If you purchased custom footbeds for your ski boots or had your ski boots custom fit you may have been told that your foot was placed in subtalar neutral and that this created the strongest position of the bones of the foot and leg for skiing. Neutral in this context refers to a neutral configuration of the subtalar joint of the ankle/foot complex.
As best I can recall, the term subtalar neutral began to emerge in the ski industry about 1978. The authoritarian manner in which it was presented and promoted suggested that it was science-based and supported with evidence that conclusively demonstrated superior performance. But I never saw or heard any explanation as to how subtalar neutral could create the strongest position for skiing of the bones of the foot and leg and I have still not seen such an explanation.
Back in 1978, I didn’t even know what the subtalar joint was. I couldn’t envision how the bones of the foot and leg could be maintained in a specific configuration while foam was injected into a liner around the foot and leg or through some other custom fit system. But in spite of the lack of even a theory to support the premise of subtalar neutral as creating ideal biomechanical alignment of the bones of the foot and leg for skiing the premise seemed to be readily accepted as fact and quickly became mainstream. By the time The Shoe in Sport (which questioned the principles on which the plastic ski boot is based) was published in 1989 (1987 in German), neutral subtalar was firmly entrenched in the narrative of skiing.
In my US Patent 4,534,122 (filed on December 1, 2013) for a dorsal support system that I called the Dorthotic, I had unkowingly tried to fix the subtalar joint in a static position as evidenced by the excerpt below from the patent:
The system of the invention applies significant pressure to the dorsal (upper) surface of the foot over the instep, including the medial and lateral aspects thereof, and hence to the bones of the mid-foot to substantially prevent these bones from moving relative to each other.
Note: The prior art refers to the current paradigm in existence.
The objective of the dorsal support system was to immobilize the joints of the bones below the ankle in conjunction with the joints of the bones of the midfoot while allowing unrestricted dorsi-plantarflexion of the ankle joint within it’s normal range of motion. But the significant medial (inner) pressure applied by the system to the bones of Podborski’s foot below his ankle made it difficult for him to stand and balance on one foot with the system in a ski boot shell even on the concrete floor of my workshop. Removing the offending structure from the dorsal support system quickly resolved the issue by allowing his foot to pronate. This made me aware that structures that impede supination did not appear to create issues. This insight raised the possibility of a fit system based on selective constraint applied to specific aspects of the foot and leg as opposed to what I termed indiscriminate (general) constraint.
Even though at the time that I wrote my US Patent No, 5,265,350 in February of 1992 I still did not comprehend the mechanism behind the claimed superior performance associated subtalar neutral, I knew enough to know that attempting to fix the subtalar joint in any configuration in a ski boot would interfere with, or even prevent, a skier from balancing on one foot.
Here is what I said in the patent:
The prior art refers to the importance of a “neutral sub-talar joint”. The sub-talar joint is a joint with rotational capability which underlies and supports the ankle joint.
………………….the prior art which teaches, in an indirect manner, that the ideal function for skiing will result from fixing the architecture of the foot in a position closely resembling that of bipedal function, thus preventing monopedal function (balance on one foot on the outside ski).
I later discovered that the above statement came close to the truth.
I also discussed the issue of subtalar neutral in my post NO NEUTRAL GROUND (2.) published on September 1, 2014. But I did not learn about the origins of subtatar neutral and especially the intense controversy surrounding it in professional circles until recently when I came across a discussion on Root and his subtalar neutral theory in an online podiatry forum.
The Origin of Subtalar Neutral
Merton’s Root’s subtalar joint neutral theory was first described in the textbooks, Biomechanical Examination of the Foot, Volume 1. – 1971 (Root, Orien, Weed and Hughes) and Normal and Abnormal Function of the Foot – 1977 (Root, Orien, Weed). The basic premise of Root’s subtalar neutral theory is that a neutral position of the subtalar joint (which Root defined as existing when the foot was neither supinated or pronated), is the ideal position of function in static (two-footed bipedal, erect) stance and in gait where the subtalar neutral theory posited that the foot was pronated in the first half of the stance phase then transitioned through neutral in mid stance to become supinated in the latter half of the stance phase.
Root’s paradigm proposes that the human foot functions ideally around the subtalar joint’s neutral position and that deviations from this ideal position are deformities.
What Root really said
Root and his associates never stated that the joints of the foot should be immobilized in subtalar neutral. The reference to static in subtalar neutral as the ideal position of function in static stance pertained to a subject standing in place in an erect bipedal stance on a flat, level, stable surface with the weight apportioned between the two feet. In this static stance the Root subtalar neutral theory posited that the subtalar joint should rest in neutral. Root and his associates never stated, implied or suggested that the joints of the foot should be configured and immobilized in subtalar neutral. Further, Root and his associates made no reference, of which I am aware, to the application of subtalar neutral to activities other than static stance and gait. Critrics have asserted that a subtalar neutral position in static stance is neither normal or ideal. In defining subtalar joint neutral as normal, Root’s theory implied the existence of abnormal pathologies in the feet of the majority of the world’s population.
The lack of evidence
Critics of Root and his associates “Eight Biophysical Criteria for Normalcy” claim the criteria was nothing more than hunches, that these conjectures were accepted as fact, when, in reality, there was no experimental data or research to support them and that the eight criteria were neither normal or ideal.
The STJ neutral position problem
One of the early critics of Root and his associates was Kevin Kirby, DPM. He is an Adjunct Associate Professor within the Department of Applied Biomechanics at the California School of Podiatric Medicine at Samuel Merritt College in Oakland, Ca.
Kirby observed a large error range in determining STJ neutral position on the same foot from one examiner to another. In unpublished studies done during his Biomechanics Fellowship at the California College of Podiatric Medicine, Kirby found that the Biomechanics Professors were +/- 2 degrees (a 4 degree spread) and the podiatry students were +/- 5 degrees (a 10 degree spread) in determining STJ neutral position.
Subtalar neutral appears to be what amounts to a knife edge between pronation and supination where neutral is the border or transition point between the two states. Unless the subtalar neutral position can be precisely and consistently identified, it is impossible to know whether the subtalar joint is pronated or supinated.
The future of subtalar neutral in skiing
Too many times theories of how the human foot functions and therefore how mechanically inducted foot problems are treated have been presented as if they were facts. The dogmatic adherence that sometimes ensues from such an approach has frequently stifled the evolution of foot mechanics. This has been particularly apparent in the field of podiatry which has been dominated by the Root paradigm. (4.)
The long standing controversy and growing challenges mounted against the credibily of Root’s subtalar neutral theory has significant implications for the continued promotion of subtalar neutral in skiing as providing the strongest position of the bones of the foot and leg.
It may eventually be shown to be unfortunate that Root’s influential textbooks were published at a time when the ski industry was attempting to come to terms with the skier/boot interface issues associated with the new paradigm created by the rigid shell plastic ski boot.
In my next post, I will discuss what a ski boot should do for the user or perhaps, more a case of what a ski boot shouldn’t do.
- Root ML, Orien WP, Weed JH, RJ Hughes: Biomechanical Examination of the Foot, Volume 1. Clinical Biomechanics Corporation, Los Angeles, 1971
- Are Root Biomechanics Dying: Podiatry Today, March 27, 2009
- Foot biomechanics- emerging paradigms: Stephen F Albert, 4th Congress of the International Foot and Ankle Biomechanics (i-FAB) Community Busan, Korea. 8-11 April 2014