Why Using Proper Terminology Can Enrich The Future Of The Podiatric Profession

Pages: 74 - 74
Author(s): 
Kevin A. Kirby, DPM

Proper terminology is very important for the future of podiatry. The words that make up the podiatric lexicon are the tools we all use to communicate in our books, journal articles and lectures. We also use these words when interacting with podiatric colleagues, other health professionals and our patients. All the health professions, including podiatry, use specific terminology that has well-defined meanings for the members of its own profession.

Podiatric terminology needs to be very exact and consistent due to the complex nature of the human foot and lower extremity. Consistency is also essential due to the fact that we use nomenclature from other medical professions to better explain the physiology, function and conservative and surgical treatment of pathologies of the foot and lower extremity. Proper language is also dependent on who we are communicating with. We may use one vocabulary to communicate with other podiatrists, another vocabulary to communicate with non-podiatric health professionals and still another vocabulary to communicate with a layperson. There is no doubt that the use of proper words and proper terminology is of extreme importance for the podiatric profession and its future. Good communication is the key. Proper words and precise, unambiguous terminology are paramount for good communication.  

Over my 30-plus years of teaching foot and lower extremity biomechanics topics to podiatry students, podiatry residents and podiatrists, I have become increasingly aware of how important the proper use of concise terminology can be for the efficient teaching of these concepts. In order to describe and expand on the knowledge of foot and lower extremity biomechanics and surgery, the international biomechanics community has chosen to use terms that are precise, unambiguous and mathematically quantifiable to describe the structure and function of the human foot and lower extremity. These terms are widely accepted and used by the members of the international biomechanics community within their books, their journals and their lectures. These terms have allowed a level of communication regarding foot and lower extremity function that is far superior to the past.

However, even though most of the rest of the health professions have adopted these standard terms used within the international biomechanics community, how many podiatrists have been keeping up with the new developments and newer terminologies used to describe the biomechanics of foot function and foot and ankle surgery? Unfortunately, when it comes to modern foot and lower extremity biomechanics and the biomechanical engineering concepts of foot and ankle surgery, many podiatrists are largely living in the past.  

Many podiatrists still think the term “biomechanics” means only the making of custom foot orthoses for their patients. Most podiatrists do not read the foot and lower extremity research that is published nearly daily within the international biomechanics community. Many podiatrists do not understand or know the definitions for many of the terms used in foot and lower extremity biomechanics research even though these terms have been in use for over a quarter century within biomechanics and surgical research that directly affects the health and foot function of their own patients.

Do you know the difference between stress and strain? Do you know the definitions of elastic modulus, moment of force or stress relaxation? Many podiatrists do not.

Many podiatrists also still think that the midtarsal joint “locks,” even though research has clearly shown that the midtarsal and midfoot joints act more like springs. Many podiatrists still think the first ray can be “hypermobile” even though the term “hypermobile” is not quantifiable and is ambiguous, having been replaced as a concept with the term “stiffness” for other foot and lower extremity joints years ago. A clear understanding of proper biomechanics and engineering terminology is necessary to remain current on the latest scientific developments in foot and lower extremity function.

We need to examine our lectures, journal articles and books closely for the terminology that describes the mechanical properties of the foot and lower extremity, and the surgeries we use to correct foot and ankle pathologies. We must constantly strive to make certain we speak and write in the language of the international biomechanics community when we communicate with others about the function and surgical correction of the foot and ankle. In other words, we must not continue using outdated terminology that is common to podiatry but uncommon to everyone else.

We need to do all these things so the podiatric profession can continue to be an integral part, and not an inconsequential part, of the international medical, surgical and biomechanics research community.

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.

 

Comments

I would argue that hypermobility has been well described within podiatric and orthopedic literature particularly when relating to the first ray. While we may lack a device that is used in the clinical setting to objectively measure this laxity, many experienced podiatrists are able to identify and stage it upon clinical examination. Of note, such devices do exist such as the Klaue device. There is also a scientifically validated classification for global joint hypermobility, the Beighton Scoring system.

Dr. Thomas:

Thank you for commenting on my article.  

Yes, hypermobiity has been "well described within podiatric and orthopedic literature when relating to the first ray." In fact, it was 82 years ago that Dudley Morton, MD, first described first ray hypermobility to attempt to describe the load deformation characteristics of the first metatarsal segment relative to the other metatarsal segments (Morton DJ:  The Human Foot:  Its Evolution, Physiology and Functional Disorders. Columbia University Press. Morningside Heights, New York, 1935). Unfortunately, World War II was still 4 years in the future when the term "first ray hypermobility" was first coined by Morton in 1935.

The idea of load deformation characteristics of the first ray has been studied by many individuals, including those mentioned by Klaue. If you note, however, most authors now use the term "mobility" to describe first ray motion under a given load, not "hypermobility." If you want to continue using the term "hypermobility," then please give me the definition that should be used for "hypermobility." What exactly is "too much movement of the first ray" and at what plantar load? In other words, what is your definition for "first ray hypermobility"?

Within the international biomechanics community, there is no body part that the term "hypermobility" is used to descibe the load-deformation characteristics of that body part of set of joints. Rather, the term "stiffness" is used to describe the load deformation characteristics of all joints under biomechanical study since "stiffness" is a precisely defined and well-understood term routinely used in physics, engineering and biomechanics, and also in foot and lower extremity research.  

Therefore, I would like my profession to advance into the future using standardly accepted biomechanical terminology that is widely understood by biomechanists, engineers, physicians and even laypeople to describe the load-deformation of objects. Bicycle frames, golf club shafts, shock absorbers in cars, springs, wood beams and shoe soles may be "stiff." However, I have never heard anyone describe their bicycle frames, golf club shafts, shock absorbers in cars, springs, wood beams or shoe soles being "hypermobile."

It only seems that podiatrists and orthopedists like to use the antiquated and non-mathematically quantifiable term "hypermobility" to descrbe the load deformation characteristics of an important segment of the foot. My hope is that every time podiatric lecturers use the term "first ray hypermobility," they become very uncomfortable since they realize there are problems with the term and it is not a proper term to describe the load deformation characteristics of the first ray. I think we can all do better as a profession to try to sound more educated in the standardly used terms within the international biomechanics community.

Cheers,

Kevin A. Kirby, DPM

Adjunct Associate Professor, Department of Applied Biomechanics, California School of Podiatric Medicine at Samuel Merritt College, Oakland, California

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