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Have Biomechanics Become An Afterthought In Podiatry?

I was honored to be invited to participate in the Orthotic Q&A panel at the American Academy of Podiatric Sports Medicine (AAPSM) Stand Alone Meeting in Boston this past month. Paul Langer, DPM, was the moderator for the discussion and Larry Huppin, DPM, and Greg Catalano, DPM, were fellow panelists.

Dr. Langer started the session by asking what we thought was right or wrong with the current state of podiatric biomechanics and orthotics. This question, a doozy to lead with, ended up taking up most of the allotted discussion time.

I responded first and stated that it seems very much to me that most podiatrists don’t really care about foot and ankle biomechanics or orthotics anymore. I think most practitioners see foot orthotics as no more than a part of the conservative management process that insurance companies mandate we attempt prior to surgical treatment.

I lamented that it seems we have stagnated as a profession when it comes to foot orthotics and biomechanics. Many practitioners do a minimal, at best, biomechanical exam on their patients and regardless of what that exam may show, they often prescribe the exact same prescription device to every patient.

Now I know this is will be viewed as an overexaggeration by many podiatrists. I honestly do not think so. For example, whenever I lecture on biomechanics, I ask if anyone uses heel lifts on a regular basis for equinus or limb length discrepancies (LLD). Some hands go up but not that many. I also ask how doctors evaluate their patients for ankle range of motion and for LLD, and if they use tests that the literature has deemed to be repeatable in clinical practice? At this point, even fewer hands are raised.

There is a lot of literature on biomechanics of the foot and ankle that is published weekly and monthly. Unfortunately, I notice it seems that few in our profession are really interested in pushing past what we were all taught in school. Very few of the most recent papers on foot biomechanics are authored by U.S. DPMs. I also see very little overall interest in docs wanting to know more about how to get better outcomes from their orthotics.

Dr. Huppin raised an interesting point that many podiatry schools are cutting back on the amount of time students spend learning foot and ankle biomechanics, both in lecture and in workshops. He stated, and all of us on the panel and most in the audience agreed, that understanding foot and ankle biomechanics is key to becoming a quality foot and ankle surgeon as well. To glaze over this subject because it is potentially seen to only be associated with foot orthotics is doing a huge disservice to all our students and soon-to-be podiatric colleagues.

Ultimately, it was a very passionate discussion and it seems, at the AAPSM meeting anyway, that there are still many podiatrists that greatly value foot and ankle biomechanics, and have a desire to improve upon what they have already learned.

I sincerely hope this is true because nothing gave me more joy in practice day-to-day than putting on my biomechanics thinking cap to figure out why a patient was hurting.

Dr. Williams is a Past President and Fellow of the American Academy of Podiatric Sports Medicine. He is the Director of Breakthrough Sports Performance, LLC in Chicago. Dr. Williams has disclosed that is the Medical Director for Go 4-D and a consultant for HP FitStation.

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