I wanted a Precepteeship Program that introduced me to aspects of Podiatric Practice that would complement my Podiatry and Residency training. I wanted the program to be a mentorship, one that was academically challenging and one that would give me hands on patient experience.

That’s what I got when I started working at Dr. Shavelson’s LifeStyle Podiatry Practice in New York City.

At LifeStyle Podiatry, the focus of practice is biomechanical. All patients are foot typed into subgroups with shared structural and functional strengths and weaknesses. From then on, because inherited structure and function of the foot is a precursor to so many current and future complaints, my biomechanical skills became more individualized and custom for each patient and I felt like I had more to offer patients.

I got to understand the importance of addressing the cascade of problems that occur up and down the posture differently for each subgroup in closed chain. I began to comprehend that those inheriting a rigid rearfoot, rigid forefoot type are more likely to develop arthritic type bunions, 1st and 5th hammertoes and callus under the 1st and/or 5th metatarsal heads. In opposition, those inheriting the flexible rearfoot, flexible forefoot type are prone to develop PTTD while the rigid-flexible types more often get bunion deformities. No more hyperpronation for me.

As I became more experienced it was second nature to educate my patients about why their calluses and wounds located where they did and what had to be done to reduce or eliminate them conservatively or with foot surgery.

I should start from the beginning and give a brief synopsis on how foot typing works. At first the concept was difficult to grasp but it made complete sense after one week. The foot is manipulated to represent weightbearing in open chain and then the Subtalar Joint is first inverted and then everted to end range of motion and the supinatory (SERM) and pronatory (PERM) positions are documented. All positions are related to The Rearfoot Tipping Point, an imaginary reproducible line bisecting the leg on the frontal plane that exists slightly differently for each practitioner intratester. This enabled me to type each rearfoot into a rigid, stable, flexible or flat rearfoot type. In the same manner, the forefoot is tested for PERM and SERM positions utilizing a Forefoot Tipping Point that bisects the first metatarsal on the sagittal plane. This enabled me to type each forefoot into a rigid, stable, flexible or flat forefoot type that when combined gave me a foot type with a RF and FF component. Finally, I appreciated the quality of motion that existed in between RF and FF SERM and PERM values as low, moderate or high. Working with The SERM-PERM Interval was huge as it allowed me to further customize my care for different patients within the same foot type.

Foot typing is confirmed by x-ray evaluation. By noting changes in talar declination and position, the shape of the sinus tarsi, the amount of diastasis between the 1st and 2nd rays, the relative periosteal thickness of the five metatarsals and the first ray declination, I could confirm my foot type diagnosis.

I learned how to manage each foot type with Dr Shavelson’s Centering Foot Orthotics. Foot type specific casting and posting techniques are applied that reposition The Vault of the Foot more optimally. The medical device engineers the foot so that when underfoot, it offsets some of the pathological forces of gravity, grf and shoes and makes pedal muscle engines better leveraged and more trainable. Vault height, postings, ray cutouts are cast and prescribed custom for each patient. Special attention is paid to the posterior tibial, peroneus longus and flexor hallucis longus and abductor hallucis muscle engines which receive strengthening and performance training as part of care. DR Shavelson also has a platform for diagnosing and treating limb length difference, even small amounts that work great for unilateral foot and postural problems as well as balance and fall issues.

The biggest change for me was when I realized how much more I could accomplish when I worked with the 3-D Vault instead of the 2-D medial longitudinal arch.

After evaluating patients who have been using the orthotics and training associated with The Foot Centering Theory, I have witnessed a much better response than my exposure to other paradigms. Patients report an increase in lifestyle. Many claiming to have “grown” their arches even when barefoot. I have seen back, hip and knee problems resolve in a very short time.

A final exciting aspect to Foot Centering biomechanics is its incorporation in programs for Onychodystrophy. I now believe that there are often biomechanical precursors to dystrophic and ugly toenails, with and without fungal infection that must be addressed as well. I have seen so many patients happy with not only more normal nails but better quality of life and shoe fit.

I am pleased to report that I have begun an approved residency Program in New York City and I am sure that the mentorship and guidance that I received while Dr Shavelson’s preceptee coupled with the biomechanical and dermatological skills I came away with helped me stand out from the other applicants.

   

  • Comments (46)
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  • 2017 Update:

    I am pleased to announce that my Preceptor for 2016-17, Chris Vu DPM, has matched for a Residency slot beginning in June in NYC.

    He has worked hard to upgrade himself personally and professionally so as to deserve the program. He was a 2016 Grad that did not match in his graduation year.

    Raisa Tsvaygenbaum DPM, who started this thread is graduating her 3 year Residency in June. I remain proud of her accomplishments.

     

    The slot for the 2017-18 LifeStyle Podiatry Precepteeship remains open to be filled by the right candidate.

    I am accepting emails from potential candidates at drsha@lifestylepodiatry com.

    Dennis

     

  • Jeff:

    Thank you for your kind words.

    I am looking to fill the spot vacated by Dr Tvaygenbaun starting Jan 1st.

    Can be unmatched, recent Resident grad or practicing DPM looking to expand non surgical practical skills.

    Serious candidates please apply to drsha@lifestylepodiatry.com

    Dennis

  • For what it's worth, I think it's great you offer the preceptorship. No need to respond since you preemptivelay stated you would not discuss further and I would not want you to go against your own word.
  • can you tell us more about your preceptorship? How long a program is this? to the needs of the candidate---=----------2 weeks/one year
     
    Is it five days a week?  Yes but I am flexible
    What are the hours? Varied
    Is a salary provided?  $20,000 annually
    Does the preceptor see patients elsewhere besides your office?  No
    Does the preceptor work in your lab at all? No

    Dennis

  • Quote:

    I am not trying to win anything. The words were confusing and superfluous and just am not sure they make any sense. You have given me manuscripts in the past that explained the same stuff without "confusing language". I don't see the added value of intrapersonal kinematics terminology. It detracts from the explanation provided. The end. Since the blog was about preceptorships can you tell us more about your preceptorship? How long a program is this? Is it five days a week? What are the hours? Is a salary provided? Does the preceptor see patients elsewhere besides your office? Does the preceptor work in your lab at all?

    I will not continue this kind of discussion with you in the future.

    If my words are consfusing for you and I won't change my language as you request, I see no point.

    I will answer your questions re precepteeship once but not have a debate.dialogue, conversation or whatever it is you call it.

    Dennis

  • I am not trying to win anything.
    The words were confusing and superfluous and just am not sure they make any sense.
    You have given me manuscripts in the past that explained the same stuff without "confusing language". I don't see the added value of intrapersonal kinematics terminology. It detracts from the explanation provided.
    The end.

    Since the blog was about preceptorships can you tell us more about your preceptorship?
    How long a program is this?
    Is it five days a week?
    What are the hours?
    Is a salary provided?
    Does the preceptor see patients elsewhere besides your office?
    Does the preceptor work in your lab at all?

  • Quote:

    1) I am not "debating" anything. I am simply asking a question that likely many others have. Intrapersonal according to most dictionaries means occuring within ones own mind....... Perhaps your usage of the word is correct. For whatever the reason when I read it - it sounds strange. As if, each individual gets their own measurement as opposed to if different practitioners do the test they would all came up with the same measurement. (Hence, more reliability). Kind of like all these measurements we have for limb length discrepancy.   they fail validity because the same practitioner often gets different measurements when they themself perform the test. I think your ideas/ thoughts are better described without throwing in added verbiage that don't simplify the thought. Your previous explanations of the same topic never had those words ....... Pearl: if one does not understand a definition of a word, telling them it is the verb or adverb of a word doesn't do much in defining the word in the context used.


    I give up. You win this non debate (IDWTTYW)

    We simply don't communicate well together.

    Can we at least agree on that?

    Dennis

     

     

     

  • 1) I am not "debating" anything. I am simply asking a question that likely many others have.
    Intrapersonal according to most dictionaries means occuring within ones own mind.......
    Perhaps your usage of the word is correct. For whatever the reason when I read it - it sounds strange.
    As if, each individual gets their own measurement as opposed to if different practitioners do the test they would all came up with the same measurement. (Hence, more reliability).
    Kind of like all these measurements we have for limb length discrepancy. I think they fail validity because the same practitioner often gets different measurements when they themself perform the test.
    I think your ideas/ thoughts are better described without throwing in added verbiage that don't simplify the thought.
    Your previous explanations of the same topic never had those words .......

    Pearl: if one does not understand a definition of a word, telling them it is the verb or adverb of a word doesn't do much in defining the word in the context used.

  • Quote:

    Dr. Shavelson - may I ask why you used the words intrapersonally and kinematically in the above posting? Would the description not make more sense had you left those words out?????? What do you even mean by them???

    Jeff:

    IHINTYW: a new acronym I made up when debating with you.  Hope I'm Not Twisting Your Words, etc.   8-)

     

    Intrapersonally: The adverb of intrapersonal

    Use in a sentence: Biomechanics, to a great extent, has its practitioners practicing intrapersonally and that is a big part of why there is so little high level applicable evidence for the science.

    Kinematically:    The adverb of kinematic

    Use in a sentence: The SERM-PERM Interval is kinematically important to determine in Foot Centering Theory.

    I used intrapersonally and kinematically in my posting because they add much meaning if one is to practice SERM-PERM Testing. To leave them out would make SERM-PERM more undefined, ambiguous, unscientific and senseless IMHO.

    Dennis

  • Dr. Shavelson - may I ask why you used the words intrapersonally and kinematically in the above posting?
    Would the description not make more sense had you left those words out?????? What do you even mean by them???
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