Functional Lower Extremity Biomechanics remains akin to religion as potential believers are asked to make a leap of faith and choose paradigms. Because current research has neither proven nor disproved with certainty the benefits of orthotics statistically, Evidence Based Medicine (EBM) for biomechanics is clinical, practical and anecdotal.

There are no less than eight modern paradigms, including Root, all with their leaders, followers, a body of work and an evangelical agenda. Each has its own language and terminology, making it difficult for the average podiatrist to choose a paradigm for practice. These theories profess to treat “the whole foot”, but with rare exceptions, they have single plane dominance with some focusing on the rearfoot, some on the midfoot and yet others on the forefoot. This makes it difficult to apply one paradigm for the heterogeneous types of feet that deserve orthotic care, since one person may need frontal plane correction, another sagital plane correction and yet another may need both. This has led to the current unstable state of biomechanics education and practice in Podiatry.

In order to make homogeneous sense of the disconnect that has surfaced as the fruits of their combined labors, I suggest a central “Tower of Biomechanics”, with a universal language, that would serve to make the paradigms comparable and understandable to our students and practitioners, too busy in their daily lives to become research scientists or engineers.

In the Tower, each paradigm would have its own area in which to research, practice and teach its followers, utilizing its own language and tenets in order to thrive and expand.

These paradigms would then gather with students and practicing Podiatrists, in a “General Assembly” and develop a core curriculum, to let practitioners pick from the paradigms on a case by case basis, custom diagnostic, casting and prescription techniques for fabricating orthotics, patient-specific.

As one possible example, Architectural Terminology can be used to explain the concept of biomechanics in the following understandable language to a patient or physician:

In Architecture, an arch has two equal pillars and a central keystone. The arch is built to support for a lifetime but if we wanted that arch to move, it would have to be powered by two bulldozers. So in order to function, nature has shortened the back (rear) pillar and lengthened the front (fore) pillar and off centered the keystone backwards, giving up a lifetime of support for the feet and posture.

Since some feet are weak in the back, some weak in the middle, some weak in the front and some weak in more than one place, with no two feet alike. Once we diagnose the level and location of a person’s weaknesses, we can determine where and how much his/her feet need balancing and support. This allows custom foot beds to be casted, prescribed and fabricated patient by patient, that provide the centering and support most feet lack, in order to have a lifetime of function without developing deformity, breakdown or the development of pain and overuse syndromes.

Next Issue: Profiling The Pedal Snowflakes

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