Encouraging Signs Of Interest In AFO Therapy At A Podiatric Medical School
- Doug Richie Jr. DPM FACFAS
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This past week was a rewarding time for me in terms of medical education. First, I had the pleasure of giving a lecture to the second-year class of podiatric medical students at the Western University of Health Sciences. Additionally, a third-year resident in family medicine from a nearby teaching hospital finished a two-week rotation in my office. Finally, I had a second-year resident from our Podiatry Surgical Residency (PSR-36) Program scrub three surgeries with me.
All of these experiences were rewarding in very different ways. It is always great to see a podiatric surgical resident improve his or her skills. In terms of working with residents, it is gratifying to realize that there is a lot of information you can teach them that they have not learned from any other rotation or attending from another specialty. It is also reassuring to see that our podiatric residents are just as bright and knowledgeable as the MD residents I work with.
My most rewarding experience last week was giving a lecture, titled “Indications and Use of Ankle-Foot Orthoses (AFOs) in Podiatric Practice,” to the second-year podiatric medical students. The fact that I presented a lecture on this subject in a podiatric medical school shows how far our profession has progressed in terms of complexity and scope of practice. Speakers did not expound on this subject at schools of podiatric medicine until only a few years ago. Accordingly, practicing podiatric physicians who prescribe AFOs routinely must rely on knowledge they have obtained by attending workshops or lectures at continuing medical education symposia. As a result, many podiatric physicians routinely prescribe the same rigid gauntlet device for every pathology, mainly because of the simplicity and the handsome reimbursement of this particular type of AFO.
Most AFOs, however, are far more complicated than rigid gauntlets. This treatment option requires the highest level of biomechanics knowledge in order to achieve a positive patient outcome. The fact that this subject is now part of a podiatric medical education curriculum will require that the students solidify their knowledge and skill in gait analysis, range of motion and muscle function analysis.
I have witnessed a serious decline in the commitment to biomechanics training at podiatric medical schools. However, a new interest in teaching ankle-foot orthotic therapy at these institutions is a positive sign.
It was rewarding not only to participate in this new trend in podiatric medical education but also to see how well the students responded to my lecture. The questions they asked clearly indicated that they understood the complexity of using braces to improve or modify range of motion of the knee, the ankle and the subtalar joints. They now know that they do not have to prescribe rigid gauntlet devices for every pathology when implementing AFO therapy. There is hope for the future of podiatric biomechanics.