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Podiatry’s Future: Biomechanics Versus Surgery Or Biomechanics With Surgery?

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Kevin Kirby, Apr 2, 2009.

  1. cpoc103

    cpoc103 Active Member

    Hi Kevin,

    Good article in podiatry today, I totally agree it seems daft that the gulf between two faculties of the same profession is so big. I know here in UK we have our own problems, in that half of our schools dont even teach bimechanics to undergrads/ they do very little maybe theories Root and so on. However, I know in my Trust our Biomech pods work really closely with the Orthopedic foot and ankle surgeons and do joint clinics, and work quite well around and together to get the best possible outcomes for Pts as not all surgeries create the best possible outcomes.

    Do you think the profession is in jepardy of causing splits within our profession which then may leave the door open for other professions to do that work? And do you think that biomech...s should be thaught at podiatry schools as a definate must have, as it underpins podiatry?

    many thanks.

    ANDY RYALS Member

    Good subject, I have a research fellowship in the UK at a local hospital alongside a Podiatric surgeon, we intend publishing research based around the effects foot surgery has on biomechanics. I'm producing an advanced cuboid dysfunction and diagnosis protocol presently and will be relying on him regarding surgery for this complaint, eventually we should produce something for others to use. My opinion is that it draws the profession together. Working with orthopods on the other hand opens up a can of worms, I have some friends that think orthopods regard us as nothing more than sub-ordinates who are incapable of making clinical decisions, this argument could rumble on.......
  3. BEN-HUR

    BEN-HUR Well-Known Member

    Good article Kevin - good logical points made... & well overdue.

    I must say, this comes as a shock to me 'cpoc103'. What do they teach? Particularly when in the majority of cases (or at least a very high percentage) of foot pathologies are the result of biomechanical causes. Isn't good (logical) medical practice to focus & treat the cause rather than the effect?
    Hence... articles like this (from the U.K) will continue to appear - http://www.timesonline.co.uk/tol/life_and_style/health/article5675591.ece - which states the following...
    I wonder if 'pride' can be found somewhere in the midst of the equation. One could say that the function of orthoses & their role in addressing adverse biomechanical forces may offset the possibility of surgery or delay the surgical procedure to a later date. I sometimes wonder if the Orthopaedic surgeons in Australia (who carry out the majority of foot surgery) feel uneasy about this, or choose to ignore this fact.

    I can't tell you the number of times I have seen a new patient after foot surgery present to me with concerns about either pain &/or concerns about their foot function (sometimes brought to their attention via G.P./M.D or Physio for example). I then realise very quickly that there is obvious adverse biomechanical issues still present. The Orthopaedic surgeon very, very rarely mentions anything about addressing these most likely causes behind the problem in the first place, or an aid in post operative support of what the surgeon has addressed via the procedure. Sure there is a need for surgery but I wonder how much can be avoided or set back via addressing the biomechanical causes in the first place. Without spelling out where I'm going with this trail of thought, I feel the essence of the next point in quote somewhat alludes to one of the issues... (besides $$$).
    Are you sure they are intelligent... if they are then I feel this attitude is arrogant. It would seem apparent that the majority of Orthopaedic surgeons in this country (Australia) would have this mindset but I'm baffled why 'logical' thinking Podiatric surgeons can be excused for having this attitude.

    Very good point - this is the crux of the issue. I have only been a practicing Podiatrist for about 11 years, so I can imagine how baffling this issue is for you Kevin in 2009.

    Yes, it very much is in jeopardy particularly it would seem in the U.K in the field of biomechanics/orthotic therapy & potentially from professions like Physiotherapy... or even Chiropractors! :empathy:

    Biomechanics must be taught in every single Podiatry college in the world... after all, that thing which our profession derives its name (foot associated with lower limb) moves & it is often pain associated with this movement that brings injured souls (excuse pun) walking or hobbling into our clinics.
    Last edited: Apr 2, 2009
  4. javier

    javier Senior Member

    I do not know if you are aware about Dr. Martinus Richter's work about intraoperative and post surgery biomechanical assessment. Perhaps it could help you.



    Visual Analogue Scale Foot and Ankle (VAS FA)

    ANDY RYALS Member

  6. MR NAKE

    MR NAKE Active Member

    this is a classic case of chicken and egg, i strongly support the views of both kevin and Ben:

    1) i strongly believe that the recruitment of podiatry students needs to be reviewed across board in all countries were its taught, as in most not all cases these are students who would have failed to enroll into medical school/dentistry and they settle for podiatry as second choice.....are they intelligent ben asked a very important question.....i dont think most are.......and knowing our human nature 3/4 are going to be furious for this but its true.....booo hoo

    i failed to enroll into med school because i flunked mathematics (F) irrespective i had a B(biology) and C(chemistry) and C(physics) at A-level equivalence.

    2) It is shocking that in UK they dont do biomechanics....this is gross, how then do we begin to match up the two gulfed disciplines of "BIOMECHANICS AND SURGERY", its difficult as it is with students who have vigorously learnt/been taught very well to understant these two independant variables with a human body as the dependant that behaves as it sees fit...whether conservative aproaches have been followed or not.

    3) We are the only proffession which disputes the core of its existence...:hammer:...in physics E=MCX2, IS ITS CORE NO ONE HAS DISPROVED IT TILL TODAY...and physicist swear by it, Alas, what do Podiatrists do, they disprove the great work of ROOT; ORIEN and WEED, yet in closed doors they look at their theorem and then come out with some frevolous techniques which always borders on the great work of these gentlemen, no wonder we are a lost flock with no sherpard....its a shame indeed....

    4) Biomechanics is the connerstone of Podiatric medicine and the understanding of the kinematics as well as the interdependant kinesiology of the human body from the feet and the upper related structures, and it has to be learnt in deeper perspective as much as it should be taught as such, failure which can only lead us to the quagmire of perplexing complexities which are evident in modern day podiatric practice.....if everything else fails try orthotics....:deadhorse:

    5) Surgery was mearnt to be the last resort as far as my teaching and little experince is concerned...:butcher:.. what then changed is the glorification of the title, who doesnt want to be called a surgeon (not forgeting of course the hard work put into it, i can see knives flashing behingd my back, hold it let me finish) has brought this paralax and further deteriorated the relations between surgery and biomechanics. biomechanics as Kevin suggested has got to be driven home as part of the surgical training and failure of it should mean no one qualifies to be a surgeon.......period

    Our quest to jump for the glory of surgery title and its bling bling, has led to our shotfalls, there is no denying we are good in our own right(some of us) but the orthopaedic surgeons are the best (some of them), lets not be haters no no no no no, if we had kept our house clean we would not have situations of physioterrorism....:eek: and some bits of chiropractors dispencing orthotics as well. if a brick is deformed who do you blame, the mould or the bricklayer?

    The human foot is so very complex and we as Podiatric biomechanics specialist/surgeons we have not done ourselves justice. we are the custodians of this intricate and sophisticated structure yet we dont even know it at all....then who will?

    In the past surgery of the foot was often consigned to the junior house officer, with the attending surgeon urging haste because "its just a simple foot case."this is no longer the norm because of a revived interest in the total care of the foot, both surgical and non surgical(biomechanics) Richardson 2008 (in campbell's operative orthopaedic, vol 4 11th ed pg 4461). Some orthopaedic surgeons have stepped their game up so should we, and i am not saying my opnions are the etiquettes to be governed by, as i know approaching the climax of the millenium we are further and further losing our perspectives.......

    Research gone made just as much as health and safety has.....LETS NOT FORGET TO STICK TO THE BASICS.........:drinks


    the last time i checked it belonged to the patient....:D
    Last edited: May 19, 2009
  7. EdGlaser

    EdGlaser Active Member

    Surgery treats the symptom, biomechanics treats the disease. The disease is the way we function.

    It is interesting to note that in the US the sinus tarsi implants are becomming more popular. Here is a surgical implant that achieves a postural change in the foot and dramatically effects its function and yet for the most part foot orthoses have not adequately addressed the posture or kinematics of foot function.

    In surgery we can measure results with x-ray angles yet our measures in biomechanics have mostly fallen short of accuracy, or inter-rater reliability. Practitioners have gravitated toward that which has measurable results. Biomechanics needs to catch up.

    If force re-distribution is the key, as Kevin suggests then we need parameters for the use of F-scan or pressure plate data. Dr. Scholls offers a free pressure plate analysis at every Wal Mart in America. It may not be the best data....but at least it is data.

    In June 2002 JAPMA, Kevin published an article with Gheluwe et al which ended with this sentence. In discussing the 17 measurements usually taken in the standard static biomechanical exam:
    "This study therefore raises the question whether podiatric physicians should continue to perform these clinical measurements on their patients or replace them with other, more reliable, clinical measurements."

    I agree with Kevin that surgery and biomechanics need to come together. I suggest that relevant measurement data that encompasses both surgery and biomechanics may accomplish this. Maybe Simon's STJ axis locator is the answer. Maybe not.

    Ed Glaser, DPM
  8. I started a post about standard teaching levels which got not much of a response.

    Yes I agree surgeons and biomechanics must come together for the good of the PATIENT, but before that happens a lot of Podiatic house cleaning needs to occur.

    This must begin with the schools. There are so many people who have the title of POD..... As a profession we must decide who gets to use the title and what level of training they have.

    Maybe the future is DPM but until we unite and define our profession, set levels of teaching all over the world and have 1 voice of what we do!! We will continue to be pushed aside by other professions.

    Michael Weber
  9. Tensegrity

    Tensegrity Active Member

    This is the first time I have been back on this forum for months. I am passionate about biomechanics so no one will be surprised that I read through the responses to Podiatry’s Future: Biomechanics Versus Surgery Or Biomechanics With Surgery?

    Podiaric biomechanics has the potential to eliminate so many painful conditions and in the process re-empower an individual to manage and control their movement so that in the end there is no need for orthotics.

    As I read I felt quite depressed by 'the them and us senario'. I have been in this fabulous profession for nearly quarter of a centuary and I have seen how effective the principles of biomechanics can be at resolving deabilitating painful conditions yet the protectionist philosophy still dominates. Ownership of the patient's condition seems to be the focus.

    We as a profession are ideally placed if we can only get away from the reductionist model of thinking and look at the macro perspective.

    When all said and done,Movement is one of the fundemental processes of life. What has to be managed is change with respect to the body's movement.

    So let's go to the source of a lot of painful coditions which is bad habits leading to postural mis-alignments that frequently cause pain. Never loosing sight of the fact that the bulk of the foot is at 90 degrees to the rest of the body.
    So please shift the focus from us and other profession to working with our patients better so it becomes a team work approach.

    Each one of us is a walking miracle and as we know there are many processes going on with us that we still do not understand. But what we do know is our body's are able to heal themselves. If they could not then surgery would be a none starter.

    So lets adopt an approach which results in the meeting of minds and working with the patient's body.

    Well that's it for now.

    I hope you all are as happy as I am at developing skills in biomechanics.

    ANDY RYALS Member

    Nice topic. I'm in the process of starting a research position in NHS looking at the biomechanical effects of Podiatric surgery on Podiatric biomechanics. I'll be looking at the Scark-Akin osteotomy (yes its been done before). Hopefully as time passes more research will be generated and alternatives to surgery via biomechanics can be utilised to offset surgery. Its early doors but thats what we would like to start to do. :cool:

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