Is it important to position foot in subtalar joint neutral position during non–weight-bearing molding for foot orthoses?

Abstract

When taking molds for foot orthoses, it is accepted practice to position the subtalar joint in its neutral position. However, foot orthoses have no contact with the talus, and this leads to a hypothesis that as long as there is correction available to appropriately align the forefoot relative to the hindfoot when taking a mold, changes in subtalar joint angles do not lead to significant alterations in the plantar surface shapes of the molds taken. This study tested this presumption with 20 subjects between 22 and 46 years old. During non–weight-bearing casting, the subtalar joints were aligned at positions of 4° of eversion, 2° of eversion, 2° of inversion, and in neutral. At each orientation, forces were applied over the forefoot such that the metatarsal heads were aligned with the rearfoot. Digital scanning was used to analyze the shape of each negative mold. There were significant changes in projection volume in different subtalar joint orientations. However, the changes in arch heights, navicular height, and protrusion were insignificant and very small. It is therefore suggested that as long as the forefoot and hindfoot are appropriately aligned, variations in the orientation of the subtalar joint would be acceptable.