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The Search for Subtalar Neutral 

Staff Writer

For my inaugural blog I would like to discuss our gold standard in orthotics for initial AFO alignment, Subtalar Neutral. As practitioners, we have been taught for many years that this is the most ideal position to maintain the ankle complex in order to achieve proper gait biomechanics. However, I would contest that maintaining the ankle in a subtalar neutral position throughout the entire gait cycle not only restricts proper gait biomechanics from occurring, but also hampers the development of normal muscle strategies and motor planning. Subtalar neutral refers to a static position, and as it relates to the normal human gait cycle, we spend less than 0.1% of stance phase in subtalar neutral. It is quite simply a position that the ankle moves through when accepting the body's weight.

I believe midline stability is what we are truly in search of. Midline stability refers to the concept of allowing the foot/ankle to move readily throughout its normal range of motion. In this scenario you only restrict the excessive positions that inhibit proper muscle exertion and proprioception from occurring. By designing an orthosis that creates a stable environment in and out of midline, the wearer can achieve improved gait biomechanics and develop more appropriate muscle strategies and motor planning. Allowing controlled motion to take place works to increase joint receptor function, intrinsic muscle function, and overall proprioceptive feedback.

The shift towards increased midline stability is not a new concept and is something that is being perpetuated throughout the world of pediatric physical therapy by some of their leading educators. As orthotists, we must continue to push ourselves to find new products and/or new fabrication techniques so that we may continue to provide better futures for our patients. Imagine the impact we can have on young lives and families if we can create systems that encourage more normal function, not create dependency on the very devices that are being fit.



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