07/30/2024    Rod Tomczak, DPM, MD, EdD

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

Dr. Kesselman asks why a podiatrist has never led
a team of researchers or published research
concerning the correlation between gait and
general health. Dr. Jacobs very succinctly states
the reason is because we don’t perform a true gait
analysis anymore. Besides, it’s difficult to
perform a true evidence-based examination in the
office. Experience-based maybe, but real objective
data is hard to glean from the equipment most
podiatrists have on hand. Most reputable journals
would scoff at an article submitted with the
title, “Too Many Toes Sign and…” or “Wet Foot
Impressions on the Floor in Diagnosing Pes Planus
and Pes Cavus.”

But Dr. Kesselman’s question addressed why a
podiatrist hasn’t authored the study. I posit
there are a few reasons. One, a biomechanics paper
is simply not as sexy as a supramalleolar
osteotomies manuscript. Secondly, podiatry is
primarily an action profession, not an abstract
research calling. Few podiatrists can pay back
outrageous student loans working in a gait
analysis laboratory.

Lastly, I think a major reason we do not have a
podiatrist as the primary author of a lead off
article in a well-respected journal is the disdain
many young physicians have toward writing. The
blame for this phenomenon falls almost solely on
high school and undergraduate teachers who would
rather not read essays or long answer exams when
running a stack of Scantrons through a reader
takes seconds and produces a grade. The art of
putting pen to paper has gone the way of cursive
writing.

Ironically, it’s not the fault of these younger
generations. STEM education has little room in
the curriculum for grammar and composition. It’s
more important to recognize a STEMI than an
adjectival stem that should require an -er for the
comparative degree. The grass is more green (sic)
on the other side of a scientific curriculum.
After all, we are behind the Norwegians in
calculus, but our students cannot compose an essay
let alone create a cogent and interesting
biomechanics treatise.

Students have been told all the high paying jobs
are in the science and technology fields and
granted, there are many positions available, but
the field of medical and pharmaceutical writing is
booming. Liberal arts majors with some science
knowledge are starting employment as writers with
pharmaceutical and medical device companies at a
handsome salary. We can’t blame our younger
podiatrists for not being interested in
publishing. We have not taught them how to write.

That’s not to say there are no members of this
younger generation who like to research and write,
but the pull to pay off debts, buy a house, start
a family and play golf is greater than writing
which is viewed as a non-paying, leisure activity
by many. Also, if I’m not very good at a
difficult task, which research/writing is
perceived to be, I tend to avoid it.

It takes a true polymath to run a successful
practice that allows a young podiatrist to pay off
debts, accomplish the things aspired to and make
true scientific advances that can be shared in
something other than The Obscure Journal of
Medicine.

In addition, we all feel we would be great
teachers and could do it better until we stand in
front of a room full of student or peers and
deliver. How many of us are willing to devote our
life to academia and still pay off debts and
satisfy the aspirations we dreamed about in
podiatry school?

Rod Tomczak, DPM, MD, EdD, Columbus, OH

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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