When assessing heel position, we examine it from two key perspectives: the sagittal and frontal planes, each providing distinct insights into heel alignment and function.

Sagittal Plane View:

• In this view, we assess plantarflexion and dorsiflexion of the heel. Observing the heel from the side helps determine if it is angled downward toward the ground (plantarflexed) or positioned with a greater angle from the floor (dorsiflexed). This alignment affects the overall position of the talus and the ankle, influencing load distribution across the foot. A more plantarflexed position tends to increase medial loading, while a dorsiflexed heel may lead to a lateral shift in load distribution.

Frontal Plane View:

• From the rear, we assess inversion and eversion of the heel. An inward tilt signifies eversion (greater pressure on the medial side of the foot), while an outward tilt indicates inversion (less medial pressure).

• Additionally, we examine the shape and tilt of the heel bone and the alignment of the Achilles tendon. An inward curve of the Achilles tendon typically suggests an everted heel, whereas an outward curve points to an inverted heel. These observations give further clues about the heel’s resting position and any underlying imbalances in foot posture.

Coupled Motions and Transverse Plane Rotation

It’s important to note that the dual actions in the sagittal and frontal planes combine to produce transverse plane rotation. Specifically:

• Plantarflexion (sagittal plane) coupled with eversion (frontal plane) tends to produce internal rotation in the transverse plane.

• Conversely, dorsiflexion (sagittal plane) combined with inversion (frontal plane) results in external rotation in the transverse plane.

Thus, a heel that is plantarflexed may also exhibit eversion and internal rotation, while a dorsiflexed heel may present with inversion and external rotation. Recognizing these coupled motions is essential for identifying compensations or structural deviations, as well as for understanding how the heel’s position influences the stability and function of the entire foot and lower limb.

This dual-perspective assessment is essential for identifying compensations or structural deviations in the heel, as well as for understanding how its position affects the stability and function of the entire foot and lower limb.

Lesson Activity

What You Need to Know:

Sagittal Plane View:

• Assesses plantarflexion (heel angled downward) and dorsiflexion (heel with greater angle from floor).

• Influences load distribution: plantarflexion increases medial loading; dorsiflexion shifts load laterally.

Frontal Plane View:

• Assesses inversion (outward tilt) and eversion (inward tilt).

• Heel and Achilles alignment provide clues: inward Achilles curve suggests eversion; outward curve suggests inversion.

Coupled Motions and Rotation:

• Plantarflexion + eversion → internal rotation (transverse plane).

• Dorsiflexion + inversion → external rotation.

• These patterns help identify compensations and structural deviations affecting lower limb stability.

Influencing Motion in the Rear Foot (To Encourage DF or PF):

1. Encouraging Dorsiflexion (DF): What would you do to encourage this motion?

2. Encouraging Plantarflexion (PF): What would you do to encourage this motion?