Original Research| Volume 50, ISSUE 5, P551-557, September 2011

Radiographic Evaluation of Navicular Position in the Sagittal Plane—Correction Following an Extraosseous Talotarsal Stabilization Procedure


      The navicular drop in the sagittal plane on weight-bearing is a valid indicator of foot pronation. Dislocation of the talus on the tarsal mechanism results in hyperpronation, which can lead to excessive navicular drop. The purpose of the present study was to radiographically determine the efficacy of HyProCure® in realigning the navicular bone in hyperpronating feet. We hypothesized that following the placement of HyProCure®, the navicular height would increase significantly compared to its preoperative value. Radiographs of 61 adult patients (86 feet) who received HyProCure® without adjunctive hindfoot or midfoot soft tissue or osseous procedures were analyzed. The distance of the navicular with respect to the cuboid was measured from the pre- and postoperative weight-bearing lateral radiographs. Additionally, we measured foot length to normalize the navicular to cuboid distance. The postoperative radiographs were taken at an average follow-up of 17 days. The mean preoperative true navicular to cuboid distance was 19 ± 6 mm as compared to a mean postoperative value of 24 ± 5 mm. The mean pre- and postoperative normalized navicular to cuboid distances were 0.098 ± 0.029 and 0.125 ± 0.027, respectively (± 1 SD). The postoperative increase in the true and normalized navicular to cuboid distance was statistically significant (p < .001). HyProCure® was effective in improving the anatomic alignment of the talonavicular joint by reducing excessive navicular drop. This indicates reduction of excessive abnormal pronation and stabilization of the medial column of the foot, which can also lead to reduction in the excessive forces placed on the supporting soft tissue structures.

      Level of Clinical Evidence


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The Journal of Foot and Ankle Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Huson A.
        Biomechanics of the tarsal mechanism: a key to the function of the normal human foot.
        J Am Podiatr Med Assoc. 2000; 90: 12-17
        • Chambers E.F.S.
        An operation for the correction of flexible flatfeet of adolescents.
        West J Surg Obstet Gynecol. 1946; 54: 77-86
        • Menz H.B.
        Alternative techniques for the clinical assessment of foot pronation.
        J Am Podiatr Med Assoc. 1998; 88: 119-129
        • Root M.L.
        • Orien W.P.
        • Weed J.H.
        • Hughes R.J.
        Biomechanical Examination of the Foot. vol. 1. Clinical Biomechanics, Los Angeles, CA1971
        • Hlavac H.F.
        Differences in x-ray findings with varied positioning of the foot.
        J Am Podiatr Assoc. 1967; 57: 465-471
        • Inman V.T.
        Joints of the Ankle.
        Williams & Wilkins, Baltimore1976
      1. Officer A, Smith R, Egan I. An investigation of the validity of subtalar joint neutral testing utilising radiography (abstract). Presented at the Australian Conference of Science and Medicine in Sport, October 28–31, 1996.

        • Wernick J.
        • Langer S.
        A Practical Manual for a Basic Approach to Biomechanics.
        Langer Acrylic Laboratory, New York1971
        • Picciano A.M.
        • Rowlands M.S.
        • Worrell T.
        Reliability of open and closed kinetic chain subtalar joint neutral positions and navicular drop test.
        J Orthop Sports Phys Ther. 1993; 18: 553-558
        • Sell K.E.
        • Verity T.M.
        • Worrell T.W.
        • Pease B.J.
        • Wigglesworth J.
        Two measurement techniques for assessing subtalar joint position: a reliability study.
        J Orthop Sports Phys Ther. 1994; 19: 162-167
        • Brody D.M.
        Techniques in the evaluation and treatment of the injured runner.
        Orthop Clin North Am. 1982; 13: 541-558
        • Stovitz S.D.
        • Coetzee J.C.
        Hyperpronation and foot pain: steps towards pain-free feet.
        Phys Sports Med. 2004; 32: 19-26
        • Graham M.E.
        Hyperpronation—the role of subtalar arthroereisis.
        Eur Musculoskel Rev. 2010; 5: 65-69
        • McPoil T.G.
        • Cornwall M.W.
        The relationship between static measurements of the lower extremity and the pattern of rearfoot motion during walking (abstract).
        Phys Ther. 1994; 74: 141
        • Lundberg A.
        • Svensson O.K.
        • Bylund C.
        • Goldie I.
        • Selvik G.
        Kinematics of the ankle/foot complex—part 2: pronation and supination.
        Foot Ankle. 1989; 9: 248-253
        • Winson I.G.
        • Lundberg A.
        • Bylund C.
        The pattern of motion of the longitudinal arch of the foot.
        Foot. 1994; 4: 151-154
        • Vinicombe A.
        • Raspovic A.
        • Menz H.B.
        Reliability of navicular displacement measurement as a clinical indicator of foot posture.
        J Am Podiatr Med Assoc. 2001; 91: 262-268
        • Cornwall M.W.
        • McPoil T.G.
        Relative movement of the navicular bone during normal walking.
        Foot Ankle Int. 1999; 20: 507-512
        • Cavanagh P.R.
        • Morag E.
        • Boulton A.J.M.
        • Young M.J.
        • Deffner K.T.
        • Pammer S.E.
        The relationship of static foot structure to dynamic foot function.
        J Biomech. 1997; 30: 243-250
        • McCrory J.L.
        • Young M.J.
        • Boulton A.J.M.
        • Cavanagh P.R.
        Arch index as a predictor of arch height.
        Foot. 1997; 7: 79-81
        • Saltzman C.L.
        • Nawoczenski D.A.
        • Talbot K.D.
        Measurement of the medial longitudinal arch.
        Arch Phys Med Rehabil. 1995; 76: 45-49
        • Williams D.S.
        • McClay I.S.
        Measurements used to characterize the foot and the medial longitudinal arch: reliability and validity.
        Phys Ther. 2000; 80: 864-871
        • Mueller M.J.
        • Host J.V.
        • Norton B.J.
        Navicular drop as a composite measure of excessive pronation.
        J Am Podiatr Med Assoc. 1993; 83: 198-202
        • Nguyen A.D.
        • Shultz S.J.
        Identifying relationships among lower extremity alignment characteristics.
        J Athl Train. 2009; 44: 511-518
        • Allen M.K.
        • Glasoe W.M.
        Metrecom measurement of navicular drop in subjects with anterior cruciate ligament injury.
        J Athl Train. 2000; 35: 403-406
        • Bandholm T.
        • Boysen L.
        • Haugaard S.
        • Zebis M.K.
        • Bencke J.
        Foot medial longitudinal-arch deformation during quiet standing and gait in subjects with medial tibial stress syndrome.
        J Foot Ankle Surg. 2008; 47: 89-95
        • Beckett M.E.
        • Massie D.L.
        • Bowers K.D.
        • Stoll D.A.
        Incidence of hyperpronation in the ACL injured knee: a clinical perspective.
        J Athl Train. 1992; 27: 58-62
        • Bennett J.E.
        • Reinking M.F.
        • Pluemer B.
        • Pentel A.
        • Seaton M.
        • Killian C.
        Factors contributing to the development of medial tibial stress syndrome in high school runners.
        J Orthop Sports Phys Ther. 2001; 31: 504-510
        • Khamis S.
        • Yizhar Z.
        Effect of feet hyperpronation on pelvic alignment in a standing position.
        Gait Posture. 2007; 25: 127-134
        • Shultz S.J.
        • Nguyen A.D.
        • Levine B.J.
        The relationship between lower extremity alignment characteristics and anterior knee joint laxity.
        Sports Health. 2009; 1: 54-60
        • Chang T.J.
        • Lee J.
        Subtalar joint arthroereisis in adult-acquired flatfoot and posterior tibial tendon dysfunction.
        Clin Podiatr Med Surg. 2007; 24: 687-697
        • Maxwell J.R.
        • Carro A.
        • Sun C.
        Use of the Maxwell-Brancheau arthroereisis implant for the correction of posterior tibial tendon dysfunction.
        Clin Podiatr Med Surg. 1999; 16: 479-489
        • Schon L.C.
        Subtalar arthroereisis: a new exploration of an old concept.
        Foot Ankle Clin. 2007; 12: 329-339
        • Viladot R.
        • Pons M.
        • Alvarez F.
        • Omaña J.
        Subtalar arthroereisis for posterior tibial tendon dysfunction: a preliminary report.
        Foot Ankle Int. 2003; 24: 600-606
        • Nielsen R.G.
        • Rathleff M.S.
        • Simonsen O.H.
        • Langberg H.
        Determination of normal values for navicular drop during walking: a new model correcting for foot length and gender.
        J Foot Ankle Res. 2009; 2: 12-18
        • Gentili A.
        • Masih S.
        • Yao L.
        • Seeger L.L.
        Pictorial review: foot axes and angles.
        Br J Radiol. 1996; 69: 968-974
        • Thomas J.
        • Kunkel M.
        • Lopez R.
        • Sparks D.
        Radiographic values of the adult foot in a standardized population.
        J Foot Ankle Surg. 2006; 45: 3-12
        • Steel M.W.I.
        • Johnson K.A.
        • DeWitz M.A.
        • Ilstrup D.M.
        Radiographic measurements of the normal adult foot.
        Foot Ankle. 1980; 1: 151-158
        • Cobey J.C.
        • Sella E.
        Standardizing methods of measurement of foot shape by including the effects of subtalar rotation.
        Foot Ankle. 1981; 2: 30-36
        • Perry M.D.
        • Mont M.A.
        • Einhorn T.A.
        • Waller J.D.
        The validity of measurements made on standard foot orthoroentgenograms.
        Foot Ankle. 1992; 13: 502-507
        • Dicharry J.M.
        • Franz J.R.
        • Della Croce U.
        • Wilder R.P.
        • Riley P.O.
        • Kerrigan D.C.
        Differences in static and dynamic measures in evaluation of talonavicular mobility in gait.
        J Orthop Sports Phys Ther. 2009; 39: 628-634
        • McPoil T.G.
        • Cornwall M.W.
        Relationship between three static angles of the rearfoot and the pattern of rearfoot motion during walking.
        J Orthop Sports Phys Ther. 1996; 23: 370-375