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The more I learn about podiatric biomechanics the more avenues, problems and theories appear.. and the less I feel I know...

Anyone else get this???

sheesh..

This is so true Samran. When I began providing orthoses it was simple but I was not achieving the desired outcomes that I had hoped for. We learned zip about evaluating and prescribing in college and the standard in my field is extremely lacking for any pathology.

After taking the pedorthic course I realized just how much more there was to learn. After finding this website I dove in and read and implemented many of the theories podiatrists discuss on this board. It has made me a much better practitioner and opened the door to referrals from medical providers, many of whom locally know my work and focus on surgery. It has become a niche for me and a wonderful addition to my daily practice.

I may not know much compared to some of the luminaries on here but through them and this site I have had the opportunity to have many mentors and bring my skill to a level that I hadn''t imagined. The problem is that as you say you often feel like there is always more to know and there is. Maybe that is part of the fascination that we all share with podiatric biomechanics and orthoses.



When I knew very little I knew a lot in my mind. I have been humbled to learn that now that I know a little, I really do not know much at all and strive to know more. Or something like that...

Regards,

__________________
"If we all worked on the assumption that what is accepted as true is really true, there would be little hope of advance." - Orville Wright

David G. Wedemeyer, D.C., C.Ped.

Dosen't that make it exciting!

As I said to the second yrs a couple of weeks ago --- "half of what I teach you this semester is wrong ..... the problem is, I do not know which half it is".

From an educators perspective thats what teaching this subject is so exciting. There is no black-and-white .... what other subject do we teach that actually requires the student to think and make decisions in the context of uncertainty? Most other subjects are about memorising a bunch of facts. This subject teaches them to think. Teaching this pushes the clinical decision making skills (these skills can be transfered to other areas)

From a students perspective .... they hate it as they want to be told the answers (where is the development of the critical thinking and the appraisial skills development that eventual leads to being a good clinician with good clinical decision making skills in that?). They find it hard to accept that there is not necessarily a right answer.

For example, life used to be good when the normal range of motion of the ankle was 10 degrees ... when they had less than that we got them to stretch and/or added a heel raise; if the had more than that, they were ok. Now its all about the shape of the force/degree curve of the ankle joint and the subject specificness of the shape of that curve (ie no longer is there is normal generic range) ... isn't that exciting?

Two of the comments I got back on the recent UK Boot Camps were: Thats why I do it!

Also see:
Teaching clinical biomechanics in the context of uncertainty
CB Payne and AR Bird
Journal of the American Podiatric Medical Association, Vol 89, Issue 10 525-530, 1999
We wrote that 10 years ago!

__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia
http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________
God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University
This is where I am, where are you?

Sam:

Part of the problem, I believe, with this common feeling of confusion you talk about, which, by the way, is shared by many podiatrists regarding biomechanics is that:

1) "podiatric biomechanics" is taught largely to students who have very little knowledge or background in physics, mechanics and engineering principles, and

2) many of the "podiatric biomechanics theories" that are taught in podiatry school are not consistent with Newtonian mechanics, which is the basis for these mechanics and engineering principles.

One of the reasons that I have written and lectured so much over the past 24 years on podiatric biomechanics topics is that I believe that podiatric biomechanics can be taught very well without multiple theories and without all the resulting confusion as long as the poditry students/podiatrists are first taught the basic terminology and principles of mechanics and engineering. My articles on biomechanics and my three books have used these basic concepts to try to simplify the evaluation, diagnosis and treatment of mechanically-related pathologies of the foot and lower extremity using mechanical concepts that are very easily understood by the student that already has a good grasp of Newtonian mechanics.

I don't necessarily agree with the approach that podiatry students should be given all the theories of biomechanics to try to determine, in their early years, what is the best theory to use since I believe this gives these students too much initial confusion with too little positive gratification. My belief is that students should be briefly taught a few of the major theories as a background during the course of their biomechanics curriculum but should be getting, the rest of their time, intense education on basic biomechanics principles, tissue stress concepts and the biomechanical application of these concepts as they relate to injury production and as they relate to the design and manufacture of orthosis/shoe therapy for their patients.

I personally don't think it is in the students' best interest to spend so much of their valuable time getting extraneous information about podiatric theories that have obvious problems and inconsistencies when their time to be taught in podiatry school is already limited. I believe that podiatry students and podiatrists should be spending more of their time learning key biomechanics principles that make sense, are commonly used within the international biomechanics community, are consistent with Newtonian mechanics, and will allow them to make better foot orthoses for their patients.

My ideas are not necessarily mainstream within the podiatry profession, and my ideas are not accepted at many podiatry schools due to many podiatry schools needing to teach varied theories to satisfy the whims of the podiaric biomechanics faculty of each school. However, I believe that once the intelligent podiatry student or podiatrist has been taught by the method which I recommend above, he or she will have little tolerance for "podiatric theories" that do not conform to Newtonian mechanics.

__________________
Sincerely,

Kevin

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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
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Hi Samran,

Abso(!@#$)inglutely!

The more I know, the more I know I don't know!

I love it though and find podiatry-arena, seminars and workshops addictive- my wife doesn't understand and thinks I'm mad and wasting time!

Cheers,

(Sponge)Brad Randazzo

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Hi Guys, I agree completely with brad.. I spent 3 hours when I got home after work last night working through Free Body diagrams and force couples and stuff.. my god it was interesting.. My fiancee thinks I am Mr. Supergeek...

Also I find the implications to practice of all this new information fascinating!

Kevin, I think the physics approach is the only way for me.. using the tissue stress approach is the way I try to practice and I tend to get fairly good results with it..

Credit where it is due, working with Mr. Isaacs for a year really was the start of my biomechanics journey.. (way back when I posted about Hip position and musculature and it's effect on pronation - i still think there is something in that, but think more now about positioning i.e. anterior pelvic tilt and internal leg positioning than the gluteals providing a significant external rotation to the leg which translates to a supinatory moment at the foot, but this is for another post, another day and perhaps another flaming by CP ;-p ). I had ideas before that, but no idea of how to express, strip down, study or try to implement these ideas... cheers mate..

I feel like a sponge at the moment..

Give me more!

Sam

Its called learning!
Its also the difference between, for example, 10 years of experience vs 1 year of experience, 10 times. Some move on, other keep repeating the same old ...

__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia
http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________
God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University
This is where I am, where are you?

I have taught undergraduate podiatrists for several years, and noted that they always struggle with "biomechanics". And those that say that they *do* understand it are clearly liars.

I was in the same position myself whilst a student. Multitudes of complementary or contradictory theories, and experienced clinicians espousing their own particular beliefs.

Then I started surgical training and began taking a very "orthopaedic" perspective on lower extremity function. I would best describe this as a very stripped down, "back to basics" and simplified approach. Simple descriptions and assessing for planar dominance where it deviates from a rectus alignment. Looking at feet in terms of classical anatomical descriptions (eg excessive varus or valgus), and dropping the research jargon.

If one gets back to basic anatomical relationships, considers the beneficial or deliterious outcomes of those relationships (ie in "tissue stress" terms) - then a zen-like calmness overtakes those competing theories.

I feel part of the problem within the profession in grappling with biomechanics has been to expect coal-face clinicians to utilise impractical examination or functional assessments which are really best suited to a reseach study. Keep it simple, and "fixing" people is relatively easy to teach and understand, without the distraction of competing or complex theories.

We should take a leaf out of drug prescribing paradigms to make life a little easier for clinicians.

LL

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Remember, it's just a foot.

Dear All,

My own problem with Bio Mech is:

I wear prescription optical glasses.

What is measured is reliable and repeatable by other clinicians.

The optics can be manufactured from the prescription by any optical lab with no differences in the prescription.

In Bio Mech we attempt to measure the unmeasureable using unreliable measuring implements/tools.

Inter clinician repeatability is absent or at best poor.

I contend that if you gave 10 clinicians the same prescription and casts that you would have at least 8 different devices.

If you have 10 clinicians could they arrive at the same diagnosis, provide identical casts and prescritions and produce identical devices?

We then place these devices into an unreliable environment ie a SHOE.

And then we charge up to $2000.00 for this.

Until bio mech is like optics for the above i will question its validity as a science.

I accept it is an artform and that it has some therapeutic benefit/merit. But i wonder how much of this benefit is the PLACEBO EFFECT?

I expect to be shouted down by this post, but over many years i have seen far too much discussion argument by my colleagues over what it is that is trying to be achieved in the examination assessment measurement and prescrition. with the cast and manufacture of the device.

measure range of motion of a joint in isolation.

move joint till resistance is felt.

50kg weakling and 140kg rugby player measuring to resistance HAHAHAHAHA

measuring a joint in isolation come on ! the toe bone is connected to the foot bone which is connected to the leg bone. etc etc.

So as we can barely persuade pts to wear good footwear that is suitable for the foot , and many clinicians provide ORTHOTICS for high heels how can we be considered a science if we do Bio Mech.

RANT RANT RAVE RAVE

sorry the psychiatric is coming to take me back to my padded cell for the night.

She has just given me my me d iiii c aa attttiiioooonnnnnnzzzzzzzzzzzz

regards David

Dave,

Hush.....................................

Meds trolley is on its way ............................

__________________
:)
twirly

Mandy Brooks
Brooks Podiatry
S64 0DE

Suffering a fondness for odd things.

Your analogy regarding optics is one I have given much thought to over the years. On the surface optics does appear a much more exact science. Some years ago, I put it to the test and went to three different opticians during the course of a week. Guess what? I ended up with three different prescriptions. I'm sure we could all google it, but what studies are there of inter-tester error among opticians? I should be surprised if these studies show zero variability. See below **

Using CAD/ CAM and given an identical scan of a foot, theoretically all labs could provide the "same" device. The problem is that traditional measurements and prescription forms may not provide enough detail. Clinicians may not be willing or able to provide all the details that might be required. Certain casting techniques have been shown to have reasonable inter-rater reliability, so theoretically it can be done.

The reality is that a range of foot orthoses prescriptions will have a positive effect. I liken this to the bell-curve, in the middle is the ideal prescription, either side of this are zones of success; outside of these are zones of failure. Is optics different to this?

I can transfer a pair of devices between shoes and they are still efficacious within limits. I can wear my glasses in various lighting conditions and they're still good, but if it's too dark or too bright they're no good. In the evening, when I get tired, I feel more comfortable without them.

** so how much variation between prescribers in either biomechanics or optics is too much variability? i.e. can we get away with 4, 8 degrees difference in rearfoot posting angle? Will optical prescriptions still work with variability of: +/- 100, 200 etc ?????

The inter-relationships and co-dependancy's between biomechanical variables can be unravelled by employing multiple-regression models. Too many bi-variate studies and not enough multiple variable models. TOO MANY meta-analyses that conclude "more research required" and not enough good quality original research. If the researchers spent their time more meaningfully, i.e. by doing the original research..... that's my rant.

BTW, I actually encourage certain patient's to increase the height of the heels of their shoes; can you guess which ones?

__________________
Science is the antidote to the poison of enthusiasm and superstition

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Hi
Agree totally with Samran the more I know the less I know!!!!
Yee gods in my day we were not even taught biomechanics but "functional anatomy"
I do think that patient rapport has a lot to do with success/failure anactotal I know no research to back it up but .....
Zaffie

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Zaffie
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