Ankle & Foot
Structural & Biomechanical
Evidence: suggestive
Subtalar Neutral Special Test
Orthopedic Physical Examination & Clinical Assessment Guide
What is it used for?
- Determining the neutral position of the rearfoot for biomechanical assessment and orthotic casting.
How to Perform
- Position: Patient lies prone with feet hanging off the table.
- Action: Grasp the 4th and 5th metatarsal heads with one hand and gently dorsiflex the foot until resistance is felt.
- Palpation: With the other hand, palpate the head of the talus (front of the ankle) on both the medial and lateral sides.
- Movement: Slowly swing the foot side-to-side (supination/pronation) until the talus head feels equal on both sides (not protruding more on one side).
Interpretation of Results
- Observation: This position is "Subtalar Neutral." The angle of the heel relative to the leg is then measured to identify varus or valgus deformities.
Clinical Context & Limitations
The Subtalar Neutral should be considered as one component of a comprehensive musculoskeletal assessment. No single special test has perfect diagnostic accuracy; thus, clinical decision-making should integrate test results with patient-reported symptoms, mechanism of injury, functional impairment, and relevant imaging.
Clinicians should be aware of potential false-positive results in patients with pain sensitisation, muscle guarding, or poor relaxation. For the Ankle & Foot region, combining the Subtalar Neutral with complementary examination tests significantly improves overall diagnostic confidence.
References
- Magee, D. J. (2021). Orthopedic Physical Assessment (7th ed.). Elsevier.
