07/29/2024    Allen Jacobs, DPM

What Your Gait Says About Your Health (Paul Kesselman, DPM)

Some years ago, tapentadol was released as an
alternative for the treatment of post-operative
pain. Bunionectomies were selected for the study.
No podiatrists were authors. Dr. Kesselman, if you
speak to students on outside rotations and
particularly residents, you will find that
patients seldom if ever are subjected to weight-
bearing examinations. Of course, ABPM and CPME will
quickly raise the requirement for a limited number
of so called “biomechanical examinations” as a
requirement. However, this is an examination that
should be ongoing daily for 3 years. This includes
patients being evaluated and treated for
conditions undergoing surgical decision-making.

The fact is that gait analysis is not a routinely
observed part of the podiatry evaluation observed
by many podiatry residents. Therefore, it is not
surprising that an evaluation of the relationship
between gait and general health did not include
podiatry input. When I served as a reviewer for
ABFAS and ABPS, seldom if ever did I see a gait
evaluation in the medical records, nor do I recall
this being a required element. Similarly, the
residents almost never see any fall prevention
evaluation such as a simple get up and go test.

Patients are told of the requirement for surgery,
the need for orthotics, treated for heel pain,
progressive collapsing foot deformity, neuroma,
forefoot deformity, Charcot’s joint disease, and
any number of foot deformities and pathologies
without gait analysis. Residents know what they
see, and go on to adopt these practices. Certainly
there are many exceptions. However, lack of gait
analysis is common in podiatry offices. A deluge
of “ I do it “ responses to this is likely.
However, the residents to whom I speak tell me
what they see. Biomechanical pseudojustification
for surgery and orthotics and braces is what they
see. Gait analysis is what they do not see.

Many PM News posters have, for many years,
lamented the lack of biomechanics/kinesiology in
our residencies and CME programs. In fact, that is
a reality. In addition, factually unsupported
claims for balance braces, “ foot types” in
children requiring so called orthotics, proposed
theories of foot function with no published
supportive research, equinus braces, are allowed
to be presented at CME meetings and qualify for
CECH through CPME standards. In short, with few
exceptions, the CME relevant to
biomechanics/kinesiology is corporate and
commercial interest biased.

True understanding of biomechanics/ kinesiology
with gait analysis is and should be a major
calling in our profession, as provided for example
by the NYCPM annually. However, Dr. Kesselman,
your query is not surprising. Think about it Paul.
You review many charts. How often do you see a
detailed or quantitative/qualitative gait
analysis? How often do you observe true
individualized orthotic prescriptions? I suspect
you know the answer. This profession professes but
does not practice the science of biomechanics and
kinesiology. We talk the talk but do not walk the
walk. And by walk I refer to patients for gait
analysis.

Allen Jacobs, DPM, St. Louis, MO

There are no more messages in this thread.