03/24/2022    Kevin Kirby, DPM

RE: NY Podiatrist Discusses Supination (Richard Stess, DPM)

I have been following with interest this topic on
“supination” here on PM News over the past week.
Since I have been writing and lecturing on foot
and lower extremity biomechanics and custom foot
orthosis topics now for the past 37 years, a
wanted to make a few important points.
First of all, just because a number of podiatrists
do not immediately respond to a post on PM News
regarding the subject of foot and lower extremity
biomechanics and foot orthosis therapy does not
also mean that many other podiatrists don’t “care”
about the subject.

Many of us who are truly interested in
biomechanics and foot orthosis therapy do not feel
the immediate need to use their valuable time to
comment on every PM News posting. That being said,
I am quite happy to spend time composing a
thoughtful response to news items posted in PM
News if I feel that I can constructively
contribute to the discussion on the topic at hand.
What this means is that one should not assume a
lack of academic interest among all podiatrists
just because no one comments on posting within a
day or two.

Second, as I have previously published within
podiatric publications for at least the past 13
years, there is no doubt that the US podiatric
profession’s decision to produce top-notch
podiatric surgeons over the past few decades has
also led to a diminution in training in other non-
surgical, but equally important, clinical fields
such as foot and lower extremity biomechanics,
custom foot orthosis therapy, and sports medicine.
I helped train podiatric surgical residents in
foot and lower extremity biomechanics and custom
foot orthosis therapy for over a quarter-century
and I personally noticed, over that time, a
definite and gradual lessening in knowledge in
these subject within the podiatric surgical
residents I had the pleasure to help train.

This is not to suggest that the podiatric medical
colleges are not doing a good job at teaching
these non-surgical subjects. Rather it is more
likely that an increased number of hours of
training in foot and lower extremity biomechanics,
custom foot orthosis therapy and other
conservative care therapies would need to be
provided to our podiatric medical professors so
that they can better ensure that graduating
podiatric medical students are more proficient in
these vitally important subjects. In other words,
the US podiatry profession will need to allocate
more time to teaching conservative care options
such as custom foot orthosis therapy and important
disciplines such as foot and lower extremity
biomechanics in their podiatric medical curriculum
if a real change in knowledge level in graduating
podiatry students in desired.

This decline in biomechanics and custom foot
orthosis therapy knowledge in our young
podiatrists is further exacerbated by the apparent
inconsistent biomechanics and foot orthosis
therapy training during the three-year surgery
residency period. In other words, unless our
three-year podiatric surgical residents can get
more frequent and numerous training sessions in
foot and lower extremity biomechanics and custom
foot orthosis therapy, there will be little chance
that our graduating podiatric surgical residents
will be knowledgeable and/or proficient in foot
and lower extremity biomechanics and custom foot
orthosis therapy.

Third, many of the podiatrists who commented on
this thread have complained about the lack of good
research on foot and lower extremity biomechanics
and custom foot orthosis therapy. It seems
certain to me that if the podiatrist has limited
themselves to only reading US podiatry journals
over the past half-century, and not looking
outside the podiatric profession to the many
excellent research papers on custom foot orthoses
being published in non-podiatric biomechanics
journals, then they will assume that there are
few, if any, good research papers on foot and
lower extremity biomechanics and foot orthosis
therapy.

There are a number of international podiatrist-
PhDs and physical therapy-PhDs that have a strong
interest in foot and lower extremity biomechanics
and custom foot orthosis therapy and have produced
excellent research in these subjects. I have had
the good fortune to lecture with many of these
fine researchers over the past three decades in
both national and international biomechanics
seminars. Their research has truly provided the
international biomechanics community with much
better insight into the intricacies and
complexities of foot and lower extremity
biomechanics and foot orthosis therapy over this
time period.

Unfortunately, and a big part of the problem, is
that very few podiatrists are aware of or have a
practical knowledge of much of this research. In
other words, while many US podiatrists are still
locked in their belief systems that were first
suggested a half-century ago by our podiatric
biomechanics forefathers, the rest of the world’s
podiatrists have moved on to a better
understanding of foot and lower extremity
biomechanics and custom foot orthosis therapy
since they actually have taken a more personal
interest in these subjects to seek out new
knowledge, rather being content to adhere to the
outdated belief systems that they were taught in
podiatry school over a quarter-century ago.

Finally, and on a more positive note, custom foot
orthoses can be a truly amazing therapy in the
treatment of the numerous mechanically-related
foot and lower extremity pathologies that present
to our offices on a daily basis. Even though
custom foot orthoses are now being prescribed by
podiatrists, physical therapists, and
chiropractors, there is absolutely no reason why
the podiatrist cannot become an expert in custom
foot orthosis therapy and also in the clinical
application of foot and lower extremity
biomechanics in the treatment of both surgical and
non-surgical treatment of the foot and lower
extremity. All that is required from the
podiatrist to become an expert in these subjects
is a desire and willingness to devote a
significant amount of time and energy in mastering
these subjects, for the ultimate benefit of
improving the lives of their patients.

However, over the next few decades, unless a
significant number of podiatrists are willing to
take the time and energy to become experts in foot
and lower extremity biomechanics and foot orthosis
therapy, there will, no doubt, be other medical
specialists that will be more than happy to wrest
the title of “foot orthosis specialist” away from
members of the podiatric profession. Even though
this event seems possible given the current lack
of interest in these subjects in today’s young
podiatrists, I personally hope that the U.S.
podiatry profession will wake up and makes the
changes that will prevent this from ever happening
to our great profession.

Kevin Kirby, DPM, Sacramento, CA

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