03/08/2024    Kevin A. Kirby, DPM

CA Podiatrist Reviews Development of Blake Inverted Orthotic

Dr. Richard Blake was the biomechanics fellow at
CCPM when I was a 2nd year student and many of
runner-students in our Class of 1983 helped Dr.
Blake make his inverted orthosis in the early years
of development of this device. Three years later, I
became the CCPM biomechanics fellow and used my
positive experience with the Blake Inverted
Orthosis to invent the medial heel skive technique,
which also produces a varus-shaped heel cup in a
custom foot orthosis as does the Blake Inverted
Orthosis. Either of these orthotic devices can be
used effectively to treat patients with pronation-
related foot and lower extremity pathologies.

In regards to the relative lack of biomechanics and
foot orthosis therapy knowledge in today's younger
podiatrists, I have been commenting and trying to
raise an alarm to the podiatry profession on this
problem for the past two decades. Unfortunately,
the problem is only getting worse. Chiropractors,
physical therapists, pedorthists, running shoe
stores and online stores have now progressively
taken over the practice of casting/scanning for
custom foot orthoses from podiatrists, not because
they have more biomechanical knowledge than the
biomechanically-oriented podiatric physician, but
because many younger podiatrist have decided to no
longer make custom foot orthoses. These recently
trained "foot and ankle surgeons", as they often
like to be called, do not seem to want to be known
as lowly "podiatrists", since their interest seems
to lie more in surgical treatment, making them what
I call "orthopedic surgeons of the foot".

Since I have been teaching biomechanics and foot
orthosis therapy, have written extensively on these
subjects, and lectured nationally and
internationally on these subjects for nearly four
decades, I feel that, sadly, podiatry is making a
very big financial mistake at focusing their
residencies more on surgical care, neglecting to
train their young podiatric residents on the art
and science of custom foot orthosis therapy.

Hopefully, the podiatric profession will start to
reverse this trend by promoting the inclusion of
biomechanics and foot orthosis therapy lectures in
every scientific seminar, establishing more
biomechanics training during podiatry residencies,
and insisting on post-graduate courses on
biomechanics and foot orthosis therapy.
Unfortunately, from what I have seen in this
country's podiatric profession and their relative
disregard for increasing biomechanics and foot
orthosis therapy knowledge in residents and
podiatric practitioners, it is likely that given
the current rate of decline of biomechanics and
foot orthosis knowledge will get worse so that, in
a decade, podiatrists will no longer be considered
the "experts" in custom foot orthosis therapy by
other healthcare professionals.

Kevin A. Kirby, DPM, Sacramento, CA

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