that it is not used enough in podiatry (as the lunge thread will show, the most respected and angriest podiatrist in the world doesn't use it much and doesn't use it at all for non-runners), and it is not utilized enough. It is more than a measurement tool. Even my physio colleagues, to my understanding, use it only as a measurement tool. It is much more.

    The other thing is the hang-up in academic circles about how you measure it. Tibial angle with a goniometer, or measure from a wall. A one degree increase shows statistical significance; but in the clinic, even if I could ascertain a one degree improvement, it is not enough to tick my treatment intervention. My rule is, that if a lay person could measure your improvement (fingers from a wall), and you standardise the measurement, then you start to get into the clinically signficant zone.

    And...as I may have raised in the Lunge Test - Please Explain thread; this NWB assessment of Ankle dorsiflexion is a croc. The ankle joint is big and tough, and the forces needed to get it to end-range dorsiflexion are more than what a clinician's hand can provide. The lunge test is at least weightbearing and functional.

    Finally I know KK disagrees, but I will always stand by my comment that:
    I cannot fathom how one can fully understand the ankle joint in terms of complete diagnoses, prognosis and when to refer on, without first understanding and utilizing the lunge test.

    If anybody disagrees, they are free to put-me-in-my-place in Melbourne in 2 weeks time.

    Craig & Craig, I know I have gone off-topic from the thread title STJ....as this is all about the ankle joint....but I hope I have answered your query and elaborated relevantly.

    Ron Bateman
    Physiotherapist (Masters) & Podiatrist
  12. Ron, can you provide details of the models for the relationships between dynamic ankle joint dorsiflexion and the lunge test for walking and running on flat level surfaces, please?

    So, assuming a linear model, if: Y = dynamic ankle joint dorsiflexion and X = lunge test,

    Y = mX +c

    m = slope =?
    c =constant =?

    Can you fill in the missing numbers please?

    what are the r square values for these models?
  13. Atlas

    Atlas Well-Known Member

    Predictable Simon.:bang:

    Podiatry-Arena royalty get questioned clinically. Answer difficult.:sinking: Alarm bells. Red alert. Pull down the shutters. What can we do rather than get into a debate about clinical common sense?

    Yes...pull out the physics manual.:boxing:
    Actually the Spooner Method of defence has taught me something, and it is this. If I ever meet Marilyn vos Savant, I will challenge her to a debate on any topic in the world...as long as its Australian Rules Football. :boxing: I think I might actually win!

    Academic intimidation/bullying might work on a few (past) posters/students in the past. Actually I was taught by one at university. He/she wasn't intimidated, just couldn't be bothered with the tree of knowledge being urinated on by the select barking dogs. Wont work with me, although you can keep trying.

    Is there another rule about robust debate with you Simon?
    1. Don't sell snake oil
    2. Make sure your surname aint Rothbart
    3. You better be an astrophysical and biophysical and nuclear physical expert.

    Just to refresh your memory Simon, and it was less than 24 hours ago in a different thread, I mentioned...
    You read it, because you responded to it. If physics mattered 100% in the clinical world, Einstein would have been the musculoskeletal physician of the century.

    And even if I could lend a physics hat, and gave you m, c, and r2 values, what is the point if you are clinically unfamiliar of the power/meaning/relevance of Y? Moreover, if you looked at my counter-argument to Kevin, I have explained why the lunge test is relevant to running AND walking, for the elite and sedentary.

    So, I'll repeat again, "Physics (nomenclature) is not my forte..."
    But what is my forte, and what I'll always endevour to do, is see the clinical relevance in anything and everything I do/read/learn/debate that is related to musculo-skeletal mechanical condtions (irrespective of the source being a podiatry student, a podiatry pHD, or a massage therapist; I'll treat the message the same.)

    You should try it sometime, because if you did, you wouldn't need to resort to your safety net of complex physics.

    Now back to the clinically relevant stuff, do you have a question that is clinically relevant? If you don't, I'll go back to debriding callous with my apron, and you can go back to the science lab with your mice and your lab coat.

    Ron Bateman
    Physiotherapist (Masters) & Podiatrist
  14. Actually Ron, I was talking statistics, not physics but this clearly isn't your forte either. Is the lunge test a valid predictor of dynamic ankle joint dorsiflexion? I think that is a clinically relevant question.
  15. Atlas

    Atlas Well-Known Member

    You're 100% correct here...but then you go on to use the term "valid predictor" without defintions! I don't hear that term much in the clinical environment, and hence I will change the radio station first thing tomorrow.

    First the physics/stats book, and now the closed cell.:welcome: Where's the bad cop?

    In other words, are you asking me if, as a clinician or lab-rat, if I just had access to objective lunge readings (measurements), and subjective end-range location reporting data? If you gave me the luxury of also doing the test with and without tib-fib squeezing; and the luxury of also doing the test with and without Brian Mulligan's distal fibular force applications....

    Could I predict dynamic ankle function? Could I predict an antalgic or compensating gait? Could I predict walking dysfunction? Could I predict unilateral running difficulty? Could I predict descending stair dysfunction? Could I predict ability to squat (buttock on heel)? Could I predict likely symptomology? Could I predict anterior ankle pathology including osseous and non-osseous impingement? Could I predict posterior issue or stretch pattern? Could I predict medial or lateral ankle pathology? Could I predict ankle instability? Could I predict a tibio-fibula distraction or syndesmosis? Could I predict a distal tib/fib condtion? Could I predict difficulty kicking football? Could I predict difficulty hopping? Could I predict long term sequale if symmetry (contralateral physiological)/normality(bilateral presentation) of test not attained?

    Yes but more relevant to the end-range; Yes; Yes; Yes; Yes; Likely; Irrelevant to function but perhaps; Yes; Yes; Possibly; Unlikely; Possibly; Possibly; Unlikely (kicking prediction needs plantar flexion assessment); Yes; Possibly

    More extreme the finding, easier to predict. Saw a negative 8 finger lunge with anterior impingement the other day. Didn't have to analyse his gait to establish most function involving dorsi-flexion would be dysfunctional (at best) or non-functional (worst). I'm going to need more brain and less brawn and some luck for that one.

    I must have misconstrued the question, because it is like asking me patient x has an AFO, or plaster cast on, or anti-dorsi-flexion strapping applied (look at Wilkerson 2002 before you tell me about the tape mechanical effect after 20 minutes), can I predict dynamic ankle dorsi-flexion?

    If I have misconstrued your question, just provide definitions, and I will re-answer.

    (Addendum:) and Officer, "2 line questions for 2 page answers shouldn't be a one-way street"

    Ron Bateman
    Physiotherapist (Masters) & Podiatrist
  16. You ain't 1/2 a 2@
  17. Atlas

    Atlas Well-Known Member

    I love the term "2@". Mark & Jez on the Peep Show, and the Oasis brothers have taught me a little bit of rustic British lingo.


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