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Tuesday, November 22, 2022

Subtalar Joint Neutral and Its Clinical Significance: Lecture Summary from the 10th Annual Schuster Memorial Seminar

The Title was: Some Fun With Subtalar Neutral
The Key Points:
  1. Positioning the foot and leg around subtalar joint neutral means that the stresses are even from medial to lateral
  2. Subtalar Joint Neutral is crucial in Repetitive Motion Activities
  3. Being too far from Neutral when functioning can cause pronatory or supinatory problems
  4. These problems can occur up the leg into the back, spine, and upper extremities
  5. Subtalar Joint Neutral has primarily a weight bearing significance
  6. Clinically it is observed from the alignment knee to foot or tibia to heel bisection (this is also called the TC or Achilles Angle)
  7. Most patients do not stand or walk in Subtalar Neutral due to variations in Tibial Varus or Valgus
  8. This variation gets more exaggerated  when the varus or valgus starts in the knee (genu varum or genu valgum)
  9. Most podiatrists obtain stability in their patients by heel verticality 
  10. Clinically it is important to know when this heel verticality is not close to subtalar neutral (on the pronated or supinated side) due to symptoms produced or not improved
Here subtalar neutal and heel verticality are together in this stable foot

Here the left foot demonstates how subtalar joint pronation away from neutral setting up the left foot for pronatory symptoms from the foot up the lower extremity change. The initial goal of treatment here will be heel verticality to make significant positive change. If the patient is not responding to treatment, then the heel will be placed in more varus positioning closer to subtalar neutral. I tend to add a Kirby Skive to my orginal RX to obtain this improved varus correction.

Here the right foot is supinated away from both heel verticality and subtalar joint neutral. The goal of lateral support to bring these two positions into better alignment (more vertical heel and more in subtalar joint neutral) are placed in the RX. 

Here Subtalar Joint Neutral would position the foot very supinated to the ground. Dr Merton Root taught to position this foot type 2 degrees from the maximally pronated position. Dr Kevin Kirby designed the Maximum Pronation Test to ascertain whether the patient was maximally pronated. 

Here the Subtalar Joint Neutral Position is 13 degrees everted to the ground due to the high Genu Valgum present. The right foot is therefore functioning 6 degrees in a subtalar joint supinated position and the left foot 3 degrees in a subtalar joint pronated position. Ideally, your initial RX should be to stabilize the foot with Root Balancing of Forefoot Deformities and a left 3 mm Kirby Medial Heel Skive. This helps get the midtarsal joint maximally pronated for incredible foot stability. Remeasuring of the RCSP with the new orthotic devices should show 13 degrees of RCSP bilateral. This will make the foot more stable. 

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