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The latest research has proven that changes in the Supra Navicular Angle (SNA) before and during weight bearing are a more accurate and reliable method of assessing foot function than other techniques including Subtalar-Neutral. Furthermore, it is imperative to access the mobility of the 1st MPT joint, as this is a critical factor related to heel lift and achieving functional propulsion.
Interesting claim. The evidence that it was more accurate / reliable than, say, the FPI was not quoted.
I will admit to being ignorant as to what the SNA was. A little digging provided some background information
The supranavicular angle was first described in
Norkin, C.C. and Levangie, P.K. (1983) Joint Structure and Function. Philadelphia: Davis.
As the feiss line. It is comprised of the angle between the 1st met and the navicular and the navicular and the medial malleolus.
Cashmere, T., Smith, R.and Hunt, A. (1999) Medial longitudinal arch of the foot: stationery versus walking measures. Foot and Ankle International. 20(2), 112-118.
Went into rather more detail.
What is the view of the community on this as a diagnostic tool?
My immediate thoughts are
- As a static measurement it may not be indicative of dynamic function
- It would appear to have the same problems as RSCP in terms of variability of soft tissue markings
-It would be somewhat skewed by the planal dominance. A foot with a transverse planal dominance for example might display far more drift than drop and could have a lower SNA than the foot with the same degree of pronation and a frontal planal dominance.
Regards
Robert
Last edited by Robertisaacs : 4th September 2008 at 02:50 AM.
It very similar to the longitudinal arch angle that McPoil & Cornwall have been working on; and yes it has been shown to be predictive of dynamic function. Most of the clinical tests that we have traditionally used have been shown NOT to be predictive of dynamic function.
__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________ God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University This is where I am, where are you?
Just got back from I-FAB (International Foot and Ankle Biomech.) in Italy. My poster was about the correlation between statuc measurements and dynamic function of the midfoot. In my study I used the static measurement Navicula Drop test ad modum Brody (NDT) and the static mesurement of navicula height during one legged standing. I correlated there result with navicula drop and the minimal navicula height during walking in 79 helathy sibjects. My results show that the NDT have an correlation of 0.49 with dynamic navicula drop. Navicula drop measured while standing on one leg versus minimal navicula height during walking have an correlation of 0.93 and an correlation of 0.68 with dynamic navicula drop. The regressionmodel based on the results show that the height of navicula during standing on one leg is very close to the actuel minimal height of navicula during walking.
Furtheremore the calcaneal angle while standing on one leg is also indicative of the maximal calcaneal angle during walking (Relationship Between Three Static Angles of the Rearfoot and the Pattern of Rearfoot Motion During Walking: McPoil and Cornwall 1996).
We did some preliminary study that shows that correlation between the LAA and dynamic navicula drop is only about 0.5. Any comments? One would think that a change in LAA would influence navicula drop?
Research show that it is possible to predict a certain height (ie minimal navicula height during walking or LAA during walking/running using static measurements), but it is very hard to predict a change i navicula height (ie dynamic navicula drop or change in MLA-angle from heelstrike to to-off using static measurements). Also it is worth mentioning that all this research is carried out examining healthy subjects. we do not know if the same correlation/predictive values can be used when we examine patients.
Cheers,
Michael
The Following User Says Thank You to MichaelRathleff For This Useful Post:
So Arch height (however measured) in static may be predictive of arch height in gait. How very retro! Back to "flat feet".
As i mentioned before, a correlation between Nav drop and actual pronation might be heavily affected by planal dominance and axial location so it would be interesting to know to what degree nav drop is predictive of pronation. Anyone know of any studies done on distribution of planal dominance / sagital axial orientation? I don't have access to the original manter study, did he provide a distribution curve?
So that being the case, does anyone use the feiss line in their assessment protocol? If so How? If not why not?
Is it useful for measureing excessive excursions of range?
I can see a use in terms of measuring the transverse planal axial location at mid stance. If we can predict the position of the STJ at MS by the STJ position at static WB then we can assess the axial location using KKs method with the joint in the relevant mid stance position and thus know where in the bundle the axis functions. A functional axial location if you will.
My name is James i am interested in seeing your poster or even better your paper on navicular drop and nivicular height during single leg stance in gait. Could you please forward it, or let me know where i can get it, if you have published it.
It very similar to the longitudinal arch angle that McPoil & Cornwall have been working on; and yes it has been shown to be predictive of dynamic function. Most of the clinical tests that we have traditionally used have been shown NOT to be predictive of dynamic function.
Think I missed this thread the first time round! In addition to the above article, whilst rummaging through Japma online I also noticed McPoil & Cornwalls 2007 paper which concluded that static measurement of the longitudinal arch angle (LAA) is highly predictive of dynamic function during running
Not something I had ever routinely performed as part of the examination, having spent many of the previous years telling my patients that static measurements/observations were not predictive of dynamic function...
Not something I had ever routinely performed as part of the examination, having spent many of the previous years telling my patients that static measurements/observations were not predictive of dynamic function...
Even though it is predictive of dynamic function (and most of the traditional measure we do are not), if you did use it as part of rountine clinical assessment, what do you actually do with the number? How does it change your orthotic prescription?
__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________ God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University This is where I am, where are you?
or other based on what that angle tells you about how the foot functions. From memory, and it was a wee while ago, the system "types" feet as high / mobile, low/rigid etc based on the angle and how it changes between RSCP and NSCP.
Greg Quinn, who runs the course, makes some interesting claims and some interesting observations. Whilst I do not "buy" the system as the evidence based solution it advertizes itself as, I found the concept interesting and the education day challenging. I took much from it, though not a practical use for the feiss line nor the orthotics system based upon it.
--> James and others. PM me with your email and I will send the poster.
I think that it is very important to notice that the measurement of LAA is not predictive of the movement of the foot during running or walking. LAA in standing is predictive of the LAA during midstance in walking or running. It doesnt tell you how much the foot moves.
One thing that my study showed was that the height of the navicular tuberositas in single leg stance is extremely well correlated with the minimal height of the navicular tuberositas during walking. But neither of our measurements was predictive of how much the medial longitudinal arch moves during walking. There is a small error in this version of the poster (cant fint the printed version). In the conclusion I write that NDT has a insignificant correlation with navicular drop during walking. This is an error, the correlation is significant.
I believe it is possible to predict navicular height or LAA using static measurements, but none of the static measurement will give you a good idea of how much the foot moves during the stance phase of walking or running.
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Feiss line / Supranavicular Angle
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Linear Mode
