03/21/2022    Paul Kesselman, DPM

NY Podiatrist Discusses Supination (Dennis Shavelson, DPM)

The lack of attention to this posting speaks
clearly to where our profession has unfortunately
placed itself. 15 or more years ago, this posting
would have had a landslide of postings, today
hardly a whisper. It would have been met with
citations from papers presented at both local and
national meetings. Unfortunately, that is no
longer the case.

A few years ago, right after the APMA annual
meeting, I posted a letter which addressed why at
best fifty or so of the 1,000+ attendees came to a
workshop hosted by several prominent DPMs
dedicated to advancing biomechanics in the 21st
century. Most of those attending this meeting were
in their late fifties and beyond. Instead of
receiving grateful letter or personal emails
regarding this matter, what I received then was an
overabundant number of emails which either
defended their academic positions at the colleges
of podiatric medicine or defended the surgical
direction our profession has taken.

I received a supporting letter from Dr. Jarrod
Shapiro and we have continued to communicate on
this issue. There were perhaps ten others who have
also not only written to me and we have continued
to dialog, and they have tried to deal with this
in their own way, via workshops, etc.
Unfortunately, most (not all) of the biomechanics
workshops I have seen advertised here or in other
podiatry related publications or those I've
attended tend to be more marketing missions than
real dialog on research. Having a few people
agreeing there is a problem is just not enough.

I am sadly disappointed that the majority of
national orthotic laboratories or academic
institutions have not funded post residency one or
two year fellowships (not a few week summer intern
programs) so that real ground breaking research
can be published. I have seen this with other
professions whose graduated residents have teamed
up with large kinesiology departments at first
class university institutions and done first class
research while simultaneously obtaining advanced
degrees in bioengineering. These programs have
generated lots of research papers with the
potential for new products. There is little if any
of that in our profession.

Few if any podiatrists (I only know a few) even
heard of some of the terms involving manufacturing
techniques which use 3 and 4D technology.
It is no wonder that I now obtain more
information on lower extremity biomechanics from
others outside our profession.

Regardless of whether or not one agrees with Dr.
Shavelson's perspective on supination should not
be the point! The mere absence of dialog is
shameful!. The mere absence of research in peer
reviewed first rate biomechanical literature is a
pity! To those faculty at colleges of podiatry: An
annual one day or weekend seminar is also not
enough!

In the immortal words of one of my teachers back
in the 1970s one cannot expect to be a good lower
extremity surgeon if one does not understand the
fundamentals and nuances of biomechanics. What
makes any of us think anything really has changed
to make that statement any less true today than it
was forty plus years ago? Why is that most
residency programs have less emphasis on
biomechanics? Why is it that when I was in
practice I could not trust a third year resident
to cast/scan a patient or even perform the most
fundamental biomechanics exam?

I am hopeful that Dr. Shavelson's letter and the
few who responded will not result in the same type
of responses as in the past. Please don't use this
forum to simply defend your academic positions in
the undergraduate world of medical education.
Please don't use this forum to cloak a one day
seminar as "advancing" research and please don't
use this forum to market your company.

It is up to those who are in positions of
leadership at academic institutions and those at
national laboratories to fund substantial research
and get this rolling. Otherwise, this issue will
be a dead issue and podiatrists will totally lose
(if we have not already) our leadership positions
in the field of orthotics. I hope this letter to
the editor sparks some meaningful dialog, but
simply defending what has been done so far is not
enough. For it if were, this letter would not be
needed.

Paul Kesselman, DPM, Oceanside, NY

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