What Happened To Continuing Education For Podiatric Biomechanics?

Doug Richie Jr. DPM FACFAS

While doing background research for this blog, I originally intended to focus on the reasons why topics relating to biomechanics have vanished from presentations at major podiatric conferences around the country. I wanted to review the lecture schedules from last year as well as upcoming meetings in 2012 to make sure that I was correct regarding the dearth of biomechanics lectures.

I was startled with what I found and it opened my eyes to what appears to be a growing trend at our scientific meetings. Practice management and marketing subjects have taken the place of sessions relating to podiatric biomechanics and conservative treatment of lower extremity conditions.

Are national podiatric seminars lacking in surgical, medical and research material for presentations so much that they need to add tracks for the business side of medicine? I have nothing against picking up practice management pearls. However, pre-conference sessions that will not interfere with more meaningful scientific tracks seem to be the best setting for coding, marketing and business strategies.

I may be wrong but I am confident that my fellow practitioners would far prefer attending lectures that directly relate to their clinical practice. They are interested in research using outcomes measures to compare both operative and non-operative interventions for the treatment of lower extremity pathologies. While there has been an explosion of knowledge in the field of lower extremity biomechanics over the past 15 years, few of my colleagues will have a chance to benefit from this movement. They will not be able to improve their own treatment protocols when it comes to non-operative interventions.

Furthermore, insights in biomechanics research have significantly affected surgical decision-making yet most premier surgical meetings offer no sessions devoted to this subject matter. The notable exceptions include the Podiatry Institute seminars and the Western Foot and Ankle Conference. Both of these organizations have featured credible credentialed speakers who present outstanding sessions devoted to updated research in podiatric biomechanics.

I have noticed that several meetings have so-called “biomechanics” sessions or workshops on their agenda. However, further scrutiny reveals that vendors or commercial entities stage these tracks and clearly promote a certain line of orthotic products. The education of our profession needs a panel of credentialed speakers who have published peer-reviewed research or hold faculty positions at respected academic institutions and can present credibly founded scientific information. Surprisingly, physical therapy and athletic training disciplines present the best researchers in lower extremity biomechanics. With a few exceptions, most large podiatric meetings do not include the proper faculty to teach modern lower extremity biomechanics.

Today, we have new scientific evidence that has re-directed our treatment of patellofemoral pain syndrome, Achilles tendinopathy, adult-acquired flatfoot and plantar heel pain syndrome. These new treatment regimens combine modification of foot orthotic therapy protocols, integration of functional rehabilitation programs and footwear modification.

When will we see this information presented at national meetings? Why are practice management topics now in the spotlight? What is our profession seeking when we register to attend a conference dedicated to continuing medical education?

I look forward to hearing from my colleagues who may wish to respond to these questions.


Yes! I no longer do bone/deep soft tissue surgery and am tired at the lack of choice I have for mandatory continuing education programs.

I agree one hundred percent with Dr. Richie's comments.

I have had this feeling for a very long time that biomechanics education is almost considered archaic to the newer podiatrists coming out of school. At least, that is what I am seeing in the eastern half of the U.S. Seems all a lot of docs consider biomechanics to be slapping patients into OTCorthotics or into the cheapest and sloppiest made orthotics on the market.

From talking with numerous colleagues at conferences, it seems like none take much pride in the actual art and science of analyzing the patient's pathology and attempting to capture this pathology in the form of an orthotic cast that can be used to make a good appliance. Many practices have the assistants slap the plaster onto the patients' feet without a good understanding of what they are trying to accomplish. This can be disastrous for the outcome.

I always have and always will prefer to do my own casting. Depending on the patient's needs, I sometimes use plaster and sometimes use biofoam. I think the true understanding of an orthotic as a motion control device is becoming lost. Today, everything out there is called an orthotic when most are simply arch supports made to an average arch. Most OTC devices are so flexible that there is very little control of foot motion gained.

And don't get me started on the "Dr. Scholl," very scientific analyzing machines at various stores like Walmart or the so called "Orthotic Stores" that are cropping up in every major city or the TV infomercials for orthotics. I think we should lobby to outlaw these businesses. If dispensing medications is so closely monitored by government entities, so should the dispensing of orthotics.

Every year, when I am asked by the APMA to submit lecture topics for the ACFAP track, there are always biomechanical based lectures recommended. As you see, none are selected for presentation at the APMA ASMs.

Unfortunately, the companies that are largely responsible for sponsoring many conference have no vested interest in sponsoring biomenchanics-related topics. They should but they don't. They want us to discuss their latest and greatest products that have very little to do with the biomechanics behind the reason we use these products.

We all know why there are suddenly an influx of derm-based topics on the lecture circuit lately, don't we?

I wholeheartedly agree with Dr. Richie. I also observe that there appears to be a further erosion of current biomechanical understanding being taught at the podiatric medical schools as well as at the post-doctoral training level.

There was a time before departmentalization took place at the podiatric schools that biomechanics was taught as an integral arm of comprehensive care for all patients. Every patient seen in a podiatry school clinic was to be examined comprehensively. All patients, particularly those who were surgical candidates, had a complete biomechanical examination before there was discussion of treatment options.

As a podiatric residency director for over 35 years, I noted a gradual decline in biomechanical understanding by our best and brightest residents. A very sorry state of affairs. I attend many national meetings and as Dr. Richie has pointed out, there has been a sparsity of good quality lectures on biomechanical understanding of various pathologies. Other professions have embraced biomechanical lectures in their continuing education seminars. These other professions (orthopedic surgery, physical therapy, pedorthists, chiropractic) seem to be eroding that area of patient care, which used to be our domain.

A solid understanding of biomechanics is essential for the comprehensive treatment of our patients. It must be done at every podiatric scientific meeting, particularly those dealing with surgical management of the lower extremity.

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