Mr. Schwartz has a “pedorthic” take on feet
getting larger. I would like to offer
a “podiatric” take in response. Growth is a good
thing; pathological spread of the closed chain
architecture of the foot is not. This can happen
before epiphyses close (juvenile bunions) or
after (not at 30, as suggested).
In foot centering theory, we call these
events “juvenile tie beam expansion” and “adult
tie beam expansion” respectively. Tie beam
expansion is pathologic and is a precursor of
pain, deformity, degeneration, and performance
issues at all ages. It occurs in feet that have
rearfoot/forefoot or combined weakness in either
their structure or muscle engine performance or
both. That is what I diagnose and treat as part
of my initial office visit.
If Bob were correct and gravity is the culprit,
wouldn’t we all be in molded shoes? Is Mr.
Schwartz trying to tell us that we don’t know
that 80% of our patients select and wear shoes
that are tight? Munson, an orthopedic surgeon,
published on that fact in 1912 after he examined
soldiers of draft age (time of epiphyseal
closure).
There is a pyramid upon which those who practice
functional lower extremity biomechanics live,
research and practice. History places podiatry
atop that pyramid in terms of education,
training and experience both surgically and non-
operatively.
Urging me to be aware of tight shoes is like a
tire salesman telling Michelin, the inventor of
tires, that that they need to be properly
inflated.
I welcome the comments and use the adjacent
advice and assistance of the pedorthic community
delivered on these pages but question the
pedorthic take on pedal collapse and the need
for posting low level biomechanical advice as if
it were enlightening.
Dennis Shavelson, DPM, NY, NY,
drsha@lifestylepodiatry.com
