Appears to have been first described as a term in 1944 by W. Sayle Creer, an orthopaedic surgeon from Salford Royal Hospital in England (ref).
Subtalar joint neutral position
• Significant and widely used position for clinical practice
• Defined as the position in which the joint is neither pronated or supinated
“One morning in 1954, just by luck I guess, I was standing in the shower without any thought abut the foot and all of a sudden the concept of neutral subtalar joint position flashed into my mind. I could hardly wait to get to the office to substantiate it. That’s what turned out to be the key to my being able to contribute to podiatry. M.L. Root, 1989” (ref: Lee WE: Podiatric biomechanics: an historical appraisal and discussion of the Root model as a clinical system of approach in the present context of theoretical uncertainty. Clinics Pod Med Surg, 18 (4):555-684, 2001)
Determine by
1) talar congruency method – palpate medial and lateral aspects of the head of the talus, just anterior to the ankle until they feel equally prominent on both sides
2) feel “the bottom of the curve” of STJ arc of motion – the so-called ‘flat spot’
3) equal concavity of curves above and below malleoli
4) original theory had a 2 to 1 ratio of pronation to supination at this joint and the joint was in its neutral position at midstance – this is not now supported by research (but may still be a good clinical guide)
5) that position that “requires more energy to move away from than towards” – it “feels” harder to move the joint away from its neutral position than towards it.
• widely used as a reference point from which to determine alignment of segments of the foot
• assumed to be the position the subtalar joint should be in at midstance (but not supported by evidence)
• has been shown that on axial calcaneal x-ray view that posterior and middle facets are parallel (congruent) when subtalar joint is neutral neutral may be point of maximum congruity for the subtalar joint maximum contact between calcaneal and talar facets for transmitting ground reaction forces through STJ
• clinically, it is considered a very useful position – but still remains to be validated
Problems with the concept of subtalar joint neutral:
• poor repeatability among clinicians in locating it
• defined by what it not rather than what it is
• the subtalar joint in population studies have shown that it is not in this position at midstance
See: https://podiapaedia.org/wiki/biomechanics/clinical-biomechanics/biomechanical-assessment/subtalar-joint-neutral-position/
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Determining Subtalar Joint Neutral Position
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