Using The Heel Bisection Line To Help Assess Orthotic Prescriptions

As part of my biomechanical evaluation, I draw a line on the back of the heel that represents the bisection of the heel. I am sure my measurement is only accurate within a few degrees. However, I am trying to have a line represent an entire heel bone and attempt to do this the best I can. I should be able to draw the same line with the patient prone or standing. It is one of the basic skills podiatrists learn.

I use this heel bisection to see if my orthotic devices are helping or if more correction is necessary. The ruler (see photo at left) is just a reference line as the orthotic device on the right foot straightens up the everted heel below.

This right foot (see photo at right) is everted to the ground. I use the heel bisection line I learned in podiatry school to represent whether the heel bone is everted to the ground, vertical or inverted to the ground. Then I can check if my orthotic device is helping make the foot more stable. You should first look at the back of the heel and decide if it is everted, vertical or inverted. Then draw your line and see if you captured this heel position. If you are performing this as you dispense an orthosis, then this should correlate to what you see in gait.

The left photo shows the use of a goniometer at the heel.

Of course, when we are designing orthotic devices, we try to make everted heels generally less everted, make vertical heels inverted when the foot is pronated and make inverted heels generally less inverted unless there are significant rearfoot varus conditions.

Editor’s note: This blog originally appeared at https://www.drblakeshealingsole.com/2019/03/for-podiatrists-significance-of-heel.html . It is adapted with permission from the author.