BACKGROUND: Clinically locating the point of no rotation to determine the subtalar joint axis location by applying pressure on the plantar surface of the foot was described by Kirby in 1987 but was never validated. We sought to extend a previously validated mechanical model to cadaver feet and to examine the intratester and intertester reliability. METHODS: Four testers with different levels of experience determined the subtalar joint axis location and moved the subtalar joint through its range of motion, capturing the movement using kinematic analysis. The comparison of the spatial subtalar joint axis location as determined by palpation between and within testers determined the intertester and intratester reliability. The helical axis method was performed to validate the model. RESULTS: The intrarater reliability varied from a high of α = 0.96 to a low of α = 0.26 for the slope and was, in general, high (α = 0.78-0.95) for the intersection. The interrater reliability scored moderate to high, depending on the specific cadaver specimen. Concerning the exact location of the subtalar joint axis, no significant difference was found between the results determined by different testers and the helical axis method. CONCLUSIONS: The palpation technique as part of the subtalar joint axis location and rotational equilibrium theory proposed by Kirby is a reliable and valid clinical tool. Experience in performing the palpation technique has a positive influence on the accuracy of the results. In the context of evidence-based practice, this technique could be a standard tool in the examination of patients with lower-limb-related pathologic disorders.
BACKGROUND: Clinically locating the point of no rotation to determine the subtalar joint axis location by applying pressure on the plantar surface of the foot was described by Kirby in 1987 but was never validated. We sought to extend a previously validated mechanical model to cadaver feet and to examine the intratester and intertester reliability. METHODS: Four testers with different levels of experience determined the subtalar joint axis location and moved the subtalar joint through its range of motion, capturing the movement using kinematic analysis. The comparison of the spatial subtalar joint axis location as determined by palpation between and within testers determined the intertester and intratester reliability. The helical axis method was performed to validate the model. RESULTS: The intrarater reliability varied from a high of α = 0.96 to a low of α = 0.26 for the slope and was, in general, high (α = 0.78-0.95) for the intersection. The interrater reliability scored moderate to high, depending on the specific cadaver specimen. Concerning the exact location of the subtalar joint axis, no significant difference was found between the results determined by different testers and the helical axis method. CONCLUSIONS: The palpation technique as part of the subtalar joint axis location and rotational equilibrium theory proposed by Kirby is a reliable and valid clinical tool. Experience in performing the palpation technique has a positive influence on the accuracy of the results. In the context of evidence-based practice, this technique could be a standard tool in the examination of patients with lower-limb-related pathologic disorders.
Authors: David Rodríguez-Sanz; Ricardo Becerro-de-Bengoa-Vallejo; Daniel López-López; Cesar Calvo-Lobo; Eva María Martínez-Jiménez; Eduardo Perez-Boal; Marta Elena Losa-Iglesias; Patricia Palomo-López Journal: BMC Pediatr Date: 2018-11-19 Impact factor: 2.125