08/25/2025    Kevin A. Kirby, DPM

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

Dr. Ribotsky, and the others who have responded to
his post, have noted a decrease in knowledge and
technical skills in foot and lower extremity
biomechanics within the podiatry profession.
After 40 years of private practice and having
trained numerous surgical residents in
biomechanics and foot orthosis therapy over a 25-
year period from the Kaiser Sacramento residency
program, I have also noted that there has been a
gradual lessening of biomechanical skills and
knowledge in our more recently trained
podiatrists. In fact, I have commented on this
same fact multiple times here on PM News over the
past decade or more.

What I find interesting is that, during my
podiatry school years from 1979 to 1983 at the
California College of Podiatric Medicine, many of
our professors commonly made comments tending to
emphasize the belief that podiatric surgeons were
better than orthopedic surgeons simply because of
their biomechanical knowledge. In fact, it seemed
to be commonly believed among the podiatry
profession during the 1980s and 1990s that the one
thing that set podiatry apart from our orthopedic
surgery colleagues was that podiatrists were more
educated on foot and lower extremity biomechanics
and, as such, could make better surgical decisions
for their patients based on this increased
biomechanical knowledge.

However, if we now fast-forward three decades from
those early days of my podiatric career, my
question is whether podiatry is now becoming the
same medical profession that we so commonly
derided about the orthopedic surgery profession of
the 1980s and 1990s? In other words, are we now
becoming foot and ankle surgical experts at the
expense of our knowledge and training in foot and
lower extremity biomechanics and foot orthosis
therapy? From my perspective as a podiatrist now
beginning his fifth decade of podiatric practice,
this seems like a distinct possibility.

As such, I must ask the following question: how
many of our podiatric seminars have lectures on
custom foot orthosis therapy and foot and lower
extremity biomechanical research? There are a few
notable seminars, such as the Schuster Seminar
held at NYCPM every year, which focus exclusively
on foot and lower extremity biomechanics research
and custom foot orthosis therapy, but they are
rare. With such few opportunities within the
podiatric profession for our colleagues to obtain
adequate post-graduate training on foot and lower
extremity biomechanics and foot orthosis theory
and therapy, our prominence as the best medical
providers for conservative treatment of
mechanically-related foot and lower extremity
disorders will likely continue to diminish over
the coming years. In fact, if this trend
continues where foot and lower extremity
biomechanics and custom foot orthosis therapy
knowledge is given such poor respect within our
profession, then it is likely that the most
sought-after medical professionals for custom foot
orthosis therapy will not be podiatrists in the
future, but rather be members of other foot-health
professions.

A final observation that I need to make is based
on my numerous international lectures on foot and
lower extremity biomechanics and foot orthosis
therapy over the past 33 years. Within the
podiatric professions within these countries, none
of them which are quite as surgically-advanced as
the U.S. podiatric profession, there seems to be
no lack of interest in learning more about foot
and lower extremity biomechanics and custom foot
orthosis therapy. Unlike the US podiatric
profession, where interest in foot and lower
extremity biomechanics and custom foot orthosis
therapy seems to be waning, every one of the
podiatric professions in these other countries
esteems biomechanics and custom foot orthosis
therapy as very important parts of their
continuing education. In fact, it seems that it is
only the U.S. podiatric profession that now thinks
so little of foot and lower extremity biomechanics
and custom foot orthosis therapy, with all the
other countries giving biomechanical education and
technical skills much more prominence within their
post-graduate seminars and conferences.

To summarize, my observations are in agreement
with Dr. Ribotsky's observations. Without renewed
effort by the US podiatric profession to provide
its surgical residents and practicing podiatrists
with more opportunities for increasing their
biomechanical and foot orthosis therapy knowledge
and techniques, it is likely that the overall
knowledge in foot and lower biomechanics and foot
orthosis therapy within our profession will
decrease further over the coming years. This
decrease in knowledge will definitely be a
detriment to the health and welfare of the
individuals within our communities where we, as
podiatrists, serve as the best medical
professionals for treating painful foot and lower
extremity mechanically-based pathologies.

Kevin A. Kirby, DPM, Sacramento, CA

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