Foot and lower extremity scientific research has been of great interest to me ever since I entered podiatry school in 1979. As a podiatry student and resident, many years before the Internet made copying papers on a copy machine obsolete, I spent hours in the library at the California College of Podiatric Medicine copying interesting research articles. In addition, during my biomechanics fellowship, I had my students meet on a weekly basis for early morning journal clubs to review and critique scientific articles relating to foot and lower extremity function, pathology and treatments.
I have also been fortunate to coauthor research articles with experienced PhD biomechanists and have spent the last three decades reviewing research papers in multiple scientific and medical journals. Having spent nearly two-thirds of my life in this pursuit, I believe some observations of foot and lower extremity scientific research from the past and present are in order.
As I alluded to earlier, the Internet greatly enhanced our ability to access not only recent scientific articles but many classic research articles from decades past. Within a few seconds on my computer, tablet or smartphone, I can download and access nearly any research papers that I am interested in reading.
For example, I recently needed to re-read the original John Hicks article on the biomechanical functions of the plantar fascia, written in 1954.1 Instead of having to search through my file cabinet of copied articles, I simply typed, “The mechanics of the foot. II. The plantar aponeurosis and the arch” into Google Scholar, and voila! Five seconds later, I had instant access to the paper. For “more experienced” podiatrists such as myself, the ability to have nearly instant access to thousands upon thousands of scientific research articles at my home, office or while traveling is quite remarkable.
Another important change over the past four decades is that there are many more foot and lower extremity research articles published now compared to when I began podiatry school. During my podiatry student and resident years, only a few foot and lower extremity research articles came out every month versus the multiple research articles currently published every week. Part of this dramatic increase is due to the greater number of journals available in which to publish these studies. In addition to the more established journals that published and still publish research for decades in printed form, a number of more recently introduced online journals give the researcher more opportunities to publish and also allows the podiatric physician to instantly access that research on the Internet.
For example, the Journal of Foot and Ankle Research, an online journal started in 2008, has consistently published excellent foot and ankle research articles which I enjoy reading. The online journal is a welcome addition to the more standard print journals I review monthly including the Journal of the American Podiatric Medical Association, the Journal of Foot and Ankle Surgery and Foot and Ankle International.
Even with these rather dramatic changes in access and the number of articles published per month, the one thing that has not changed in the last four decades in foot and lower extremity research are the characteristics that make a research article “good,” or even, over time, allow it to be considered a “classic.”
Foot and lower extremity researchers still need to design their study well, perform accurate measurements, analyze their research data correctly, write their article with clarity and, perhaps most importantly, make unbiased conclusions regarding their data in the discussion of their research publications. Unless the authors perform each of these critical steps with skill, accuracy, integrity and a lack of bias, one simply cannot trust the results and conclusions from that research article as a reliable source of scientific and useful clinical information for our patients.
All in all, during my years as a podiatry student, resident, clinician, researcher and research reviewer, there have been many changes in foot and lower extremity scientific research. Perhaps the biggest change is instant access to scientific articles published from just a few days ago to over a century ago. In addition, we have seen an impressive increase in the number of research articles with online journals now allowing researchers more avenues for publications and clinicians increased access to important research articles.
However, something that has not changed over the last four decades of foot and lower extremity research is that in order for a research article to become widely read, clinically useful and, even, a classic within the foot and lower extremity scientific research literature, it still must be well-executed, honest, objective and well-written.
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.
1. Hicks JH. The mechanics of the foot. II. The plantar aponeurosis and arch. J Anat. 1954;88(1):25-30.