Newer graduates from Podiatry colleges don't have a clue about Biomechanics (CSPM excluded). They can't take a decent neutral cast to save their souls. I have worked with residents for years. They don't care about biomechanics at all - it's all an "arch support" to them. All they want to do is cut on everything that walks. Biomechanics is a fading "art form" in podiatry that will be sadly missed.
I believe that biomechanics is stressed in school, only there is only emphasis on the Root method. At my institution there is no discussion of first ray mechanics, sagittal plane theory, ect. For 2 years the same methods are taught but in the clinics there is relatively no supervision for biomechanical MEASUREMENTS. I believe this is where the disconnect is, students arbitrarily making up numbers for various measurements with attendings not following up, so you have the lack of diversity which leads to apathy from students because of all the new work being put out saying that roots methods are "bunk" and a lack of supervision. Leads to what we have today...." arch support"
Biomechanics is huge in my practice. I discovered early on that most podiatrists don't know crap about orthotics or biomechanics nor do they care. Meanwhile I'm cashing in on others lack of knowledge in the complex field of biomechanics. I guess they can chase down surgery patients and deal with the hassle.
Biomechanics is nice if it would only yield a consistent result. There are other schools out there that teach the same biomechanics as the notorious CSPM, but still can't give any better results than the next guy. Also, it would be nice to have a biomechanical theory that was more than the "good old boys club." That is why there is such a departure from the age old ROOT WEED biomechanics. Surgery should be able to take on this "Biomechanical" approach, but again, since the biomechanical theory has been disappointing, why use or learn something that doesn't make a huge difference? It is interesting that the blogs of biomechanics I have followed are nothing but "Bible Bashing." End result is everyone is mad at each other and no one the wiser. In its current state, Biomechanics is good enough to pass a test and nothing more. If biomechanics actually worked, than the customized orthotic would be consistent from clinician to clinician, remove interoperator error, and could actually beat an OTC orthotic head-to-head. Studies currently show to the contrary for almost all custom orthotics out there. Instead of Biomechanical Theory, how about Biomechanical Postulates?
Biomechanics is the one thing that no other profession
seems to really understand or even really care about. There is
so much misinformation about the mechanics of ambulation
that it must be stressed in our education.
Richard L Bell D.P.M. Long Beach Ca.
I disagree with the statement "new graduates don't have a clue about biomechanics." I agree that more emphasis in residency is spent towards surgical management and medicine than that focused on biomechanics. However, there is still a great deal of emphasis on biomechanics in the schools. Today biomechanics is more focused on the surgical implications and planning, NOT orthotics and bracing. There is a place for both, but as our profession progresses, ultimately so will our focus on making orthotics, taping, and bracing patients, especially when there are Cpeds, Physical therapist, Chiro which entire practice focus on non-surgical management. I am a CPed and use a lot of biomechanics in my practice, but I do NOT focus this background on orthotics etc, more on surgical reconstruction, etc.
Our profession is largely separated by (by the fact of the ABPS vs ABPOPPM) boards. I think the majority of us agree that we should have 1 surgical board (ABPS) and do away with the others.
It is great that some of you post that you "cash" in on others lack of knowledge ... great ethical statement. I will chase the surgical cases and will gladly refer to my peers whom prefer the non-surgical options when appropriate. We do what is best in our hands and our passions ... NOT TO CASH IN. Very embarrassing to hear a physician — or should I say 'podiatrist' — say this.
I have been involved with training residents for many years. I think they graduate with a good knowledge about diabetic wound care and surgery. I have never seen one who had good knowledge of how to treat patients Biomechanically. I don't think they have to be experts in Root Biomechanics but in general they really don't have a clue in the entire process of making, choosing, dispensing and adjusting orthotics. They do go right out and start making orthotics for patients when they start in practice.
The emphasis in DPM education is surgical even though what got us here that remains unique to podiatry is biomechanics.
We are turning out surgeons that can beat/compete with the orthopedic foot fellow but his MD degree, hospital base and the numerical and capital strength of the AMA trumps our work.
Biomechanics took us away from the cubicle in a department store and, when practiced, EBP will bring us the medical recognition that we deserve.
(personal bias as a practicing DPM and lab owner)
Biomechanics and orthotics have been lost from podiatric medicine. When I was in school in the 1980s, we laughed about the practitioners who did padding in their practice. Today's graduates seem as lackluster about biomechanics and orthotics.
In practical terms, the term "orthotic" should never be used by a podiatrist again (as the term implies nothing) and a new term should be copyrighted by the profession.
The problem that biomechanics has is that patients expect everything to be covered by their insurance and many refuse to pay anything out of pocket. Biomechanics should be to podiatry what oral care is to dentistry: something very necessary, but not covered by insurance.
The reality is that insurance companies may pay for an "orthotic" but will not pay for a biomechanically engineered subtalor joint stabilizer.
If one practices according to insurance allowances, then there is no need for biomechanics or biomechanical orthoses.
If you do not understand the biomechanics of the foot, you have no business doing surgery on it.
I recall in my chiropractic days learning that the upper extremity, we are flexors and the lower extremity, we are extensors. However, in the lower extremity, the extensors only work in open chain kinetics whereas the flexors work in closed chain kinetics. Hence in closed chain kinetics, in particular from the knee down, the origin and the insertion reverse. This is the main reason for surgery failures of the foot as the surgeon does not take this into consideration.
Here is a simple example. I look to someone who has had a stroke. The posterior muscles or flexors overpower the extensors. Then I look at the wheel chair the patient is in and instead of the toe being higher than the heel, it should be reversed. One can say it is mind over matter, but as one once said to me, biology always wins.
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