Evaluation and management of foot and ankle disorders: present problems and future directions

Recent research has raised serious concerns regarding the reliability and validity of the evaluation and treatment scheme proposed by Root et al. Although the Root et al theory is widely referenced in the physical therapy literature and commonly taught in continuing education courses, current issues of concern include: 1) measurement technique reliability, 2) the criteria proposed for normal foot alignment, and 3) the position of the subtalar joint between midstance and heel-off during walking. The intent of this paper is to review these three problem areas which have been identified with the Root et al theory as well as to propose the use of a "tissue stress model" which the authors have found to be an effective alternative for evaluating and treating foot disorders.