08/25/2025    Paul Kesselman, DPM

Have We Lost our Biomechanical Expertise?(Bret M. Ribotsky, DPM, Paul Stepanczuk,, DPM )

Having written on this subject many times here, it
seems that despite some efforts by the schools
industry and others, not much has changed.
The question is not so much who is at fault, but
who is responsible for taking charge of this
situation and coming up with a remedy.
Is it industry, the schools, CPME, residency
directors, attendings hiring new practitioners out
of residency or APMA, ACFAS, ABPM, etc.?
Or is it a combination of all of the above?

To repeat the same old story and a reflection of
the issue(s):

Karen Langone, Jeffrey Ross, I ,and others less
than a decade ago presented a three-hour symposium
on "Advanced Biomechanics for the 21st Century" at
a past APMA meeting. Fewer than 50 attendees out
of the thousand at the APMA meeting attended this
symposium for its entirety. Most who did were well
over 50. Where have all the younger DPM's gone?

If you speak to most orthotic labs catering to
podiatrists, they will tell you that most of their
new business does not come from podiatrists. And
while hating to say this, many of their
knowledgeable clients are not DPMs.

Checking off the boxes to standardized diagnostic
types of orthotics with neutral postings, either
is a reflection of laziness or a lack of knowledge
or both.

Additionally, most of the biomechanics and
orthotic design and fabrication literature and
symposiums I have attended over the past decade
are not
specifically organized or presented by
podiatrists.

While there are more biomechanical symposiums than
a few years ago, mostly put on by the schools or
industry, this is simply not enough.
The three year residency program seems to focus so
much on medicine and surgery. By the time these
residency graduates become practitioners,
they have forgotten what they may have been taught
at the undergraduate level in podiatry school.

At ICPM back in the '70s Dr. Donald Aronson began
his course on biomechanics by simply stating these
prophetic statements:

Biomechanics is the calculus of the podiatry
school curriculum and you will need a minimum of
five years before mastering it.
By that time theories will have changed and you
will need a lifetime to keep up with them.
Without this knowledge you will be ill equipped as
a surgeon.

So if we were to apply that simply to mathematical
calculus, how many of us after one year could sit
down and find the area under a curve?
Few if any. Biomechanics is something which
continues to evolve especially with the computer
age.

It needs to be reinforced throughout one's career.
The profession cannot expect young or established
practitioners to comprehend this
often abstract and complex subject without
considerable continued education.

In the past, I have even offered to organize a
blue ribbon panel to address this situation.
Most of what I received were emails which were
defensive in nature of their specific piece of the
pie, but offering little assistance
whether ideological or offering to assist in
organizing such a blue ribbon panel of experts. I
am still waiting....

Hence ,I agree with both Drs. Ribotsky and
Stepanczuk.

To paraphrase a song from the 60's: Where have all
the biomechanists gone?

Paul Kesselman, DPM, Oceanside, NY

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