Key Insights On The Evolution Of Orthoses And Biomechanics

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Guest Clinical Editor: David Levine, DPM, CPed

   While more research continues to emerge on biomechanics, some physicians feel it is not emphasized enough in podiatry and that other specialists may be gaining more of a foothold in prescribing orthotic devices. Accordingly, expert panelists discuss these controversial issues and examine the potential impact for the profession.

   Q: With much emphasis in our podiatry journals on surgery, where and how do you see biomechanics in our profession evolving?

   A: As David Levine, DPM, CPed, notes, orthotic devices came of age in the 1970s in the podiatry profession. He says at that time and for several years thereafter, biomechanics and orthotic devices became mainstays of podiatry. In later years, Dr. Levine notes that podiatrists became more drawn to surgery with enhancements in surgical techniques and the growth in the number of procedures DPMs could perform.

    “We became enamored by the good and the money that came with foot surgery,” says Dr. Levine. “This came at the expense of some of the simpler, less glamorous aspects of the profession.”

   Scott Spencer, DPM, expresses surprise that the profession has not “exhausted the surgical avenue and looked to return to understanding the mechanics of the foot and foot function.” While he says there have been new additions to old procedures, Dr. Spencer feels surgical treatment has not drastically changed.

    “In the arena of foot mechanics, there are many new and exciting ideas out there that are not getting the exposure that they warrant. There are many journals that provide a great deal of emphasis on biomechanics but they are not read by the majority of practitioners,” maintains Dr. Spencer.

   Dr. Spencer says there needs to be a renewed emphasis on understanding the importance and practical application of biomechanics for everyday practitioners. He believes physicians such as Merton Root, DPM, William Orien, DPM, and John Weed, DPM, had such a large impact because they combined biomechanics with practical application, which really got people’s attention.

   Doug Richie Jr., DPM, reminds that biomechanics is not just limited to foot orthotic therapy. Even though journals have monthly articles on joint moments, walking and running kinematics, muscle function and pathomechanics of injury, he says most major podiatric scientific meetings ignore these important topics. In addition, Dr. Richie says biomechanics is not taught as extensively in the podiatric medical schools as it was 20 years ago.

    “Thus, the field of lower extremity biomechanics has evolved extensively in the past decade while the participation of the podiatric discipline has dwindled,” points out Dr. Richie.

   Although orthotic devices are still important, Dr. Levine notes it started to become clear within the last eight to 10 years that orthoses alone could not solve all of the podiatric biomechanical issues that faced the profession.

    “The shoe could no longer be ignored. Podiatrists were slow to acknowledge this,” asserts Dr. Levine. “Other specialties could not ignore it. The foot suffering public just wanted relief and usually with surgery as the last resort.”

   The therapeutic shoe bill changed the podiatric perspective regarding footwear, concludes Dr. Levine. He says the bill was an eye opener for what one could do for patients using shoes as a treatment modality. He hopes such bills will continue to evolve in a positive way and not just stop with shoes. Dr. Levine emphasizes that the entire podiatric biomechanical arena includes shoes, orthotic devices, shoe modifications and surgery. He feels the best method of re-emphasizing this understanding lies in establishing positive working relationships with other related specialties including pedorthists.

   Q: How will our attitude toward podiatric biomechanics affect the orthotic device?

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