Can Podiatrists Be The Premier Surgeons Of The Foot And Ankle Without An Understanding Of Current Biomechanics Research?

I recently had the privilege of serving on the faculty of a seminar entitled
“Biomechanics for the Foot and Ankle Surgeon,” which was recently held in Oakland, Ca. This conference was sponsored by the California School of Podiatric Medicine at Samuel Merritt University in association with the Prescription Foot Orthotic Laboratory Association (PFOLA).

The content of this meeting was certainly the first of its kind in the podiatric profession. The purpose was to update the attendees on recent advances in knowledge in biomechanics, which would have direct application to improving outcomes in foot and ankle surgery.

Kevin Kirby, DPM, started the day with an outstanding comprehensive overview of engineering terminology, which is commonly used in research publications relevant to orthopedic surgery. Joint moments, stress-strain, material stiffness and load to failure are frequent properties that are studied when researchers investigate the efficacy of internal fixation, soft tissue anchors and tendon transfers.

A great deal of attention was devoted to studies of flatfoot surgery and pathomechanics. Shannon Rush, DPM, and Jeffrey Christensen, DPM, presented their stellar and elegant research on first ray function. Their papers are among the most important and unfortunately overlooked research published in the podiatric literature. How many of you are aware of which surgical procedure will best reduce hypermobility or improve stiffness of the first ray?

Howard Hillstrom, PhD, showed a fabulous overview of the gait lab at the Hospital for Special Surgery in New York City. This prestigious orthopedic hospital has millions of dollars in grants to study gait abnormalities in children as well as interventions for osteoarthritis of the knee and hip. How many podiatric residency programs have access to a gait lab?

This conference was sold out and the evaluations from the attendees reflected an extremely enthusiastic response. This raises the question: Why is the subject of biomechanics absent from almost every surgical conference in the podiatric community?

At the recent American College of Foot and Ankle Surgeons (ACFAS) conference in Washington D.C., there was no session nor even a single lecture devoted to surgical biomechanics. How can any surgeon adequately evaluate foot and ankle pathology without a sound knowledge of current insights in lower extremity function?

In comparison to our orthopedic colleagues, podiatric physicians are increasingly ignoring the role of biomechanics when teaching advances in the field of reconstructive foot and ankle surgery. While many in our profession believe we are superior to orthopedic surgeons based upon our “biomechanical” knowledge, the truth of the matter is that we have fallen behind many other disciplines in our awareness and teaching of recent biomechanics research.

In my opinion, re-focusing attention to biomechanics will be critical for podiatric physicians to stake the claim of being the premier surgeons of the foot and ankle.



Anonymoussays: May 21, 2009 at 6:54 pm

a good reminder, Dr. Richie. Keep up the good work!

--Manoj

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Anonymoussays: May 22, 2009 at 9:33 pm

Well stated Dr. Richie. It is about time the profession understands that we as a group need to "re-focus" on the biomechanical principals that contribute to foot pathology. It is about time a prominent podiatric physician states it clearly.

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