Methods for Taking Subtalar Joint Measurements

Elveru, Robert A; Rothstein, Jules M; Lamb, Robert L; Riddle, Daniel L.

doi:10.1093/ptj/68.5.678

Cited by 99 publications

(56 citation statements)

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“…The medial and lateral borders of the calcaneus were palpated to visually estimate the longitudinal midline. 17 With the subject in subtalar joint neutral (defined in the same manner as navicular drop), the goniometer axis was positioned over the bimalleolar axis (midpoint between the medial and lateral malleoli), the stationary arm aligned with the midline of the distal lower leg, and the moveable arm aligned with the midline of the calcaneus. Subjects were then instructed to relax their stance, and the difference between the angles in subtalar joint neutral and relaxed stances was recorded (Figure 8).…”

Section: Clinical Measuresmentioning

confidence: 99%

Sex Differences in Clinical Measures of Lower Extremity Alignment

Nguyen¹,

Shultz²

2007

J Orthop Sports Phys Ther

174

135

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Selected lower limb injuries and, in particular, those of the knee have been reported to occur in greater prevalence in females compared to males. 4,29,49,60,61,85 Sex differences in lower extremity alignment (LEA) have been included among a myriad of risk factors as a potential cause for the prevalence of knee injury in females. 21,29,34,33,47 Anecdotally, females have been cited as having greater anterior pelvic tilt, femoral anteversion, tibiofemoral angle, quadriceps angle, genu recurvatum, tibial torsion, and foot pronation. 21,29 However, apart from the measure of quadriceps angle, there is little empirical data to support these sex differences in a healthy population.While the literature consistently demonstrates greater mean quadriceps angles in females, 1,23,24,26,28,84 limited studies support a sex difference in mean pelvic tilt 24 and genu recurvatum. 81 Conversely, no sex differences have been observed with measures of tibial torsion 57,77 and foot pronation as measured by navicular drop 6,24,51,81 t StuDy DeSign: Descriptive, cohort design.t ObJectiveS: To comprehensively examine sex differences in clinical measures of static lower extremity alignment (LEA).t bAckgrOunD: Sex differences in LEA have been included among a myriad of risk factors as a potential cause for the increased prevalence of knee injury in females. While clinical observations suggest that sex differences in LEA exist, little empirical data are available to support these sex differences or the normal values that should be expected in a healthy population.t MethODS AnD MeASureS: The right and left static LEA of 100 healthy college-age participants (50 males [mean 6 SD age, 23.3 6 3.6 years; height, 177.8 6 8.0 cm, body mass, 80.4 6 11.6 kg] and 50 females [mean 6 SD age, 21.8 6 2.5 years; height, 164.3 6 6.9 cm; body mass, 67.4 6 15.2 kg]) was measured. Each alignment characteristic was analyzed via separate repeated-measures analyses of variance, with 1 between-subject factor (sex) and 1 within-subject factor (side).t reSultS: There were no significant sex-byside interactions and no differences between sides. Females had greater mean anterior pelvic tilt, hip anteversion, quadriceps angles, tibiofemoral angles, and genu recurvatum than males (P<.0001). No sex differences were observed in tibial torsion (P = .131), navicular drop (P = .130), and rearfoot angle (P = .590).t cOncluSiOn: Sex differences in LEA indicate that females, on average, have greater anterior pelvic tilt, thigh internal rotation, knee valgus, and genu recurvatum. These sex differences were not accompanied by differences in the lower leg, ankle, and foot. Understanding these collective sex differences in LEA may help us to better examine the influence of LEA on dynamic lower extremity function and clarify their role as a potential injury risk factor.

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Section: Clinical Measuresmentioning

confidence: 99%

Sex Differences in Clinical Measures of Lower Extremity Alignment

Nguyen¹,

Shultz²

2007

J Orthop Sports Phys Ther

174

135

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“…Although risk factors are ideally measured by a single, experienced investigator, [18][19][20] this becomes impractical when multiple centers and testers are required to collect sufficient data. An added concern is the potential to lose examiners during the course of a multiyear study, requiring examiners to be replaced.…”

Section: Articlementioning

confidence: 99%

Intratester and Intertester Reliability of Clinical Measures of Lower Extremity Anatomic Characteristics: Implications for Multicenter Studies

Shultz

Nguyen²,

Windley³

et al. 2006

Clinical Journal of Sport Medicine

106

137

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Abstract:Objective: To determine whether multiple examiners could be trained to measure lower extremity anatomic characteristics with acceptable reliability and precision, both within (intratester) and between (intertester) testers. We also determined whether testers trained 18 months apart could perform these measurements with good agreement. Setting: University's Applied Neuromechanics Research Laboratory. Participants: Sixteen, healthy participants (7 men, 9 women). Assessment of Risk Factors: Six investigators measured 12 anatomic characteristics on the right lower extremity in the Fall of 2004. Four testers underwent training immediately preceding the study, and measured subjects on 2 separate days to examine intratester reliability. Two testers trained 18 months before the study (Spring 2002) measured each subject on day 1 to examine the consistency of intertester reliability when testers are trained at different times. Main Outcome Measurements: Knee laxity, genu recurvatum, quadriceps angle, tibial torsion, tibiofemoral angle, hamstring extensibility, pelvic angle, navicular drop, femur length, tibial length, and hip anteversion. Results: With few exceptions, all testers consistently measured each variable between test days (intraclass correlation coefficient>=0.80). Intraclass correlation coefficient values were lower for intertester reliability (0.48 to 0.97), and improved from day 1 to day 2. Intertester reliability was similar when comparing testers trained 18 months before those trained immediately before the study. Absolute measurement error varied considerably across individual testers. Conclusions: Multiple investigators can be trained at different times to measure anatomic characteristics with good to excellent intratester reliability. Intratester reliability did not always ensure acceptable intertester reliability or measurement precision, suggesting more training (or more experience) may be required to achieve acceptable measurement reliability and precision between multiple testers.Keywords: lower extremity alignment | risk factor assessment | posture | measurement stability Article:Little is known about the factors that predispose an individual to anterior cruciate ligament (ACL) injury.1,2 In part, this is because of the myriad of factors that have been proposed to explain the risk of ACL injury. Controlling and measuring multiple variables creates considerable challenges, as variables have the potential to interact with one another, and many of these variables are poorly defined or difficult to obtain reliably.3 Many of the potential risk factors cannot be measured after ACL disruption, because the injury modifies the risk factors, [4][5][6][7][8][9][10][11] and bilateral asymmetry cannot always be assumed. 12,13Because of these limitations, large prospective studies are recommended to identify ACL injury risk factors.14-17 However, prospective studies present their own challenges, as a large cohort of subjects is needed to yield sufficient ACL injuries. Uhorchak et al 16 prospectively fol...

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“…T h e subject assumed a prone position, with the foot and ankle to be measured extended approximately 6 in off the plinth and the opposite lower extremity placed in a position of hip flexion, external rotation, abduction, and knee flexion (5,15). No specific randomization was established for measuring the right o r left foot first.…”

Section: Measurement Procedures Open Kinetic Chain Subtalar Joint Neumentioning

confidence: 99%

“…Unilateral stance was used to simulate the midstance position of gait in which the STJ should be in the neutral position (8.9.12). Tester 1 used the palpation technique to feel for talar dome congruency, placed the subject's foot in STJN if necessary, and aligned the goniometer in the same manner as for the OKC measurement (5). Again, the angle was read and recorded by the other tester ( Figure 2).…”

Section: Closed Kinetic Chain Subtalar Joint Neutralmentioning

confidence: 99%

“…One accepted method for measuring STJN was described by Root et a1 (1 3) and later modified in detail by Elveru et a1 (5). The method for measuring STJN, as described by Elveru et a1 (5), requires that the subject is positioned prone in the OKC, and the head of the talus is palpated for bilateral congruency while the forefoot is passively pronated, and the ankle is dorsiflexed until a soft end feel is reached.…”

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