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evnin all

a quick question, Is it important to have a sound grasp of Basic biomechanics to practice Podiatric Medicine effectively?

I only ask because over the last year or so I have come across many a Podiatrists, that obviously don't.

It is my belief that every Podiatrist should have a good understanding of Basic Biomechanics to deal effectively with most of the patients that present in our clinics. For example, any SRch should know about the significance of the Sub talar joint or define what a Rearfoot Varus is.

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They should not be allowed to practice if they don't.

Our lecture notes to the 1st and 2nd yr students are here:
http://www.latrobe.edu.au/podiatry/pod12pbmdesc.html
http://www.latrobe.edu.au/podiatry/pod21pbmdesc.html

Anything less could be considered incopmetence.

__________________
Craig Payne
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God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.

Absolutely!
How can basic biomech problems be addressed otherwise?
One point - personally I have a concern that some of our biomech tenets are accepted as scientific truisms when they have yet to be proved so.....

I know CP injects a healthy dose of sceptisicm into his biomech teaching, which I agree with wholeheartedly, but some of the biomech teaching elsewhere relies on a certain amount of dogma, which perhaps holds back, (rather than enhances) our profession ?
Regards,
David

I am constantly amazed at the level of biomechanical evaluation performed by some of the profession, amazed at the conclusions reached to be exact.

With regards to truisms: It appears many podiatrists, and physios etc for that matter, would like a step by step guide to the biomechanical assessment, with relevant conclusions and treatment plans outlined. Difficult in under 10 points, as i was recently asked to outline by a fellow podiatrist. The point of this is, how could these people ever develop the concept of critical reveiw within biomechanics?

As Craig P mentioned in a past post, only 50% of what you are taught is correct, you work out which 50%! Difficult when a person struggles to understand ''well how? or why'' with ''that is what mr X claims is correct on x training course''. Indeed difficult if you do understand some of the hows and whys

Anyhow the Particular training course, for CPD, included, this 10 point procedure.
It was merely satisfactory for determing very rough ideas as to foot type/function suitable for running shoe retailers, at very best.

Back at work, this procedure was carried out for all biomechs, suprising that treatment outcomes were not predictable, or maybe not Trying to gain the approval of work buddies, and others that had attended this 'workshop thing', that a greater array of skills, and testing adapted to the patient needs may be appropriate could not even be imagined. The 10 point test and treat was correct because that is what is written in the course book. And so it was indeed correct, Otherwise it would not be written in a book.

Now i am no master of the occult arts (biomechanics), but i hope i am better than the sheep mentioned above (at least i try and figure it out). But surely this lack of critical approach in graduates may stem back to undergraduate days? E.g. Taking what any one lecturer says as gold and so correct to all occasions? Or not considering it essential to read beyond the requirements, which are invariably straight from rooterian theory (any such word?). Although we all have our most 'fancied' areas! A basic grasp in all should be required, shouldent it?


The idea that a phenomenon is not caused by the same pathomechanics in all patients, indeed that the biomechanics may vary between patients has, as you may see, been a source of aggitation quite recently.

Kind regards steven

I suppose that if the foot weren't the part of the body that the ground transmits it's force through with every step, then biomechanics would not be important to the well-trained podiatrist. In addition, if the podiatrist only wanted to trim toenails, callouses and corns, then I suppose that biomechanics would not be an important subject to grasp. However, since the foot is the prime terrestrial mechanical interface of the human body and the accelerations and decelerations of human body that occur in weightbearing activities nearly all occur either directly or indirectly from the mechanical interaction of the foot with the ground, then it seems to me that this question is self-evident, even to the layperson.

Would an orthopedic surgeon ask "is it important to have a sound grasp of basic bone healing to practice orthopedic surgery?"

Would a rheumatologist ask "is it important to have a sound grasp of basic pharmacology and immunology to practice rheumatology?"

Would a vascular surgeon ask "is it important to have a sound grasp of basic vascular anatomy to practice vascular surgery?"

If you don't know basic biomechanics, then you should not be able to receive a podiatry degree or treat patients with mechanical foot pain. If you want to be a better podiatrist to help more patients , then you should learn more biomechanics. If you want to be a more effective podiatric surgeon and have fewer complications, then excellent biomechanics knowledge is a must. Unless gravity ceases to exist and/or humans are no longer bipedal organisms, then this will always be the case.

__________________
Sincerely,

Kevin

**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College

e-mail: kevinakirby@comcast.net

Private Practice:
107 Scripps Drive, Suite 200
Sacramento, CA 95825 USA
My location

Voice: (916) 925-8111 Fax: (916) 925-8136
**************************************************

Totally agree .... biomechanics is one THE key basic sciences of podiatry .... it underpins most of what we do --- it is not a part of it --> it is it!!! I am surprised that this sort of discussion comes up .... its not an issue in Australia.

This why I somewhat disagree with what is happening in the UK. There is a seperate Podiatric Biomechanics Group, of which many friends of mine are involved with ---- BUT, I do not beleive that this sort of group should need to exist as an entity. Podiatric biomechanics is not really a specality, IMHO. Its a basic science and should be fundamental to everything (basic care, surgery, orthoses, paediatrics, sports, orthoses, rheumatoid arthritis, occupational etc) that we do.

I make this very plain to students on day one of the biomchanics course (as well as tell them that 50% of what we are about to teach is wrong, but do not know which 50% it is spiel) .... the get told in no uncertain terms that they do not have a choice about being interested or not interested in biomechanics --- there is no option .... it underpins most of what they learn and do in the final two years of the course - they will not graduate without it ... and should not be allowed to practice without it.

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Craig Payne
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God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.

Afternoon

I think from the responses this thread has got, then the answer is yes!

My next question is this... How do these people get through their degree course?

When I was training, I was at pains to make sure I had a good,sound understanding of Biomechanics, because it does underpin nearly everything we do. The level of knowledge that some degree trained Podiatrists display is no better than your average lay person who has just read a copy of runners world.

Quote "Your biomechanical knowledge is not in question at level 3. You have all passed biomechanics in the second year, and so can not fail for a lack of biomechanical knowledge at this stage"

They don't here.

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Craig Payne
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God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.

It is interesting how they do in this country. So can anyone explain how it occurs here but not in other parts of the world?

One of the posts below states that your biomechanics knowledge is not in question once you reached level 3. This is acceptable if you have passed yours second year. But surely the student who has a poor understanding of basic biomechanics shouldn't get through & if they, how are they allowed to?

Here they don't - they have written exams 1st and 2nd yr on biomehcanics ... as I said above:
If they struggled with the concepts in 1st and 2nd yr, then they will struggle even more in 3rd & 4th yr ----- they will not survive the paediatrics, sports medicine, orthoses prescription and clinical practice in those years without a good understanding of the biomechanics as these subjects develop it further and apply it (--> clinical reasoning skills).

Now what happens after they leave here is another story .... don't get me started on that one

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Craig Payne
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Follow me on Twitter | Run Junkie
God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.

Hello

From my experience I think there are two reasons for students failing to understand biomechanics.

Firstly, nothing is actually taught at university. The student engage in study and listen to lectures. In biomechanics the subject is difficult for an tutor to present as there are differing theories and little evidence. Where do you start and what do you present, It has been described as pre-scientific, practitioners holding to one school or another, rather like psychotherapists.

This leads to a second problem for a diligent student . When presented with a patient not only do they have to decide what is wrong with the patient but also whether the condition really exists. Can it really be measured, given that it may not be possible to do so reliably or consistently. And what particular theory should they follow in their treatment? That, with no experience to draw on, confusion reigns.

Of course they can produce another orthotic following the same old recipe, completely disengaged but clearing the hurdle anyway. You won't lose any marks for that.

If there is a failure it might be with the college not the student.

Cheers
Luke Hawkins

Nothing in this post is intended in any way to be a criticism of any college or tutor anywere, they are all excellent institutions and very nice people, its just the subject that's a bit woolly, thats all.

In my 20 years of teaching biomechanics to podiatry students, podiatrists and other health professionals, one of the most startling observations is how you can say the same thing to three different students and get three totally different results:

1) This student is interested in biomechanics, has a good aptitude for three dimensional thinking and mechanics, will understand everything you have said, will be eager to learn more, and will ask very good questions.

2) This student is somewhat interested in biomechanics, has a fair aptitude for three dimensional thinking and mechanics, will understand most of what you have said, but will be slightly confused by some of it.

3) This student has either already decided that biomechanics is a waste of time or has a poor aptitude for three dimensional thinking and mechanics, will only understand little of what you said and will also be very confused by the subject.

We, as biomechanics professors, are expected to somehow teach all three of these students at the same time. We are then criticized for our "teaching style" mostly by the student #3's and much less frequently by a few of the student #2's. However, these criticisms are more than made up for by the sparkling eyes and probing questions that we receive from the student #1's, who are like sponges soaking up the information, ready for more intellectual growth, and anxious to become outstanding biomechanics practitioners.

Therefore, one must first ask, before you criticize your teachers or institution, which student you were of the three listed above. If you are student #1, then, I believe, you have every right to criticize the professor if he didn't perform. If you are student #2, then you may have some right to offer some suggestions. However, if you are student #3, then you should be spending extra time reading and getting tutoring in biomechanics if you really want to understand how you can help your patients with mechanically related problems of their foot and lower extremities.

__________________
Sincerely,

Kevin

**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College

e-mail: kevinakirby@comcast.net

Private Practice:
107 Scripps Drive, Suite 200
Sacramento, CA 95825 USA
My location

Voice: (916) 925-8111 Fax: (916) 925-8136
**************************************************

Kevin,

There was no criticism intended. Without a doubt students will vary in their application and mechanical comprehension. But the subject is still able to create confusion.

Kind regards,
Luke Hawkins

Luke .... that confusion is not necessarily a bad thing.

Here is what I posted in another thread:
We published this paper on it:
CB Payne and AR Bird: Teaching clinical biomechanics in the context of uncertainty. J Am Podiatr Med Assoc 1999 89: 525-530

__________________
Craig Payne
__________________________________________________ ___________________________________
Follow me on Twitter | Run Junkie
God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.

Luke,

Difficult subjects will always create some level of confusion, even for the best students being taught by the best professors. For me, the intellectual challenges of biomechanics were always very appealing to me, even from my first year of podiatry school (25 years ago). I knew, from the start of my podiatric education, that I could spend a lifetime studying the subject and still be learning something new every day. This is still why I find biomechanics so exciting: there is so much to learn about how and why each individual's foot and lower extremity functions mechanically the way it does during weightbearing activities.

The limiting factor in learning biomechanics, for most students and podiatrists, in my opinion, is their interest in the subject, their mechanical aptitude, their prior physics and mathematics education, and their educational environment (i.e. professors). I was very lucky to have some of the best podiatric biomechanics professors in the world to learn from. We need to develop many more of these professors if we expect to be able to train students to have an excellent understanding of the intricacies of foot and lower extremity biomechanics.

And by the way, Luke, I took no offense to your comments. Your points are well made.

__________________
Sincerely,

Kevin

**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College

e-mail: kevinakirby@comcast.net

Private Practice:
107 Scripps Drive, Suite 200
Sacramento, CA 95825 USA
My location

Voice: (916) 925-8111 Fax: (916) 925-8136
**************************************************

Being of a non-scientific mind and one of the back door English entrants to Podiatry where biomechanics is basically self taught ( and woefully lacking because of this ) I have had to reduce clinical biomechanics to a level that gives me a visual insight, from the start, when looking at a patient.

As far as I understand, all human ambulatory movement is about bending moments, therefore the questions I try to answer when examining a pt is this:

Does it bend?
Should it bend (even that much!!)?
If it does not bend is that good or bad for this particular pt?
What is the cause or the affect of this bending or lack of bending?

The biggy then, of course, is what am I going to do about it?

Perhaps one of the daunting thoughts in peoples minds when studying the biomechanics is worrying about the affect their prescription may have upon a patient. In my experience you have to prescribe really badly to have a marked affect. After all, if they show signs of being uncomfortable the primary advice above everything else is that they can always take the things out

Perhaps if all students commenced learning their biomechanics at this simple, visual level (I know we all have different learning styles but I would have thought that visual style is basic to all styles, after all that's how we learn how to spell) and the daunting concept of "accuracy" and the over emphasised mantra of "potential to harm" was de-mystified then they may have confidence to explore and experiment.

When you take the play out of learning it becomes more difficult to do!

Ian Linane

hi there,
Kevin Kirby made a comment along the lines that if podiatrists only wanted to treat toenails and corns and calluses perhaps they dont need such a knowledge of biomechanics.
i find i use biomechanics every minute of my treating day. When i treat a callus, toenail or corn i am asking myself....is there a biomechanical basis for this problem? of course other factors come into play such as trauma and footwear but i cannot understand how podiatrists can practice without this knowledge. The 'cut and come again' process (ie not looking at underlying cause and debriding only) has been prevalent for far too long.
Also, i know that biomechanics is theoretical but it is up to the individual to keep abreast of curent info and use what is useful to them.
i know i am talking to the converted but i thought i'd have my say.
cheers :)

Thats an observation I've made but from a students perspective. I believe, in an ideal world, the third group should be taught seperately.

I'd like to think that in Biomech/Pathomech I'm a 'type 1' student, I do get it (95% of time), I do find it interesting and, most importantly, I'd like to move on to the next thing. Not mess about for 2 hours going over the same thing with the group for which it just don't click. It gets very tedious.

Hello All,

Every podiatrist needs some basic biomechanics skills, even if its only enough to recognise that there may be a problem and refer on to someone with more experience/biomechanics knowledge. If you've got the skills and time yourself then fine.

Put yourself in the patient's shoes: wouldn't you like to think that if you presented with a callus or h/d that was possibly symptomatic of a biomech. anomaly then the podiatrist would:
1. be able to determine whether or not the cause of the lesion was biomechanical
2. have the sense to investigate further or refer on if he or she didn't have the skills, equipment or time to deal with the biomechanical side of the equation?

However it is a bit of a double edged sword when the evidence, as has been stated earlier in this thread, is not strong enough to support the various theories therefore if the patient asks searching questions about the problem (that we may percieve them to have) then we can't really give an answer that is backed by good scientific research. Not only that but dissatisfied patients could claim that private practitioners were 'rushing' them into paying for something that they, the patient, are getting no benefit from.

Mind you we should bear in mind that many medical treatments and drugs (eg paracetamol) have not been the subject of many decent RCTs and yet are used every day!

Sometimes peices of research prove things that we 'knew all along' and us old DPodM's can lean back with a smug smile.
It will be great when we have some biomechanics evidence that gives us some real confidence in our diagnosis and treatment.
But then life may not be as exiting!

John

Of course a podiatrist MUST have at least a basic knowledge of biomechaics to be a decent pod.I myself am no superstar of biomechanics but at least I know the ABCs of it and I think I know a little more.I like to think that I am at least competent.

Dear All

I have just returned today to Australia from 5 weeks teaching foot biomechanics in the UK. We taught in Glasgow, Preston, Newcastle and London. All participants stated that they had NO formal biomechanics training in their undergraduate podiatry courses but dearly wanted some.

Sad but true. many stated that currently there is not much taught along the biomechanics line. These participants graduated from 20 years to 4 years ago.

Even sadder was the very poor anatomical skills shown by participants. Almost to a tee they all agreed they had poor hands-on anatomy skills.

This finding is not unique to the UK.

Regards,
musmed. Paul Conneely.

Hi musmed,

Questions:-

1. "Is there a tread-mill in Biomechanics, a possible conclusion followed from your thinking?"

2. "Or is it like the emperors/kings new clothes?"

3. A foolish question perhaps, "Shall I dustbin myself for the rest of the day?"

Regards,

Colin.

Hi Musmed.

You wrote
"Sad but true. many stated that currently there is not much taught along the biomechanics line. These participants graduated from 20 years to 4 years ago.

Even sadder was the very poor anatomical skills shown by participants. Almost to a tee they all agreed they had poor hands-on anatomy skills."

As a part-time Educator, thats pretty much what I've found to be the state of play in the UK today too.

Worse, some pods are seduced by computer gizmo's which will do-all-the-measuring/make-the-orthoses/make-a-cup-of-tea while-U-wait .

Listen up, UK Pods, there is no substitute for basic biomech skills!

Cheers,
davidh

Hi Davidh,

Yes, I shall dustbin myself for the rest of the day and read Nordin and Frankel again!
What would we do without mechanical engineering, trouble with feet though is you tend to break them using it!

Regards,

Colin. (David don't worry about me, I think it was the full Moon last night?).

PS. No I forgot to switch the light on! The keyboard you know?

PSS. Return to sanity! Assuming bio-mechanics is not the emperors/kings new clothes? This thread is an exceptionally good, enlightening one and well worth a second read to all those who like me received the basic only!

Interesting to note the comments on anatomical knowledge. I find this is consistently one of the weakest areas in the students I teach at undergraduate level. Even though they have a great deal of official hours in anatomy, and high expectations that the knowledge will be assimilated and applied in the clinical context, it seems to be the subject that trips people up.

I suspect that there is a problem in the initial teaching, in that it tends to be learned through rote learning (a superficial or low level cognitive approach). Transferring that 'learning' to the more cognitively demanding area of functional anatomy/biomechanics is not always successful. I would prefer to see anatomy taught every year across the 4 years of the course, rather than in the first year only. Its a pretty huge subject, and repeated exposure, in different contexts, would be very helpful.

As for practising clinicians, I suspect the problem is that you do not have to necessarily explain in perfect anatomical terms what is wrong to the patient. Many conditions can be treated by general principles, even if you have forgotten the actual name of the muscle/tendon/ligament you are treating. You know the damn thing is an invertor, and you need to rest/ice/strap etc - but the name can pass you by for the moment.

cheers,

Felicity

Work Hard, Fear God and Keep Your Bowels Open

Hi All,

In the private sector anatomical knowledge was treated more like a venerated religion and less of a science! It reminds me of how Biomechanics is approached today. An aside I wonder if anyone has actually counted, (putting it crudely), Biomechanical Patients as against general practice patient presentations in podiatry? I would be keen to know just how many of the population actually get this sort of treatment and how many don't?

The problem with Anatomy is basically that as a Chiropodist I will never have to open the box! Therefore my main interest is being able to map out the surface plan of nerves, blood vessels, (So that I rarely now if ever strike oil!), tendons surface muscles etc. and joints are paramount in what I need to remember. You would be surprised what comes back in a rush if you are presented with it!

I suppose we all have are favorite text books. My favorite has always been Richard S. Snell "Clinical Anatomy for Medical Students!" drift back more than once or twice a year to it but not aspiring to be a surgeon, head knowledge rather than APPLIED!

Regards,

Colin.

My practice is about 30% work related injuries (ankle, foot fractures/sprains, crush injuries), 30% sport injuries, 25% non-sports mechanical injuries, 5% outpatient surgery, 5% ingrown toenails/warts/dermatology, 3% diabetic care and 2% "routine care". Of those patients, about 35% of those patients receive custom foot orthoses. I make approximately 85 pairs of foot orthoses a month, on average, working 3.5 days a week in my private office.

Anatomy and biomechanics are the two most important areas of knowledge in a practice such as mine. Inferior anatomical knowledge prevents the podiatrist from making accurate diagnoses in the foot and lower extremity. In other words, does the podiatrist know how to palpate for the popliteal tendon vs the lateral femoral epicondyle or does they know how to determine between a lateral component plantar fasciitis vs peroneus brevis insertional tendinitis vs. 5th metatarsal-cuboid joint capsulitis?

Biomechanics is the key to understanding the etiology of foot and lower extremity mechanically-based pathologies and to determining the best mode of treatment for these individuals. I am very sorry to hear about the poor biomechanics training in many podiatry schools. To me, it is hard to imagine treating a mechanical part of the body (i.e. the foot) without good mechanical knowledge of that part. I imagine it is much like trying to be a car mechanic without understanding the mechanical function of the components of a car..... I wouldn't take my car to that mechanic.

__________________
Sincerely,

Kevin

**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College

e-mail: kevinakirby@comcast.net

Private Practice:
107 Scripps Drive, Suite 200
Sacramento, CA 95825 USA
My location

Voice: (916) 925-8111 Fax: (916) 925-8136
**************************************************

You are quite right Felicity, is does seem to be the part of Podiatry that seesm to stump alot of people.

I am 2 years post graduation and felt that while learning anatomy in my 1st year of study, I too would have felt more comfortable with my anatomy had there been a review in the 2nd and 3rd years. It is only by practice that you learn, and although wrote learning is probably the key to gaining that initial knowledge, when tieing it in with the function of the foot/leg thats when you need to be able to put 2-and-2 together. I was mentioning you exact comments to our lecturers back at school.

Our figures at a multi-disiplinary Sports Medicine practice would be similar to Kevin's with there being more like 50% sporting injuries and around 10% work related injuries. I would say that New Zealand as sporting nations go has quite a high number of active people, and with our ACC (Accident Compensation Corporation) set-up it enable people to be partly of full covered for their sporting or work related injury if is was due to an accident as such.

Dear Mr Bain

I do not understand your questions and thus I cannot answer them. Please resubmit and I will do my best to answer them.

As regards to foot anatomy. I have examined nearly 100,000 feet over the past 15 years. I have yet to see a patient who suffers from headache, and/or neck pain and or low back pain/ache hae normal foot mechanics.

There again I suppose the feet do not matter.

This is why treatments applied to where it hurts do not work This is most treatments. They never look for dysfunction. Thus if you cannot/not want to examine foot motions for dyfunctions you have sadly missed the boat and boy is it a big one.

Musmed
paul Conneely