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How Should Biomechanics Be Taught to Podiatry Students/Podiatrists?

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Kevin Kirby, Apr 16, 2010.


  1. Members do not see these Ads. Sign Up.
    After reading the comments of Jeff Root and Eric Fuller today in the MASS Discussion thread, I thought it would be interesting to find what everyone thought are the absolute essential theories/subjects that need to be taught to both the podiatry student and the practicing podiatrist on the biomechanical function and treatment of the foot and lower extremity given our current state of knowledge.
     
  2. 1st assume that anatomy knowledge is very good if not students are in trouble.

    I still beleive that Teaching Root in a historical sense is a great place to start......

    1. there is huge amounts of information out for the students to read.
    2. It gets them to think about terms such as Varus, Valgus, Pronation, Supination etc.
    3. The Root biomex exam gets the students to feel and touch feet and it can easly be built upon as the days go past.
    4. it gets then to measure, discuss and think about gait and " the Normal foot"

    Then after the Root exam is understood the students are taken thru the process of looking at the problems with the ´cookbook´approach. It gets them thinking about understanding to who, why and where of what they read not just in biomechancis but in all readings.

    So then Subtalar joint axis Rotation and Equilibrium theory is introduced. This is where I find the students start having light bulb moments - It somewhat starting to make sense.

    The Nester module of MTJ is introduced and discussed

    Then different models of biomechanical treatment must be introduced such as sagittial plane, tissue stress etc.

    The above level 1 biomechanics.

    Level 2 looks in more detail the things that we throw around here such as internal, external moment, vectors etc. Now these things have been introduced in level 1 in discussed of the STJ and MTJ but they get expanded on in level 2. Level 2 becomes much more physics based.

    I´m sure I could expand but thats it for now.
     
  3. RobinP

    RobinP Well-Known Member

    I'm not a podiatrist so can you tell me what percentage of the curriculum is currently devoted to biomechanics - approximately. The school that an ex colleague of mine attended seemed to be as little as 10%. That was a few years ago so has this changed. I would guess that in the US and AUS it is slightly different?

    Robin
     
  4. efuller

    efuller MVP

    The amount in the curriculum varies from one school to another. When I was teaching there were 5 semesters of biomechanics plus a one month rotation that was a half day long. When I was a student there was more. There was a clinic devoted to biomechanics.

    Eric
     
  5. efuller

    efuller MVP

    Some thoughts on what should be taught:
    Anatomy. Terminology (definitions varus etc.)
    Biomechanical anatomy including seeing joints move and how motions are limited. (ligaments and bony block of motion.)
    An axis of motion is an imaginary line that describes motion and an imaginary line cannot limit motion
    Physics: Newton's laws (if it moved something caused it to move) (if you use the term compensation, explain what forces cause the compensation.)
    Free body diagram analysis.
    Rotational equilibrium
    Stress, strain and failure (Causes of mechanical pain)
    Above applied to anatomical structures. Modeling (Kevin's rotational equilibrium model) (Windlass mechanism) HAV formation.
    Orthotic Theory (How an orthotic alters the internal and external forces within the foot.)
    Muscle biomechanics (length tension curves.) Muscular input into the mechanics of the foot is variable. pennation, tendon excursion, lever arms at various joints. Multi joint muscles.


    Maybe not necessary but would be helpful to understand research
    Joint power
    Physics of walking

    Not necessary, but helpful historically
    The concept of paradigm/ paradigm shift
    Comparison of different paradigms Neutral Sagittal plane

    Those are some quick thoughts

    Eric
     
  6. Better to have it integrated into the curriculum, biomechanics is not a specialist area of practice, forces and their effects on the human body influence all areas of practice. Teach fundamental mechanics then integrate into curriculum from paediatrics to gerontology (and everything in between). Foot orthoses do not = biomechanics, nor ever will.
     
  7. efuller

    efuller MVP

    I agree. I could see how my list could be interpreted as biomechanics = orthotics. However, the stuff I mentioned could certainly be integrated into the regular curriculum. When I was mentioning biomechanics of muscle I was thinking of the biomechanics of tendon transfers. There still should be a section on how orthotics work.

    Regards,
    Eric
     
  8. Eric, I wasn't replying to your post directly, just replying to the original post. Foot orthoses are not biomechanical, although they may influence biomechanics they are themselves mechanical in their direct effects. Foot orthoses should form part of the curriculum in their own right along with other therapeutic strategies.
     
  9. Jeff Root

    Jeff Root Well-Known Member

    Simon, I completely agree. Biomechanics should be taught in a way that applies to surgical and non-surgical treatment. In fact, basic biomechanics (ie. locomotion) should be taught independently of treatment.

    If you are teaching a student to become an automobile mechanic, you first teach him how an engine and all of its components function. You then teach him how to take an engine apart and how to put it back together again. Finally, you teach the student how to diagnose engine trouble and how to repair it. Mechanics is mechanics, be it auto related or bio related. Anatomy, physiology (at the functional level need), diagnosis and then treatment.

    Regards,
    Jeff
     
  10. Agreed. And it should also be taught in general medicine and orthopaedic surgery too - having examined a distraught 23 year old girl yesterday who had recently undergone 1st MTPJ arthrodesis/fusion for a mild hallux valgus by an orthopaedic registrar. :bash:
     
  11. I agree that biomechanics needs to be integrated within the curriculum of the multiple disciplines taught within podiatric medical colleges. However, biomechanics also needs to be taught separately as a discipline to enable deeper understanding of important biomechanical concepts.

    In the first year of study, along with typical lower extremity anatomy courses, there should be a good basic course on biomechanics terminology. Forces, moments, kinetics, kinematics, axes of rotation, rotational and static equilibrium, rigid body modelling, moment arms, elastic modulus, stress, strain, pressure, shearing, tensile, compression forces, vector analysis, free body diagram analysis and modelling concepts, to name a few, should be introduced and taught so that students can have a firm undertstanding of the basic concepts that are discussed in musculoskeletal biomechanics research.

    In addition, somewhere within the first or early second year, I would teach Root et al's concepts of lower extremity deformity classification to allow the students to better appreciate the various structural abnormalities within the foot and lower extremity that exist within the population. I would discuss the limitations with the subtalar joint neutral position concept but also try to emphasise how range of motion examination and examination of the relative three dimensional relationships of the foot components to each other may affect foot function and foot pathology. Gait function for walking and running would be introduced and gait examination techniques started.

    Within the second year foot orthosis the competing biomechanics theories would be introduced, subtalar joint axis rotational equilibrium theory and tissue stress theories would be particularly concentrated on, along with how foot orthoses may be designed to minimize pathological stresses in injured tissues. The history of orthoses and standard orthosis types and modifications would also be taught along with orthosis casting/imaging techniques and manufacturing techniques. Gait examination techniques would be practiced.

    In the third year, practical skills for examination, orthosis casting, gait examination, orthosis modifications and diagnosis and treatment of various common foot and lower extremity pathologies would be taught. Emphasis here would be in trying to integrate the concepts learned in the first and second years into a more mature ability to use these biomechanics concepts, along with tissue stress concepts, to understand how best to treat mechanically-based injuries of the foot and lower extremity. Also emphasis would be placed on the biomechanical effects of common foot surgeries and how changes in internal structure of the foot and lower extremity can positively and negatively affect the kinetics and kinematics of gait.

    Of course, the list above does not represent a comprehensive list of concepts that should be taught in podiatry school. Rather, these suggestions outline a basic idea of the more important biomechanical concepts that I feel should definitely be taught to podiatric medical students to make them better clinicians in the future.:drinks
     
  12. Jeff Root

    Jeff Root Well-Known Member

    Kevin, I agree. Having heard you lecture about this at podiatry conferences, I think you should write a textbook on this. The book should be called something like "The Principles of Biomechanics of the Lower Extremity". It would make a great book for students as well as practitioners of multiple specialties. Nice of me to volunteer you for more work, but I think it would be a huge contribution to education because it would consolidate these concepts into a single, coherent resource.

    Jeff
     
  13. No problem, Jeff. It should be on Amazon.com by Monday.:rolleyes::cool:

    How is that cloning technology coming along anyway....?
     
  14. Petcu Daniel

    Petcu Daniel Active Member

    Which will be the place for Neuromotor Effects of Foot Orthoses ?
    Thank you,
    Daniel
     
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