Clinicians' assessment of the hindfoot: a study of reliability

Static measurements of position of the hindfoot and clinical assessment of motion of the hindfoot often are used in the assessment of foot function and manufacturing of orthoses. However, the reliability and validity of static measurements and dynamic observation and assessment of the hindfoot are controversial. The purpose of this investigation was to examine reliability of static and dynamic assessments of the hindfoot in a setting that reproduced clinical conditions.

Twenty-four healthy participants were evaluated by four experienced clinicians for four commonly used static measurements and dynamic assessment of hindfoot function. The protocol was repeated 2 weeks later.

Results indicated that reliability of results, both intertester and from test to test were poor to fair for static measurements of the hindfoot (r = 0.075 to r = 0.755, p < 0.05). The error estimates associated with these measures were high; subtalar neutral position and resting calcaneal stance position both demonstrated measurement errors of more than 4 degrees (95% confidence intervals-4.1 degrees and 5.1 degrees, respectively). Retest reliability of dynamic assessments were considered reasonable for only one clinician (kappa = 0.55). Intertester agreement was poor among all clinicians.

Clinicians taking static measurements demonstrated large errors that do not reflect the precision that has been assumed in clinical theory using these measurements. The availability of static assessments did not improve dynamic assessment. This poor reliability calls into question the importance placed on static and dynamic measurements of the hindfoot in clinical decision-making.