The Medial Heel Skive -- Theory, Evidence, and Reproducibility
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The Medial Heel Skive -- Theory, Evidence, and Reproducibility
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This presentation critically examines the medial heel skive (MHS), an orthotic modification introduced by Dr. Kevin Kirby in 1992 to improve pronation control, particularly for patients with medially deviated subtalar joint axes. Although the MHS has been widely adopted by both clinicians and the orthotic industry, its foundational claim—reducing rearfoot pronation by increasing the supination moment across the STJ axis—has never been empirically verified by rigorous scientific research over the past three decades. The only mechanical assessment demonstrated that increasing the skive depth resulted solely in a localized pressure spike due to the medial force on a reduced contact area, not an increase in vertical force or a shift in the center of pressure. Ultimately, the paper concludes that the MHS remains an unvalidated, theoretical geometric modification that has become entrenched in practice through cultural inertia rather than established scientific evidence, a problem compounded by issues with reproducibility in both traditional and digital foot orthosis manufacturing.