Van Alsenoy Ken K, D'Août Krisiaan, Vereecke Evie, De Schepper Joris, Santos Derek
a Artevelde University College, Podiatry.
J Am Podiatr Med Assoc. 2014 Jun 24. doi: 10.7547/12-147.1.
Abstract Background Clinically locating the point of no rotation to determine the subtalar joint axis (STJA) location by applying pressure on the plantar surface of the foot, was described by Kirby in 1987, but never validated. The purpose of this study is to extend a previously validated mechanical model to cadaver feet and to examine the intra-intertester reliability. Methods Four testers, with different levels of experience, determined the STJA location and moved the STJ through its range of motion capturing the movement using kinematic analysis. The comparison of the spatial STJA location determined by palpation between and within testers determined the inter- and intratester reliability. The helical axis method was performed to validate the model. Results The intrarater reliability varies from high (α = 0.96) to low (α = 0.26) for the slope and is in general high (α between α= 0.78 and α=0.95) for the intersection. The interrater reliability scores moderate to high, depending on the specific cadaver specimen. Concerning the exact location of the subtalar joint axis, no significant difference was found between the results determined by different testers and the helical axis method. Conclusion The palpation technique as part of the Subtalar Axis Location and Rotational Equilibrium Theory proposed by Kirby is a reliable and valid clinical tool. Experience in performing the palpation technique has a positive influence on the accuracy of the results. In the context of evidence based practice, this technique could be a standard tool in the examination of patients with lower limb related pathology.
摘要 背景 1987年，柯比描述了通过在足底施加压力来临床定位无旋转点以确定距下关节轴（STJA）位置的方法，但从未得到验证。本研究的目的是将先前验证的力学模型扩展到尸体足部，并检验测试者之间的可靠性。方法 四名经验水平不同的测试者确定STJA位置，并通过运动学分析在其运动范围内移动STJ以捕捉运动。测试者之间和测试者内部通过触诊确定的空间STJA位置的比较确定了测试者间和测试者内的可靠性。采用螺旋轴方法对模型进行验证。结果 评分者内可靠性对于斜率而言从高（α = 0.96）到低（α = 0.26）不等，对于交点而言总体较高（α在0.78至0.95之间）。评分者间可靠性得分中等至高，具体取决于特定的尸体标本。关于距下关节轴的确切位置，不同测试者确定的结果与螺旋轴方法之间未发现显著差异。结论 作为柯比提出的距下轴定位和旋转平衡理论一部分的触诊技术是一种可靠且有效的临床工具。进行触诊技术的经验对结果的准确性有积极影响。在循证医学实践的背景下，该技术可能成为检查下肢相关病理患者的标准工具。
