Is podiatry scientific? I hesitate to ask or hear the answer to this question because it’s fraught with so much argument, debate, and controversy. The details are also important. Are we talking about the science of dermatology as it applies to the foot, surgery, or something else? For the sake of our discussion, I’ll propose that we use as a model the one aspect of podiatry that is most unique to our specialty: biomechanics. So, as the representative model for podiatry, is biomechanics scientific?

Let’s first establish what is meant by the scientific method. This is a system of analysis that uses many tools to explain the world around us. It consists of multiple steps that lead to an improved understanding of the world.

Let’s take a quick detour to discuss what a theory means in science versus in the public sphere. The colloquial, nonscientific version of a theory is a version of a hypothesis in which information is linked together, often with some level of ambiguity and doubt. It is often an opinion. A scientific theory, on the other hand, is a set of rules, supported by empirical fact, to explain a phenomenon. It is a concept that is so well verified that it is as close to a fact as possible. These are the theories we’re talking about here.

Back to our scientific method discussion. If the result of our original study does not match the prediction from the hypothesis, then that hypothesis is incorrect in some way (or there was something wrong with the study’s methodology). Let’s say during our flatfoot study that we found 100% of patients with painful flat feet and pronated subtalar joints had degenerated posterior tibial tendons. So far so good.

However, we also found degenerated posterior tibial tendons in the group that had non-flatfooted patients with excessively pronating subtalar joints. This contradicts the original prediction that all of the flatfooted patients with excessively pronating subtalar joints had degenerated tendons, and we would be forced to conclude that something was wrong with our hypothesis. It would then be time to re-evaluate the hypothesis and make a new prediction. For instance, we might change the hypothesis to reflect that it wasn’t the presence of flat feet but rather the excessive pronation alone was enough to cause damage. A new study would then be performed to confirm this new hypothesis.

After several more iterations of this process, we might find it confirmed that excessive subtalar pronation alone is sufficient to cause posterior tibial tendon degeneration. Obviously this is a completely made-up scenario. We know that adult acquired flatfoot has multiple contributing factors including age, weight, activity level, and biomechanical factors.

It’s worth a couple of comments here about the scientific method and podiatry. First, the vast majority of the studies concerning biomechanics of the lower extremity are severely limited by both currently available technology (functional MRI is both new and very expensive) and the ethics of human experimentation (we can’t just cut people open to see what’s going on). Second, the medical (and for that matter scientific) literature has a heavy bias toward publishing studies with positive results rather than failures. This is called publication bias, and it will greatly affect how we see the evidence to support a theory.

With all of this in mind, we can finally get to the answer of the original question, Is podiatry scientific? Intellectual cliffhanger! I’ll leave you here to contemplate your answer to the question, and next week we’ll also consider these questions: What is biomechanics? Is it a science? What approaches or methods have been used to study biomechanics of the foot? Have these approaches been scientific? Are there new methods on the horizon that will move our profession forward into the future?