Whatever Happened To Biomechanics In Podiatry?
Recently, I have noticed much discussion on the lack of knowledge in foot and lower extremity biomechanics and custom foot orthosis therapy in newly trained podiatrists within our country. Although this seems like a serious matter to many podiatrists, I’ve observed other podiatrists who seem to favor striving toward becoming foot and ankle surgical specialists without much training in biomechanics and foot orthosis therapy. After 36 years of teaching foot and lower extremity biomechanics, sports medicine, and foot orthosis biomechanics at international and national conferences and podiatry schools, and 28 years of training podiatric surgical residents on these same subjects, over the past decade I have seen a noticeable decline in knowledge of foot and lower extremity biomechanics and foot orthosis therapy in younger podiatrists. Since podiatrists are foot doctors, and since the foot is the prime weight-bearing structure for our bodies, understanding the mechanical function of the foot and how it relates to the mechanical function of the rest of the lower extremity is fundamental knowledge for any podiatrist, whether practicing for decades, or newly arrived into clinical practice.
Why Biomechanics?
Why is an understanding of foot biomechanics so crucial for the podiatrist? First of all, scientific research tells us that the foot is the part of the body subjected to the largest magnitudes of daily external forces, by a vast margin, when compared to any other body structure. During walking, the foot withstands peak ground reaction forces of about 1.2 times body weight, and during running, one’s body exerts three times its weight on the foot.1 Sprinters can exert nearly five times their body weight on the plantar aspects of the feet.2
These large external forces that act on our plantar feet during daily weight-bearing activities mean that it is likely that the vast majority of pathologies that podiatrists see within their clinical practices stem from abnormal magnitudes of external and/or internal forces acting on and within the structural components of the feet and lower extremities. Biomechanics is the study of how forces acting on and within the foot and lower extremity can cause the clinical pathologies that podiatrists treat daily. Therefore, it seems logical to strive toward training podiatry students, residents, and clinicians on the intricacies of foot and lower extremity biomechanics to improve both surgical and non-surgical treatments of the foot. Furthermore, in my experience, as far as non-surgical biomechanical treatments are concerned, custom foot orthoses have been, and still are, one of the most effective therapies for treating mechanically-related pathologies of the feet and lower extremities.
Whatever the reason for this gradual decline in biomechanics and custom foot orthosis knowledge in recent podiatric residency graduates, I feel the eventual effects on the American podiatry profession are very clear. Within the next two decades a gradual realignment may take place in which other health professionals become best known as the “foot orthosis experts.” Physical therapists, pedorthists, and chiropractors, have all expressed increased interest in biomechanics and custom foot orthosis therapy over recent years. In other words, if our emphasis on teaching and reinforcing these subjects does not soon increase, these other professions will likely become the “foot orthosis experts” in the eyes of the medical community.
Looking To The Future
Certainly, in this day and age of immediate online access to expert clinical skills training and scholarly articles, any health professional who has a keen interest in developing their knowledge and skills in biomechanics, pathomechanics, and custom foot orthosis therapy is able to do so. If the training focus for our young podiatrists does not soon change, these eager non-podiatric health providers who want to attain expert status in foot orthosis therapy will be able to achieve that goal. Therefore, if you are a podiatric educator, a podiatric residency director, and/or a podiatric seminar organizer, please start providing more foot and lower extremity biomechanics and custom foot orthosis therapy educational opportunities for the podiatry profession, so that we may continue as the medical experts in foot and lower extremity biomechanics and custom foot orthosis therapy in the coming decades. Our beloved profession and our patients deserve it.
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.
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1. Nilsson J, Thorstensson A. Ground reaction forces at different speeds of human walking and running. Acta Physiol Scand. 1989;136(2):217-227.
2. Di Caprio F, Buda R, Mosca M, Calabro’ A, Giannini S. Foot and lower limb diseases in runners: assessment of risk factors. J Sports Sci Med. 2010;9(4):587-596.
