What Happened to American Podiatric Biomechanics?

After attending the recent ACFAOM conference, one of the underlying themes I noticed during various group discussions and personal conversations (and in some cases, overtly stated) was the lack of biomechanics being taught at the podiatric medical schools nationally. This led to the following question: Has the podiatric profession abdicated its place as the world's experts in biomechanics of the lower extremity?

What Happened to American Podiatric Biomechanics As a disclaimer, I'll state I am an assistant professor at Western University College of Podiatric Medicine (WUCPM) in Pomona, California, where, coincidentally, I am one of our biomechanics teachers. To be clear, I do not profess to be one of our national biomechanics experts, though I do have a strong professional interest in the subject. Additionally, I'll clarify my teaching role a little. WUCPM teaches podiatry in an integrated fashion with a series of classes we call "Podiatric Medical Principles and Practice." All podiatric-related topics are combined into a case-based format in which all subject matter is covered within these cases. For example, we might discuss a case that focuses on hammertoe deformities. Within that case, we would cover the biomechanics, pathophysiology, nonsurgical, and surgical treatments, as opposed to splitting these topics up into various separate classes. My point here is not to argue in favor of one teaching method or another, but to clarify my involvement and level of teaching as it relates to biomechanics.

With that said, let's get to the question: What happened to American podiatric biomechanics?

I ask the question specifically about American podiatric biomechanics, because it seems alive and well in other professions, such as physical therapy, pedorthics and others. For an example of the environment, look to the June issue of Lower Extremity Review Magazine. The cover story is about evidence-based use of metatarsal pads, written by Greg Garguilo, a freelance medical writer. Looking through the article, here are some interesting statistics:¹

Number of experts by specialty interviewed or quoted:
Physical therapy: 1
Orthopedist: 2
Non-Orthopedist MD: 1
Pedorthotist: 2
Non-US Podiatrist 1
US Podiatrist 1

Out of eight experts interviewed or quoted in the piece, only one was an American podiatrist.

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The article itself has 24 citations in the references. Of the 24 citations, ZERO were authored by American podiatrists.

Of these 24 references, FIVE were from podiatric journals. And, as mentioned, none of these studies were authored by American podiatrists. Three articles published in the Journal of the American Podiatric Medical Association were from the Netherlands, England, and one was authored by an American PhD bioengineer. One article published in the Journal of Foot and Ankle Surgery was from a pedorthotist. One article by an Australian researcher was published in the Journal of Foot and Ankle Research, and one was published by a Canadian in The Foot.

By no means is this a scientific review of types of publications and who is publishing in them. I admit that there is some serious selection bias in my choice of one article from one trade magazine about one specific biomechanics-related subject. But this does at least give us a taste of the biomechanics environment.

If one examines the most recent two issues of the Journal of the American Podiatric Medical Association (JAPMA), one would again see a paucity of American biomechanics represented.

The JAPMA May/June 2014 issue had three biomechanics-related articles. Of these, one was authored in the Netherlands², one authored by an American physical therapist³, and the third was authored in Spain.⁴

The JAPMA March/April 2014 issue also had three biomechanics-related articles, one from an American DPM⁵, one authored in Spain⁶, and the third authored in Brazil.⁷

Of these six articles over a four-month period, only ONE was from an American podiatrist, relatively consistent with the subjective discussion of the magazine article above.

There should be no fault placed on either the non-podiatric or foreign authors and researchers, nor on the journals themselves. In fact, JAPMA should be congratulated with the number of international and multispecialty submissions that it receives.

American podiatrists are simply not carrying their weight. Besides a small number of podiatrists, it seems we stopped contributing after Root, Orien, and Weed published their work on subtalar neutral theory. In fact, most of the current science that argues against the legitimacy of Root theory comes from others outside the American podiatric profession.

Why is this so? It boils down to research. It's telling to note that the one paper in the JAPMA March/April 2014 authored by American podiatrists⁵ is from the Center For Lower Extremity Ambulatory Research (CLEAR) at Rosalind Franklin University, a dedicated research lab. Similarly, the vast majority of major lower extremity biomechanics research is coming out of other research labs.

This, in fact, would be the solution to our lack of presence in the biomechanics community. We need to invest time, money, and effort into creating American podiatric biomechanics laboratories at each of the podiatric medical colleges and support the ones that already exist. Once this is done, we can create research fellowships, which will seed the colleges and our community with future experts to move the field. Until this happens, we will continue to move inexorably away from our previously dominant position in this field, and our students and residents will learn ever-decreasing amounts of foot function, all to the detriment of our profession and, most importantly, our patients.

Best wishes,

Jarrod Shapiro, DPM
PRESENT Practice Perfect Editor
[email protected]