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This was published in The Journal of Current Podiatric Medicine June-July, 1989, pg. 41
it was a Biomechanics Issue edited by Justin Wenick, D.P.M. and I was the guest editorialist.
The Future of BIOMECHANICS
The following guest editorial addresses the issues of competency in biomechanics treatment of foot problems and competition among various branches of the health professions for the dispensing of orthotics. The importance of clinical and public education and the role of professional societies are discussed.
Dennis Shavelson, D.P.M.
__________________________DENNIS SHAVELSON, a Diplomate of The American Board of Podiatric Surgery, is a Clinical Associate Professor in the Department of Medicine at NYCPM
In my opinion, the future of podiatry lies in the practice of Biomechanics. Biomechanical evaluation, gait analysis and the casting and fabricating of orthoses can be the cornerstone of success for the podiatrist.
If what we believe is true, that the effects of gravity, hard, unyielding shoes and ground surfaces , poor posture and poor foot mechanics will eventually lead to pain, deformity and reduced quality of life then biomechanics should be easy to promote to the public. Orthoses should be accepted like eyeglasses and both we and our patientswould benefit from wider use of prescription inserts.
Yet, while other professions are taking advantage of the opportunity in biomechanics, podiatrists have not kept in stride. We appear to be losing our “foothold” as foot function experts. Physical therapists, chiropractors, orthopedic shoe stores and ski shops are fabricating orthotics from casting foam and less than custom prescriptions.
If we are to remain leaders with them, we must take steps to correct our own complacency.
We must educate podiatrists, other professionals and the foot suffering public about orthotics biomechanics and neutral foot casting just as we have taught them about lasers and same day surgery. We must especially find a way to speak to the lay person in simple, understandable terminology that enhances their awareness of the podiatrist’s role in treating feet biomechanically.
As a teacher at one of the colleges of podiatry and someone who works closely with preceptees, externs and residents as well I can see that one of the problems associated with our being “upstaged” by other professional biomechanicsts is the insufficient clinical exposure to the subject that our students receive in school and at the postgraduate level. We must pay more attention to cultivating enthusiasm in our young podiatrists for this specialty.
Also, there have been few additions to the podiatric literature on the subject of biomechanics. Fundamental scientific research into foot types, mechanical and postural pathology and clinical control of the foot is sparse and has been largely conducted by other professions.
The Journal of the Foot and Ankle, Orthopedic and Sports Physical Therapy and The Journal 0f the American Chiropractic Association all have published research of the kind that should be published by podiatrists.
To hear us talk, the podiatric community contains experts in sports medicine, podopediatrics, biomechanics and orthotic fabrication. If this is true , we should be more visible at seminars and publishing more regularly on the subject. I believe The Amerian College of Foot Orthopedics is missing a golden opportunity to publish a journal and sponser seminars, pamphlets and public relations programs that would enhance the field and the opportunities for all of us.
At present, there are no true standards to the science of biomechanics. Today, the same patient, examined by ten different practitioners, would get ten different diagnoses and ten different orthotics. It is crucial that podiatrists be able to assess patients accurately in order for the credibility of biomechanics to broaden. Podiatrists must step to the forefront of this issue. We must invest more time and effort in upgrading our expertise and set the standard for biomechanical diagnosis and treatment in order to remain at the top of The Biomechanical Pyramid. □
The principles behind Biomechanics are one founded by researches as far back as Royal Whitman in 1906.
The understanding of the bodies biomechanics has been well researched in the forties and fifties by notable anatomists such as Hicks and Wood Jones however we as Podiatrist tended not to follow these scientists rather base our belief structure on what has come out of shoe makers and very basic orthopaedic beliefs that are not based on sound scientific research.
We are similar to the dental profession in the understanding of biomechanics with one very serious exception, we, as a profession have lost control of the manufacture of devises. This has led to serious inconsistencies in the quality of the devise and therefore impacts on the effectiveness of treatment.
Journal articles that have been written over the past two decades are flawed in the respect that no style of manufacture is specified and that research is based on an 'orthotic' where the neither the casting technique nor the control point is even mentioned.
We wish to be respected by our fellow health practioners without having done the 'hard yards' in a consolidated view in biomechanics and orthotic manufacture.
The Academics have failed to recognise this and in some cases discourage the Podiatry student from totally understanding why orthotics are made and how they are meant to control the foot and thus the biomechanics of the lower limb.
We as a profession need to take a long hard look at ourselves and demand the Universities change their curriculum to a more Clinical and well researched base.
Once we as a profession can offer a united front to the rest of the health practioners, biomechanics will then become the powerful tool it is.
Alex Adam
We as a profession need to take a long hard look at ourselves and demand the Universities change their curriculum to a more Clinical and well researched base.
I agree and the problem is more widespread than just the podiatry curriculum; although I couldn't fault the research base.
We had some tutors with some great experience; but when the more-than-occasional clinical answer of "what does the research say?" bounces back at you, it short-changes all involved.
Sackett mentioned 2 aspects of EBP. We have all fallen in love with one aspect at the expense of the other.
What was the minimum number of orthotic devices one had to make to pass the course? Less than the fingers on your hand. I reckon some got through making one pair perhaps.
As students we could even use a lab
The other thing is that we over-prescribe rigid 5mm devices to little old ladies with deformed feet. We under prescribe EVA devices. There is a whole world out there that the orthotist does really well, that we should compete with.
From our student perspective, we have no idea of what was behind the scenes. Funding issues? Did the head of school at the time dabble in orthotics/biomechanics for instance?
The diabetes and primary-care side of the course was taught very comprehensively; perhaps at the expense of applied clinical biomechanics. But if these pod assistants and foot-care nurses get more rights to foot care, where does it leave the podiatry graduate? Blending in with a large simply educated herd.
Ron
Physiotherapist (Masters) & Podiatrist
Last edited by Atlas : 4th April 2009 at 12:45 AM.
The principles behind Biomechanics are one founded by researches as far back as Royal Whitman in 1906.
Actually, Alex, you need to go back much further to over two centuries before Royal Whitman, to 1680, to the work of Giovanni Borelli to discover the first book on biomechanics titled De Motu Animalium.
Quote:
Originally Posted by Alex
The understanding of the bodies biomechanics has been well researched in the forties and fifties by notable anatomists such as Hicks and Wood Jones however we as Podiatrist tended not to follow these scientists rather base our belief structure on what has come out of shoe makers and very basic orthopaedic beliefs that are not based on sound scientific research.
Mert Root and colleagues referenced the works of Hicks and other researchers of earlier years in his published books on biomechanics. To say that biomechanics was "well researched" in the 1940s and 1950s is a joke. Little foot and lower extremity research was done in those eras and it was of relatively poor quality due to the lack of sophistication of researchers and their equipment. There is more research and much better quality research being published currently on foot and lower extremity biomechanics now in a month than there was published in whole years in the 1940s and 1950s. The problem currently is not of lack of research, but 1) a lack of interest in the podiatric profession in biomechanics, 2) a lack of qualified instructors who understand and can teach biomechanics in an effective manner in podiatric medical schools, 3) and a lack of emphasis on teaching basic and advanced biomechanics concepts at our podiatric medical institutions.
Quote:
Originally Posted by Alex
We are similar to the dental profession in the understanding of biomechanics with one very serious exception, we, as a profession have lost control of the manufacture of devises. This has led to serious inconsistencies in the quality of the devise and therefore impacts on the effectiveness of treatment.
Journal articles that have been written over the past two decades are flawed in the respect that no style of manufacture is specified and that research is based on an 'orthotic' where the neither the casting technique nor the control point is even mentioned.
I agree with your criticism of journal articles and their general lack of description of foot orthosis manufacture and design criteria. Unless we know exactly how the orthoses were made and the materials they are constructed from when we read foot orthosis research, then we will never know if the research results with orthoses came from a true inability of an optimally designed orthosis to perform a mechanical function or came simply from a poorly constructed foot orthosis performing poorly.
Quote:
Originally Posted by Alex
We wish to be respected by our fellow health practitioners without having done the 'hard yards' in a consolidated view in biomechanics and orthotic manufacture.The Academics have failed to recognise this and in some cases discourage the Podiatry student from totally understanding why orthotics are made and how they are meant to control the foot and thus the biomechanics of the lower limb.We as a profession need to take a long hard look at ourselves and demand the Universities change their curriculum to a more Clinical and well researched base.Once we as a profession can offer a united front to the rest of the health practitioners, biomechanics will then become the powerful tool it is.
Alex Adam
I agree that podiatrists need to become better educated in foot and lower extremity biomechanics. However, from my viewpoint and in my country, podiatrists generally know much more about foot and lower extremity biomechanics than any other health professional. If we want to be perceived as experts in foot and lower extremity biomechanics and experts in foot orthosis therapy, then we better well get up off our seats and start reading the literature, attending biomechanics seminars, reading and trying to understand the excellent biomechanics postings here on Podiatry Arena and training our podiatry students and podiatry graduates with more high-quality courses on biomechanics. If we don't take these critical steps, then another profession certainly may take our place in assuming the role of foot and lower extremity biomechanics and orthosis experts that, I believe, is rightfully ours within the health professions.
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
Actually, Alex, you need to go back much further to over two centuries before Royal Whitman, to 1680, to the work of Giovanni Borelli to discover the first book on biomechanics titled De Motu Animalium.
[Mert Root and colleagues referenced the works of Hicks and other researchers of earlier years in his published books on biomechanics. To say that biomechanics was "well researched" in the 1940s and 1950s is a joke. Little foot and lower extremity research was done in those eras and it was of relatively poor quality due to the lack of sophistication of researchers and their equipment.]
Having been a student of the early 1980's I found little information regards biomechanics, however due to my anatomy and physics background I realized the information I required was in Anatomy and applied Physics journals. Anatomists have investigated the mechanism of the foot for many years and this allowed the development of my research into the closed pack position of the cuboid.
I feel the use of the mind, dissection and histological investigation far out weighs the use of modern equipment when it comes understanding the function of the foot due to the variability factors of the human body. Gross biomechanics that use pressure plates and high speed cameras only allow us to investigate mean forces and the compensation that the joints of the body have to resist gravitational and ground reactive forces.
[There is more research and much better quality research being published currently on foot and lower extremity biomechanics now in a month than there was published in whole years in the 1940s and 1950s. The problem currently is not of lack of research, but 1) a lack of interest in the podiatric profession in biomechanics, 2) a lack of qualified instructors who understand and can teach biomechanics in an effective manner in podiatric medical schools, 3) and a lack of emphasis on teaching basic and advanced biomechanics concepts at our podiatric medical institutions.]
Totally agree with the latter however the former comment is, I feel, based on Podiatric techniques and schools of Biomechanical research. There was significate research carried out in the period but by anatomist and othopaedics alike.
Having been a lecturer myself I found considerable resistence from heads of school to investigate the true nature of foot biomechanics and the general comment that was directed at my research was "don't know why you bother we all know that orthotics do not work". This encouraged to self fund my research at Melbourne University with Anatomists as my supervisors.
[I agree with your criticism of journal articles and their general lack of description of foot orthosis manufacture and design criteria. Unless we know exactly how the orthoses were made and the materials they are constructed from when we read foot orthosis research, then we will never know if the research results with orthoses came from a true inability of an optimally designed orthosis to perform a mechanical function or came simply from a poorly constructed foot orthosis performing poorly.]
The diversity in manufacture of orthotic devises is based on the fact that our profession has failed in establishing a recognised technique. In 1989 I attempted to organise a Podiatric technician's course under the umbrella of the Dental mechanics. It went as far as the association body for their sanction however it was rejected on the grounds that it was not in the professions interest to dictate the manufacturing process.
I agree that podiatrists need to become better educated in foot and lower extremity biomechanics. However, from my viewpoint and in my country, podiatrists generally know much more about foot and lower extremity biomechanics than any other health professional. If we want to be perceived as experts in foot and lower extremity biomechanics and experts in foot orthosis therapy, then we better well get up off our seats and start reading the literature, attending biomechanics seminars, reading and trying to understand the excellent biomechanics postings here on Podiatry Arena and training our podiatry students and podiatry graduates with more high-quality courses on biomechanics. If we don't take these critical steps, then another profession certainly may take our place in assuming the role of foot and lower extremity biomechanics and orthosis experts that, I believe, is rightfully ours within the health professions.
I couldn't agree more and unfortunatley in Australia we have come to a point where Chiropractors, physiotherapists and sports doctors all issue orthotics without fully understanding what there fuction is, a well orchestrated wholesale sales team. The problem is, as it is always, contra indication of orthotic therapy are often ignored. It is inpart this that has given orthotic therapy a bad name within the public eye.
In conclusion Our profession is at a cross roads, we either take the education of the young and develop a vision for the future of Podiatry or we accept the inevitablity of other health professions taking over our discipline and we become just carers of the feet.
Kindest regards
Alex Adam
Last edited by Admin : 7th April 2009 at 01:55 AM.
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The Future of Biomechanics
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