It has now been 30 years since I first opened my podiatric practice, joining a group of orthopedic surgeons in a multispecialty practice. It has been a great experience for me as many changes have occurred within podiatry and the rest of the medical profession during this time. Some of the changes within podiatry have been good but I believe other changes have not been so good for our profession.
One of the positives that has occurred is that podiatrists have become a more integral part of the medical community than three decades ago. When I first started practice, the orthopedic surgeons I worked with were skeptical of my abilities and the abilities of other podiatristsToday, however, these same orthopedic physicians consider me and many of my podiatric colleagues to be an important part of the medical community, showing little evidence of the skepticism that I first noticed three decades ago. Their views also seem to reflect the improved perception of podiatrists in the rest of the medical community.
I believe the change in status of the podiatric profession over the past 30 years is directly due to two factors. First of all, there were, and still are, many dedicated, high-quality podiatrists who worked hard for years before I entered practice, laying the groundwork for podiatrists to gain access to hospital and surgical privileges. This generation of podiatrists selflessly devoted themselves to the promotion of podiatry within all our medical communities and advanced the podiatric profession long before many of us started our own practices.
The second factor that has elevated the podiatric profession is the improved medical and surgical training of the podiatry students and podiatric residents who have eventually become members of our medical community over the past three decades. The more recently graduated podiatrists, with their increased medical knowledge and surgical skills, set an excellent example for the podiatric profession within our medical community. These young podiatric physicians, with their energy, skills and knowledge, have increasingly become the leaders of our podiatric medical community and will guide us into the future.
Unfortunately, during that same timeframe, I see problems possibly brewing for the future of the podiatric profession. Over the past 30 years, I have taught biomechanics, sports medicine, foot orthosis therapy and shoe biomechanics concepts to podiatry students at the California School of Podiatric Medicine at Samuel Merritt University (formerly the California College of Podiatric Medicine). In addition, over the past 26 years, I have helped train podiatric surgical residents on non-surgical and surgical biomechanics theory and techniques, foot orthosis therapy and sports medicine concepts.
What concerns me now about podiatry is that even though the third-year surgical residents all possess excellent clinical skills in medicine as well as forefoot, rearfoot and ankle surgery and trauma, many of the practical clinical skills in foot orthosis therapy and sports medicine that were once common among the podiatrists who graduated in my era have become sorely lacking. Even though I train these very intelligent podiatric surgeons on casting, prescribing and modification of foot orthoses along with sports medicine and shoe biomechanics concepts, these young podiatric physicians seem to come to me with relatively little skill and knowledge of non-surgical treatment methods.
Clearly, podiatrists need to be knowledgeable of foot and lower extremity biomechanics, and proficient in their non-surgical skills so they can provide excellent conservative care to their patients. It is important to keep in mind that many patients do not want to or cannot take time away from their work and family to have surgery.
Is this lack of training in non-surgical podiatric skills the fault of these third-year podiatric surgery residents? No. Rather, it is likely due to the podiatric surgery residency hierarchy emphasizing improved surgical skills at the expense of non-surgical skills. It is apparent that important conservative skills have been relegated to a minority status within the current mandatory three-year podiatric surgery residency model while all priorities are devoted toward molding podiatry residents into expert foot and ankle surgeons.
So has podiatry improved over the last 30 years? In some ways, we seem to be stepping forward but in other ways, we seem to be stepping backwards. Let us hope that we can continue to strive together to correct these deficiencies in non-surgical podiatric education and skills within our current post-graduate podiatric residency programs. It will be essential for us to do so if we want to remain the experts in both the surgical and the non-surgical treatment of foot and ankle pathologies for the good of our patients and for the good of the podiatric profession as a whole.
Dr. Kirby is an Adjunct Associate Professor within the Department of Applied Biomechanics at the California School of Podiatric Medicine at Samuel Merritt University in Oakland, Calif. He is in private practice in Sacramento, Calif.
Thank you to Drs. Phillips and Bernard in putting forward their own observations and opinions regarding the teaching of biomechanics to our podiatry students and residents. Unfortunately, the problem only gets worse every year as more biomechanically-trained podiatrists retire and newer podiatrists, who have little biomechanics and foot orthosis training, take their place.
I jJust had two patients this week who had seen younger podiatrists for the treatment of plantar fasciitis and these podiatrists recommended foot surgery before even mentioning foot orthoses for the treatment of their plantar fasciitis. Patients aren't stupid and will go to the health care provider who is good at providing the service needed when podiatrists only know how to do surgery, and little else. I will likely be training more pedorthists and physical therapists in the future on how to do good custom foot orthosis therapy since most podiatrists don't want to be bothered by such "unimportant" information.
This is bad for podiatry ... and their patients.
Kevin A. Kirby, DPM