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Does anyone have any comments about the adult flat foot article in Podiatry Today?

I would rather wait till others have a say then I would like to put my 2 cents worth in.

Not sure who the article is directed towards...mentioning a lot of information not relvant to your general Podiatrist seeing this supposed condition.

Waiting for your response.

Gareth.

Link to article:

Roundtable Insights On Adult-Acquired Flatfoot

If we take the article for what it is (a discussion amongst a group of professionals who are presenting their personal opinions) then it is a perfectly reasonable article.

I have skimmed it very quickly but from what I've read they have touched on all aspects of the diagnosis and relating the stages of the condition to the available management options.

It concurs with the literature that I have read on the topic.

Ian

Gareth and Colleagues:

For your information, this article reflects the most common points that are talked about at podiatric surgical seminars throughout the USA. I know Alan Catanzariti very well (he was a classmate of mine) and know Gerard Yu fairly well and both are very knowledgable and accomplished surgeons of the foot and ankle and give great lectures on the subject. To me, the article is very typical of the ideas that will be tossed back and forth between foot surgeons who are more tuned to surgical correction of a deformity than to conservative approaches to a pathology. This is neither good or bad. It simply is a different way of approaching these types of patients.

For the nonsurgical podiatrist, this article has limited application due to its predominantly surgical approach. I disagree with some of what is said in the article and think the reliance on x-rays instead of using clinical examination and functional tests and the lack of discussion regarding foot orthosis modifications are my biggest complaint with this roundtable discussion. In other words, the medial heel skive is critical to achieving treatment success with the treatment of posterior tibial dysfunction with foot orthoses, and this is not mentioned anywhere in the roundtable discussion.

However, I am very aware of the predominantly surgical approach of many US podiatrists and this type of roundtable discussion is really not anything new here in this country. When I have lectured in New Zealand and Australia, I have found the level of sophistication of the seminar participants regarding various foot orthosis modifications to be generally much better than their surgery-oriented podiatric colleagues in the US.

Interestingly, I am sure that many of the patients that I see with posterior tibial dysfunction (about 7-8/month) that become asymptomatic with good conservative care (about 75%) would be considered surgical candidates in the offices of many podiatrists who are considered to be experts in foot surgery. This is simply a matter of different types of expertise in the hands of different podiatrists.

If you have any more specific questions about the statements made within this article, I would be happy to comment on them since the kinetics of flatfoot deformity has been one of my primary academic and research interests over the past 20 years.

__________________
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
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In reply:

I must apologise for being for being so frank regarding my very quick post, in future I should wait and detail my comments more precisesly rather than starting a thread off with no 'meat' to it.

Thankyou to Admin for putting the link in of the article.

Again Kevin, another well respected post and almost entriely highlighting the points that I was going to mention regarding this article.

I find it interesting that as (myself) being a Podiatrist who doesn't perform surgery for the foot and ankle, as with almost all the Podiatrists in this country that it seems rather invasive to be trying to correct a foot position that is potentially partially or almost entirely correctable using good prescription of foot orthoses and shoes that are suitable for the various activities. As you said this is the way that we are taught as professionals in this country and at the level to which we are taught originally and with this comes a on going trend to 'stick to your knitting' so to speak using the same or simimilar techniques you feel are most appropriate.

I would have liked a more clinical examination with the article and the mention of foot orthoses as well, although remembering that the topic of the discussion was purely on a surgical approach.

Maybe a rush of blood in my hasty post.

100% agree.