I have been reading with interest about the discussions regarding the biomechanics education within podiatry here on PM News. Drs. Ross, Jacobs, and Udell have all made some very good points which I would also like to elaborate on.
I have spent the last 35 years of my professional life teaching podiatry students, podiatric surgical residents and podiatrists here in the U.S. about the intricacies of foot and lower extremity biomechanics. I have also had the honor of lecturing abroad multiple times over the past 28 years to podiatrists in other countries that consider biomechanics of the foot and lower extremity to be a very important subject, and not a subject that is somehow secondary or isolated from surgical correction of the foot and ankle. From these experiences, I would like to offer my opinion of why biomechanics education has become a “second- class citizen” within the United States (U.S.) podiatric profession and how this is affecting the young podiatric practitioners of today.
1. Even though podiatry students are just as, if not more intelligent, than those podiatry students of three decades ago, they are not being given enough opportunities to hone their skills in biomechanics from the time they leave their respective podiatry schools to the time they start their podiatric practices three years later. Nearly all the podiatry students I have taught over the past 35 years are interested in biomechanics. However, more recently, especially over the past 10 years, the podiatric surgical residents I have trained in biomechanics and foot orthosis therapy are less proficient in nearly all forms of conservative care modalities, including strapping, foot orthosis casting, foot orthosis prescription, foot orthosis modification, and shoe knowledge than their podiatric surgical resident counterparts from over 10-15 years ago.
I believe this is due to the fact that their post-graduate training is relatively deficient in regular and practical training in these important subjects. Ultimately, this lack of consistent training makes them less knowledgeable and/or less comfortable in applying these important conservative treatment skills to their patients once they enter their respective podiatric practices
2. There are very few seminars being held within the US currently which devote significant time to biomechanics education and training, including the biomechanics of foot and ankle surgery. As a result, there are few opportunities for podiatrists who are interested in such subjects to increase their knowledge and clinical skills. The former PFOLA seminars, notably those PFOLA seminars which were organized by the late Dr. Paul Scherer, were great examples of podiatric seminars where the best international minds of foot and lower extremity biomechanics could come together to learn from each other. Unfortunately, even these excellent PFOLA seminar were poorly attended by US podiatrists, with much greater interest in these excellent seminars coming from international podiatrists, PhD biomechanists, physiotherapists and pedorthists/orthotists, than from US podiatrists. The Richard Schuster Memorial Seminar held in New York every year is the one exception where biomechanics education is the main goal of the seminar, and it is an excellent seminar.
3. Podiatrists in the UK, Australia, New Zealand, Spain, Portugal, Canada, Italy, Belgium and The Netherlands are currently still very much interested in foot and lower extremity biomechanics education within their respective countries. The only country that I lecture frequently at where foot and lower extremity biomechanics seems to not of great interest to most podiatrists is here in the U.S. For me, it is disappointing to me that I need to travel away from my own country to lecture to a group of podiatrists who are as excited about foot and lower extremity biomechanics as I am. And for those of you who think that “biomechanics” is somehow a synonym for foot orthoses, that is not what I mean when I say “biomechanics”. Rather, biomechanics is defined as the scientific study of the action of external and internal forces on the human skeletal system. In other words, biomechanics is not orthotics!
4. Podiatrists in the U.S., for the most part, do not regularly read biomechanics journals outside of podiatric journals. Members of the international biomechanics community regularly read these journals on a regular basis in order to keep themselves up-to-date on the latest foot and lower extremity biomechanics knowledge and ideas. How many podiatrists do you know that regularly read abstracts or articles from the Journal of Biomechanics, Gait and Posture, Clinical Biomechanics, and Journal of Applied Biomechanics? My guess is less than 10% of U.S. podiatrists regularly read articles or abstracts from these journals.
If podiatrists are only reading the biomechanics-related papers in the U.S.-based podiatric journals, then they are missing out on about 75% of the new information and research on foot and lower extremity biomechanics. In other words, if we, as podiatrists, want to become respected for our biomechanics knowledge within the medical and research community, then we will need to stay current on the latest theories, research and knowledge on foot and lower extremity biomechanics by regularly reading outside our own journals.
5. The growing emphasis on surgery among podiatrists here in the U.S. over the past two decades seems to be creating a situation where younger U.S. podiatrists are becoming increasingly more surgically-oriented, at the expense of their conservative care knowledge and clinical skills. This seems to be creating a situation where many of these young podiatrists are not providing their patients with adequate conservative care options that may allow the patient to avoid surgery. It is possible that by the US podiatry profession going to great lengths to make their newly trained podiatrists all into surgical specialists, that we are unfortunately also creating podiatric colleagues who do not have sufficient training in effective conservative care options that will allow them to provide their patients with both excellent conservative and surgical care for their foot and lower extremity pathologies.
These factors being said, I feel there is still hope for the podiatric profession here in the US to improve its respect for the importance of biomechanics in the treatment of the pathologies which affect the feet and lower extremities of our patients.
First of all, I would encourage all major podiatric seminars to have a “Biomechanics Track”, such as that which has been in place at the Western Foot and Ankle Conference in Anaheim for at least the past decade. A morning or afternoon “Biomechanics Track” would allow those podiatrists who want to improve their biomechanics education more opportunity to learn about the importance of the biomechanics of surgery, the biomechanics of foot orthoses and the biomechanics of treating wounds in our patients. This is absolutely critical for our profession to remain to be perceived as the leaders in foot and lower extremity biomechanics knowledge within the medical profession .
Secondly, I suggest that every podiatric residency program devote more teaching and clinical techniques emphasizing the biomechanics of surgery, the biomechanics and practice of foot orthosis therapy and the biomechanics of wound care into their curriculums. Residents need continual practice in these subjects so that our podiatric surgical residents are actually gaining practical biomechanics skills and knowledge during their residency years and not losing skills due to a relative lack of adequate practice and training during their residency years..
And lastly, I suggest that all podiatrists who have seen the decline in biomechanics skills and knowledge in our younger podiatric colleagues become more vocal to your podiatry schools, to the organizers of podiatric seminars and within excellent avenues of podiatric communication available to us such as PM News. Make it known that you strongly feel education and training in the biomechanical function of the foot and lower extremity is not an optional educational item within our podiatric education, but rather is an absolute necessity to allow the podiatrists of tomorrow to be able to provide both the best conservative and surgical care options to their patients.
Kevin A. Kirby, DPM, Sacramento, CA
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11/19/2019 Chuck Ross, DPM
The Richard O. Schuster Memorial Seminar
I recently attended the Richard O. Schuster Memorial Seminar and had two immediate thoughts. First, I was incredibly impressed with the presentations and the manner in which Dr. D'Amico and his dedicated staff managed the entire weekend. Congratulations on a superb job.
My second thought brought me back to the recent discussions on PM News about the "lack" of appropriate education in the area of biomechanics with some blaming the shortcomings on the colleges of podiatric medicine. After the many superb and timely presentations, I must beg to differ and perhaps place blame (not necessarily appropriate) on the 3-year surgical residency programs instead.
Having been immersed in biomechanics and orthopedics since my education began at CCPM with professors such as Root, Weed, Sgarlato, Smith, and many others to my transition to New York with another superb group such as Schuster, Wernick, Tax, D'Amico and others I have come to appreciate the many hours that were spent in educating students in this area of education.
I have had the good fortune to teach and/or lecture at most of our podiatric medical institutions and am continually impressed with the orthopedic/biomechanic departments at each and every one of our facilities. HOWEVER, there is a dramatic lack of a continuum once students graduate and enter residency programs, with few exceptions as the emphasis is solely upon surgery.
Some of my fondest memories are hearing speakers such as Guido LaPorta, Allen Jacobs, Mark Benard and many others who "preached" and practiced a similar mantra: You cannot expect good surgical outcomes unless you first understand the biomechanics as to why the problems began in the first place.
I do not wish to leave without a possible solution to consider. Why not have the APMA partner with Dr. D'Amico and institute a "traveling road show" in biomechanics with many of the presenters that he has utilized over the past 7 years and bring this superb educational experience to the residency programs. I would be interested in hearing from my colleagues.
Chuck Ross, DPM, Leeds, MA
Podiatry Management •1062 E. Lancaster Ave, Rosemont Plaza Ste 15 F, Bryn Mawr, PA 19010