10/03/2019    Loretta Logan, DPM, MPH

Welcome to the Future of Podiatry (Paul Kesselman, DPM)

As chair of the Department of Orthopedics and
Pediatrics at the New York College of Podiatric
Medicine (NYCPM) I feel it is necessary to
respond to your recent comments regarding the
current state of orthopedic training at the
schools of podiatric medicine. While I agree
with the consensus that the younger
practitioners entering practice have placed
surgery at the head of their treatment plans,
the first sentence in point #1, “The
undergraduate level of biomechanical training is
apparently shameful as compared to when I was at
ICPM 1977-1981” was particularly troubling.

I would be happy to share curriculum documents
with you which show the evolution and expansion
of orthopedic training from the time of then
NYCPM chair Dr. Richard Schuster, and modified
to its current design by successive chairs and
my predecessors, Drs. Joseph D’Amico, Edward
Rzonca, Mark Caselli, Justin Wernick, Russell
Volpe and myself. I will assert that among the
colleges of Podiatric Medicine, NYCPM
consistently stands out as being a school that
the students feel is “orthopedically heavy”, due
to the rigorous classroom and clinic sessions
delivered throughout the 4-year curriculum.

While we no longer ‘build (custom orthoses, in-
house) from scratch’ from a neutral position
cast, students are well-trained in casting and
fabrication detail for fully prescription
devices and are able to complete on the fly
prescriptions using modifiable “blanks” to which
they add posting, accommodation and other
standard orthosis additions and features in our
orthotic laboratory.

In response to your statement in point # 2, “Do
students have any idea about orthotic materials,
construction, how to cast (or scan correctly). I
dare say no!”, I emphatically say yes! Our
students have didactic lectures and workshops on
casting, materials, footwear/pedorthics and
orthotic fabrication delivered by clinicians who
bring decades of experience to the craft. Our
students also have over 500 hours of clinical
rotations dedicated to biomechanics/orthopedic
sciences and where full biomechanical exams and
observational gait analysis are taught and
routinely used to evaluate and treat both adult
and pediatric patients. Our gait lab, which
features current pressure mapping and video
technology serves to assess patients whether for
orthopedic prescription, diabetic or pre-
surgical evaluation. It is our belief that this
academic and clinical experience better serves
orthopedic education (and the patient) than
would time spent creating plaster molds, et al…
especially considering that orthotic labs have
also largely abandoned this in favor of digital
and cad-cam technology.

I will also point out that NYCPM consistently
leads in post-graduate education in orthopedic
sciences. The annual Richard O. Schuster
Biomechanics Seminar is an event unlike any
other in North America and routinely showcases
not only NYCPM faculty but highly regarded
clinicians from around the country. NYCPM
faculty participate nationally in exam
development (APMLE and specialty board),
evaluation of residency training standards and
continuing education events where their
expertise and passion for this domain is
evident.

Hopefully, the information above will address
the second statement in that same initial
paragraph that your description of the
‘shameful’ state of podiatric orthopedics is
based merely on your “…query of student
residency interviews or externships over the
past 10 years.” Could your frustration in
questioning these particular students and their
unacceptable responses be reflective of the
fourth sentence in the same paragraph regarding
the opinion that Dr. Aronson voiced stating it
would take a ‘minimum’ of five years to master
the subject?

During the 2018 Richard O. Shuster Biomechanics
Seminar, I presented “An Analysis of the
Biomechanics/Orthopedics Curriculum in the
Colleges of Podiatric Medicine.” My research
involved reaching out to each of the schools to
obtain information on their curriculum in
Biomechanics/Orthopedics from as far back as
they could take me to the current day. My
analysis concluded that the level and quality of
training in the colleges of Podiatric Medicine
showed that biomechanics/orthopedic sciences is
being taught and with rigor and dedication at
all schools. As a faculty member at one our
sister institutions stated “the concern is at
the handoff point (residency training) where the
importance or expertise in biomechanics may be
diluted or lost.”

Yes, there are issues with regard to residency
programs not placing enough emphasis on the
biomechanical exam as part of the pre-surgical
workup (though I imagine that there are some
programs who do this quite well.), however that
is something that the Council will need to
address. And yes, this is something that clearly
needs to be accomplished as soon as possible.

While your letter does highlight several areas
of deficiency within our field, I wanted to take
this opportunity to address item # 1 and state
unequivocally that there is nothing shameful
about the biomechanical training at NYCPM. I
hope this provides you with a better
understanding of our approach here at NYCPM,
where we strive to carry on the legacy of some
of the iconic figures in podiatric biomechanics
who have gone before us. I assure you it is a
responsibility that is not taken lightly.

Loretta Logan, DPM, MPH, NY, NY

Other messages in this thread:

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09/20/2019    Robert Kornfeld, DPM

Welcome to the Future of Podiatry (Paul Kesselman, DPM)

Dr. Kesselman's 10 points are right on the
money. I had a patient who came to me for a
second opinion recently. She had seen a young
podiatrist who recommended surgery for an "IPK"
sub 5th met head (metatarsal osteotomy). When
she came to my office, the lesion was quite
large and apparently had not been debrided. When
I began to debride the lesion, I felt a click on
my scalpel.

Further debridement revealed a piece of glass in
the patient's foot which I easily removed. I
told her she did not need surgery. She was very
grateful but very angry that a doctor would
recommend surgery without appropriate
examination of the area of chief complaint. He
x-rayed her foot and told her she needed
surgery. There was no recommendation for
conservative care of any kind.

I have been a podiatrist for over 39 years and
in private solo practice for 37 years. In that
time, I have seen a once viable, growing, and
incredible profession sink to new lows every
year. In my opinion, the 3-year surgical
residencies have done much to diminish our
medical skills and our rational approach to
differential diagnosis. I've done thousands of
surgeries in my career, but never without
careful consideration to the mechanism of
pathology.

I do believe the current path will eventually
destroy the profession of podiatry. It isn't my
problem, however. I am at the tail end of a
great and lucrative career that I fashioned on
my own so that I could be the best podiatrist I
could be without influence from insurance
companies and Medicare. I have a niche practice.
I do not accept insurance of any kind. I work
smart and not at all hard. I attempted many
times to bring this information to the
profession but was ignored by all the Colleges
of Podiatric Medicine (as irrelevant). My
practice is medical, not surgical at this point.
Podiatry wanted to feel like "real" doctors and
pushed the surgical agenda to self-destruction.

I attend the Schuster Biomechanics Seminar at
NYCPM every year and gain invaluable knowledge
from some of our most revered biomechanics
experts. That has done more for my practice than
my scalpel ever did.

I wish the future of podiatry the best of luck,
but in my opinion, you have shot yourselves in
the foot.

Robert Kornfeld, DPM, Robert Kornfeld, DPM