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Subtalar Joint Axis Location and

Rotational Equilibrium Theory of
Foot Function

Kevin A. Kirby, DPM, MS

Journal of the American Podiatric Medical
Association 91(9): 465-487.
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Introduction
More recent theories on foot function

Sagittal Plane Facilitation Model

Rotational Equilibrium Theory

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Primary Weight-bearing Structures

Kirby, Leondorf & Gregorio (1988)

N=100
Anterior Axial Projection of the Foot

Primary anatomical weightbearing structures during closed

kinetic chain gait are the medial calcaneal tubercle and 5th
metatarsal head.
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GRF Normal
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STJ Axis Orientation

• Courses posterior-
lateral-plantar to
anterior-medial-dorsal
• 16° medial to sagittal
plane
• 42° superior to
transverse plane
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Root et al. (1971)

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Root et al. (1971)

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Clinical Assessment of STJ Axis

Position

Kirby KA, Methods of Determination of Positional

Variance in the Subtalar Joint Axis. Journal of the
American Medical Association 1987; 77(5): 28-
234.
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Plantar Parallel Position

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STJA clinical approximation

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Quantification of STJA
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Subtalar Joint Axis Deviation

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STJ Axis Positional Variance

• Within Normal Limits

• Medially-Deviated

• Laterally-Deviated
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STJA Normal Orientation

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Medially Deviated Subtalar Joint

Axis
• medial to the WBR
structures of the foot
• slightly internally
rotated
• ¯ supinatory moment
• present in functional
overpronators
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Medially Deviated STJ Axis

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Internally rotated & medially

translated talus
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Superior view: talar position

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Posterior view convexity

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Common injuries associated with

MD-STJA
• Plantar fasciitis • Medial tibial stress
• Hallux limitus syndrome
• 2nd MTP joint • PFPS
capsulitis • Pes anserinus bursitis
• Abd. Hallucis strain • PT tendonitis and
• Sinus tarsi syndrome tendon dysfunction
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Laterally Deviated STJ Axis

• lateral to WBR
structures of the foot
• slightly externally
rotated
• ¯ pronatory moment
• present in functional
underpronators
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Laterally Deviated STJ Axis

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Externally rotated & laterally

translated talus
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Superior view: talar position

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Posterior view concavity

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Prominent peroneus longus &

brevis tendons
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Common injuries associated with

LD-STJA

• Inversion ankle
sprains
• Peroneal tendonitis
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STJA orientation
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Medial Heel Skive Technique

• Prescribed for a medially-deviated STJA and

injuries associated with same;
• Originally created for children; and
• Appears to be clinically more effective than a
Blake-Inverted or Root Functional design.
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Rationale
Increase Supination Moment

OR

ORF Inferior to Medial Calcaneal Tubercle

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Indications & Contraindications

Indications Contraindications

• pediatric flexible pes • plantar heel pain (heel

planus spur syndrome, plantar
• posterior tibialis heel bursitis or medial
dysfunction calcaneal neuritis)
• higher level of • lateral ankle instability
pronatory control
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Medial Heel Skive Technique

Negative Cast Balancing

Positive Cast Modification
Land marking & Positioning of MHS
Design Parameters
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Essential Landmarks
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Positioning the Skive

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Medial Heel Skive

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Medial Heel Skive Depth

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Shell Parameters

• 3-5mm polypropylene shell

• Extrinsic rearfoot post
• Minimal MLA dressing
• Lateral phalange
• 18mm+ heel cup
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So what?
• This model may provide a new set of subject
inclusion criteria that can be added to existing
parameters;
• Evaluating 3-D moments about the STJA may
provide us with new insights into:
– the mechanism of running injuries,
– orthotic efficacy; and
– shoe prescription.
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Thanks for comin’ out!

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Rotational Equilibrium