11/19/2019    Chuck Ross, DPM

The Richard O. Schuster Memorial Seminar

I recently attended the Richard O. Schuster
Memorial Seminar and had two immediate thoughts.
First, I was incredibly impressed with the
presentations and the manner in which Dr.
D'Amico and his dedicated staff managed the
entire weekend. Congratulations on a superb job.

My second thought brought me back to the recent
discussions on PM News about the "lack" of
appropriate education in the area of
biomechanics with some blaming the shortcomings
on the colleges of podiatric medicine. After the
many superb and timely presentations, I must beg
to differ and perhaps place blame (not
necessarily appropriate) on the 3-year surgical
residency programs instead.

Having been immersed in biomechanics and
orthopedics since my education began at CCPM
with professors such as Root, Weed, Sgarlato,
Smith, and many others to my transition to New
York with another superb group such as Schuster,
Wernick, Tax, D'Amico and others I have come to
appreciate the many hours that were spent in
educating students in this area of education.

I have had the good fortune to teach and/or
lecture at most of our podiatric medical
institutions and am continually impressed with
the orthopedic/biomechanic departments at each
and every one of our facilities. HOWEVER, there
is a dramatic lack of a continuum once students
graduate and enter residency programs, with few
exceptions as the emphasis is solely upon
surgery.

Some of my fondest memories are hearing speakers
such as Guido LaPorta, Allen Jacobs, Mark Benard
and many others who "preached" and practiced a
similar mantra: You cannot expect good surgical
outcomes unless you first understand the
biomechanics as to why the problems began in the
first place.

I do not wish to leave without a possible
solution to consider. Why not have the APMA
partner with Dr. D'Amico and institute a
"traveling road show" in biomechanics with many
of the presenters that he has utilized over the
past 7 years and bring this superb educational
experience to the residency programs. I would be
interested in hearing from my colleagues.

Chuck Ross, DPM, Leeds, MA

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11/23/2019    Kevin A. Kirby, DPM

The Richard O. Schuster Memorial Seminar

I have been reading with interest about the
discussions regarding the biomechanics education
within podiatry here on PM News. Drs. Ross,
Jacobs, and Udell have all made some very good
points which I would also like to elaborate on.

I have spent the last 35 years of my
professional life teaching podiatry students,
podiatric surgical residents and podiatrists
here in the U.S. about the intricacies of foot
and lower extremity biomechanics. I have also
had the honor of lecturing abroad multiple times
over the past 28 years to podiatrists in other
countries that consider biomechanics of the foot
and lower extremity to be a very important
subject, and not a subject that is somehow
secondary or isolated from surgical correction
of the foot and ankle. From these experiences, I
would like to offer my opinion of why
biomechanics education has become a “second-
class citizen” within the United States (U.S.)
podiatric profession and how this is affecting
the young podiatric practitioners of today.

1. Even though podiatry students are just as, if
not more intelligent, than those podiatry
students of three decades ago, they are not
being given enough opportunities to hone their
skills in biomechanics from the time they leave
their respective podiatry schools to the time
they start their podiatric practices three years
later. Nearly all the podiatry students I have
taught over the past 35 years are interested in
biomechanics. However, more recently, especially
over the past 10 years, the podiatric surgical
residents I have trained in biomechanics and
foot orthosis therapy are less proficient in
nearly all forms of conservative care
modalities, including strapping, foot orthosis
casting, foot orthosis prescription, foot
orthosis modification, and shoe knowledge than
their podiatric surgical resident counterparts
from over 10-15 years ago.

I believe this is due to the fact that their
post-graduate training is relatively deficient
in regular and practical training in these
important subjects. Ultimately, this lack of
consistent training makes them less
knowledgeable and/or less comfortable in
applying these important conservative treatment
skills to their patients once they enter their
respective podiatric practices

2. There are very few seminars being held within
the US currently which devote significant time
to biomechanics education and training,
including the biomechanics of foot and ankle
surgery. As a result, there are few
opportunities for podiatrists who are interested
in such subjects to increase their knowledge and
clinical skills. The former PFOLA seminars,
notably those PFOLA seminars which were
organized by the late Dr. Paul Scherer, were
great examples of podiatric seminars where the
best international minds of foot and lower
extremity biomechanics could come together to
learn from each other. Unfortunately, even these
excellent PFOLA seminar were poorly attended by
US podiatrists, with much greater interest in
these excellent seminars coming from
international podiatrists, PhD biomechanists,
physiotherapists and pedorthists/orthotists,
than from US podiatrists. The Richard Schuster
Memorial Seminar held in New York every year is
the one exception where biomechanics education
is the main goal of the seminar, and it is an
excellent seminar.

3. Podiatrists in the UK, Australia, New
Zealand, Spain, Portugal, Canada, Italy, Belgium
and The Netherlands are currently still very
much interested in foot and lower extremity
biomechanics education within their respective
countries. The only country that I lecture
frequently at where foot and lower extremity
biomechanics seems to not of great interest to
most podiatrists is here in the U.S. For me, it
is disappointing to me that I need to travel
away from my own country to lecture to a group
of podiatrists who are as excited about foot and
lower extremity biomechanics as I am. And for
those of you who think that “biomechanics” is
somehow a synonym for foot orthoses, that is not
what I mean when I say “biomechanics”. Rather,
biomechanics is defined as the scientific study
of the action of external and internal forces on
the human skeletal system. In other words,
biomechanics is not orthotics!

4. Podiatrists in the U.S., for the most part,
do not regularly read biomechanics journals
outside of podiatric journals. Members of the
international biomechanics community regularly
read these journals on a regular basis in order
to keep themselves up-to-date on the latest foot
and lower extremity biomechanics knowledge and
ideas. How many podiatrists do you know that
regularly read abstracts or articles from the
Journal of Biomechanics, Gait and Posture,
Clinical Biomechanics, and Journal of Applied
Biomechanics? My guess is less than 10% of U.S.
podiatrists regularly read articles or abstracts
from these journals.

If podiatrists are only reading the
biomechanics-related papers in the U.S.-based
podiatric journals, then they are missing out on
about 75% of the new information and research on
foot and lower extremity biomechanics. In other
words, if we, as podiatrists, want to become
respected for our biomechanics knowledge within
the medical and research community, then we will
need to stay current on the latest theories,
research and knowledge on foot and lower
extremity biomechanics by regularly reading
outside our own journals.

5. The growing emphasis on surgery among
podiatrists here in the U.S. over the past two
decades seems to be creating a situation where
younger U.S. podiatrists are becoming
increasingly more surgically-oriented, at the
expense of their conservative care knowledge and
clinical skills. This seems to be creating a
situation where many of these young podiatrists
are not providing their patients with adequate
conservative care options that may allow the
patient to avoid surgery. It is possible that by
the US podiatry profession going to great
lengths to make their newly trained podiatrists
all into surgical specialists, that we are
unfortunately also creating podiatric colleagues
who do not have sufficient training in effective
conservative care options that will allow them
to provide their patients with both excellent
conservative and surgical care for their foot
and lower extremity pathologies.

These factors being said, I feel there is still
hope for the podiatric profession here in the US
to improve its respect for the importance of
biomechanics in the treatment of the pathologies
which affect the feet and lower extremities of
our patients.

First of all, I would encourage all major
podiatric seminars to have a “Biomechanics
Track”, such as that which has been in place at
the Western Foot and Ankle Conference in Anaheim
for at least the past decade. A morning or
afternoon “Biomechanics Track” would allow those
podiatrists who want to improve their
biomechanics education more opportunity to learn
about the importance of the biomechanics of
surgery, the biomechanics of foot orthoses and
the biomechanics of treating wounds in our
patients. This is absolutely critical for our
profession to remain to be perceived as the
leaders in foot and lower extremity biomechanics
knowledge within the medical profession .

Secondly, I suggest that every podiatric
residency program devote more teaching and
clinical techniques emphasizing the biomechanics
of surgery, the biomechanics and practice of
foot orthosis therapy and the biomechanics of
wound care into their curriculums. Residents
need continual practice in these subjects so
that our podiatric surgical residents are
actually gaining practical biomechanics skills
and knowledge during their residency years and
not losing skills due to a relative lack of
adequate practice and training during their
residency years..

And lastly, I suggest that all podiatrists who
have seen the decline in biomechanics skills and
knowledge in our younger podiatric colleagues
become more vocal to your podiatry schools, to
the organizers of podiatric seminars and within
excellent avenues of podiatric communication
available to us such as PM News. Make it known
that you strongly feel education and training in
the biomechanical function of the foot and lower
extremity is not an optional educational item
within our podiatric education, but rather is an
absolute necessity to allow the podiatrists of
tomorrow to be able to provide both the best
conservative and surgical care options to their
patients.

Kevin A. Kirby, DPM, Sacramento, CA