The Reliability of Subtalar and Hindfoot Assessment for Interventions in Ankle and Foot Dysfunction

Subtalar joint and hindfoot measurements are commonly made in the clinic to assess foot and ankle positions in cases of lower extremity dysfunctions. The research studies we reviewed were limited to reliability studies of hindfoot or subtalar joint assessment. Most of the studies we encountered in our literature review addressed the subject of a tester’s experience in measuring as it relates to measurement reliability, however few studies found that experience had a lot of bearing on how reliably the measures could be taken. Based on the studies we encountered, the use of goniometric measurements for clinical assessment and interventions is mostly unreliable. We acknowledge, however, that no other current tools are available to allow for these clinical measures to be made objectively without additional costs or training. Therefore, we recommend cautious use of closed-chain measurements with careful consideration for the impact of potential measurement error on intervention choices. Clinical Interest: During our clinical internships and in our physical therapy classes we have encountered subtalar and hindfoot assessment techniques, and have received beginning level training in the assessment of the hindfoot and its motions. These experiences made us question the reliability and validity of the current measuring techniques, especially with regard to using non-weight bearing measures to assess or control weight bearing activity. Our clinical question is concerned with the reliability with which these biomechanical measurement techniques can be taken. We had no specific patient scenario on which to base this question, only the concept that we as physical therapists need to take a deeper look into the reliability of our measures in the assessment of foot dysfunction. The present climate of physical therapy is moving to evidence based practice, however the current research does not always agree with the current standards of practice. Our clinically answerable question: Population: Adults with foot and ankle dysfunctions. Tests: Physical therapy assessment of subtalar or hindfoot position in both open and closed kinetic chain postures using various measurement tools (e.g. goniometry, inclinometer). Comparison: None. Outcome: Intra and Intertester reliabilit