Interrater reliability of subtalar neutral, calcaneal inversion and eversion

Area of Science:

• Orthopedics
• Sports Medicine
• Physical Therapy

Background:

• Accurate assessment of subtalar joint (STJ) motion is crucial for diagnosing and managing foot and ankle pathologies.
• Previous studies have yielded inconsistent findings regarding the reliability of STJ measurements.
• Standardized protocols are essential for reproducible clinical assessments.

Purpose of the Study:

• To determine the interrater reliability of calcaneal inversion/eversion and subtalar joint neutral (STJN) measurements.
• To compare mathematical and palpatory methods for assessing STJN.
• To compare calcaneal eversion measurements in prone, bilateral stance, and unilateral stance positions.

Main Methods:

• Three examiners measured 20 patients with recent ankle pathology using a standardized protocol.
• Interrater reliability was assessed using Intraclass Correlation Coefficients (ICC).
• Analysis of Variance (ANOVA) compared motion differences between test positions (prone, bilateral stance, unilateral stance).

Main Results:

• Prone measurements for calcaneal inversion/eversion and STJN exhibited low to moderate interrater reliability (ICC: 0.25–0.60).
• Weight-bearing measurements demonstrated high interrater reliability (bilateral stance: r=0.91; unilateral stance: r=0.75).
• Significant differences in motion were observed between test positions.

Conclusions:

• Non-weight-bearing measurements of calcaneal position and STJN have limited clinical value due to low reliability.
• Weight-bearing assessments provide more reliable measures of subtalar joint motion.
• Clinicians should consider weight-bearing positions for more accurate evaluation of STJ range of motion.