Will Physical Therapists Be Teaching Us Biomechanics In 2030?

During my four years as a podiatry student at the California College of Podiatric Medicine from 1979 to 1983, among my very distinct memories were the frequent comparisons between podiatrists and orthopedic surgeons.

   In terms of differences, we learned that podiatrists focused only on the foot and ankle whereas orthopedic surgeons were less expert than podiatrists since they needed to focus on all of the bones and joints of the body. We learned that orthopedic surgeons didn’t know much about the biomechanics of the foot and lower extremity in comparison to podiatrists since podiatrists only had special intense training on orthoses and biomechanics. We also learned that orthopedic surgeons did incorrect surgical procedures, such as first metatarsophalangeal joint (MPJ) fusions. Of course, all podiatrists knew for a fact that one must preserve first MPJ range of motion and never fuse this joint, but use an implant instead.

   It is very interesting now to see how things have changed regarding the differences between podiatrists and orthopedic surgeons since I was a podiatry student. We now have orthopedic surgeons called “foot orthopedists,” who focus only on surgery of the foot and ankle. We also have standardized three-year podiatric surgical residency programs. Unfortunately, it is often the case that our residents receive very little practical biomechanics training in these residency programs.

   Major scientific meetings for foot orthopedists organized by the American Orthopaedic Foot and Ankle Society often include more lectures on foot and lower extremity biomechanics than do many podiatric surgical seminars. Finally, a quarter century since we learned that orthopedic surgeons were doing subpar surgery by performing first MPJ arthrodesis procedures rather than implant procedures, podiatrists are increasingly doing the same first MPJ fusions that we once shunned as a profession.

   Since I have been teaching biomechanics, sports medicine and the biomechanics of surgical procedures to podiatric surgical residents over the past quarter century, I have made a few observations that I believe are ones that many other podiatrists have also noted. While it seems that the podiatric surgical residents have become much more advanced in their surgical and medical knowledge, they have also collectively mastered progressively fewer practical skills in biomechanics. As a result, at the end of their podiatric surgical residencies, they simply possess too few practical skills in biomechanics and foot orthosis therapy techniques to practice the full range of conservative practice that many patients desire.

   While I appreciate that better skills in foot and ankle surgery are an important part of the training for our future podiatrists, it seems that we, as a profession, are currently going down a path that we may one day regret.

   For the last decade, there have been no post-graduate podiatric programs that emphasize the intricacies of foot and lower extremity biomechanics. From 1984 to 1985, I had the good fortune to receive such training via the Biomechanics Fellowship at the California College of Podiatric Medicine. Former graduates of this biomechanics fellowship, such as Ronald Valmassy, DPM, Richard Blake, DPM, Eric Fuller, DPM, and Larry Huppin, DPM, will likely no longer be available to teach podiatrists practical and advanced biomechanics techniques by the year 2030.

   Without a post-graduate training program in biomechanics developing by 2030, podiatrists won’t be the ones teaching these subjects at many of our professional seminars. Rather, other medical professionals, such as physical therapists, who more greatly respect the importance of conservative therapy through biomechanics knowledge, may very well be the ones teaching biomechanics at our seminars.

   What will we, as a profession, become by the year 2030 if we continue on the current path we are heading down?

   We will become exactly the same profession that we derided back in the early 1980s when I was a podiatry student. We will be foot and ankle surgeons with a limited knowledge of biomechanics and foot orthosis therapy techniques. We will be limited in scope of practice due to our non-MD degree. We will, by the year 2030, simply become limited license orthopedic surgeons who are very well qualified and eager to cut, saw and fixate the bones of the foot and ankle. However, we will be very inadequate at being able to offer the best conservative care measures that our patients desire and deserve for their painful foot and ankle pathologies.

   I, for one, hope this vision is wrong and that the podiatrists of this country can see the light.

   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.

   Dr. McCord retired in December 2008 from practice at the Centralia Medical Center in Centralia, Wash.