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All of the metatarsal heads lie in one plane 3. The plane of the met heads is in the same plane as the plantar condyl es of the calcaneus Subtalar Neutral Defined as the measurement of the angle between a line that bisects the distal 1/3 of the lower leg and a line that bisects the calcaneus The angle should be zero degrees in the normal foot, but actually is 2-3 degrees of varus (inverted) in most subjects Metatarsal Heads The second, third, and fourth met heads are usually in the same plane un less there has been some trauma or longstanding structural deviation Deformities are usually found in the first and fifth met heads Assessing alignment of the first met head to the second and the fifth me t head to the fourth is clinically important Forefoot-to-Rearfoot Relationship Frontal Plane: the calcaneal bisection is commonly used to compare the h eel with the forefoot. The calcaneal bisection is almost perpendicular to the p lantar condyles and should be perpendicular to the plane of the metatarsal heads . If the plane of the metatarsal heads is perpendicular to the bisection of the calcaneus, the forefoot-to-rear foot relationship i s normal or "neutral". is normal or "neutral". Sagittal Plane: An imaginary plane representing the ground surface is ap plied to the plantar surface of the calcaneus. The metatarsal heads should rest upon this plane. Transverse Plane: The forefoot should have the same longitudinal directi on as the rear foot. This relationship is observed in the STJ neutral position. Rearfoot Varus - The most common structural deformity - Caused by a failure of the calcaneus to complete the ontogenic derotat ion during childhood - At heel strike, the STJ is slightly supinated and the lower limb is ad ducted, resulting in an inverted calcaneus and ground contact occuring on the la teral aspect of the foot - The STJ goes through an abnormal amount of pronation in compensating f or the rear foot varus Forefoot Varus - Is a osseous deformity of the forefoot - The most probable cause of this deformity is insufficient developmenta l rotation of the head of the talus Forefoot Valgus - Two types of forefoot valgus: 1) All of the met heads may be everted, or 2) the first met head may be plantarflexed while the second-fifth met heads l ie in the appropriate plane - A possible cause in excessive ontogenic rotation of the talar head Forefoot Equinus - Sagittal plane deformity - The forefoot structure is plantarflexed when compared to the rearfoot