Jarrod Shapiro, DPM
Practice Perfect Editor
Assistant Professor,
Dept. of Podiatric Medicine,
Surgery & Biomechanics
College of Podiatric Medicine
Western University of
Health Sciences,
St, Pomona, CA

It's Time for a Biomechanics Summit

I enjoy biomechanics. This is one of the subjects I like to put my time into when teaching at Western University. I've always felt a deep personal connection to this subspecialty of podiatry. One of the reasons I became a podiatrist was because of my own personal experience with foot pain. As a long-standing sufferer, I felt a somewhat profound moment of liberation when Dr. Paul Scherer taught my podiatric medical school class about Root biomechanics. Why liberation, you might ask? Dr. Scherer's lectures opened my mind to the "why" of my foot pain. After years of pain, I finally had a framework to understand the origins of my pedal pathology which empowered me to deal with my symptoms.

As the years went on, and I learned ever more about lower extremity function, I began to see the other facets of biomechanics, the ones I had missed during my introductory lecture courses in podiatry school. I saw, for example, there were various other theories about how the foot functioned. With each theory seemed to come another biomechanics lab in the business of creating orthotics. I also started to see the weaknesses of the Root theory: the poor research base (example Manter's study on joint axis was based on very small numbers, limiting the scientific strength) and the lack of high quality research studies in the published literature. Clearly, biomechanics of the foot is a much more complex pursuit than I originally had been taught. At this point in my career, I now wonder, who's actually right and who's wrong? Can it be possible all of them have value? I would love to hear a real debate/conversation. I'd pay good money to be in a room with Drs. Kirby, Fuller, Danenberg, Scherer, Glaser, Shavelson, and many more. I'm sure some good would come out of it, and it would be very enjoyable if for nothing else to see the fireworks fly!

Tonight's Premier Lecture is
Nutrition and Neuropathy
Allen Jacobs, DPM, FACAS

If you read the eTalk threads on Podiatry.com that have something to do with biomechanics, you might see a common theme: controversy. Lots of discussion revolves around the place of podiatric medicine in the larger biomechanics world, with some arguing podiatry's loss of "pre-eminence" in this arena in favor of the surgical side. It's time for us to think about what we as a profession want. Are we OK with physical therapists taking over the role of creating orthotics? Is it alright that pedorthists and prosthetists are treating patients that used to be our responsibility? If you are then, so be it. Podiatry will move further toward orthopedics and we can redefine ourselves as "Orthopodiatricians" (or something like that) and relinquish our role (and income) associated with biomechanics. The other side of the argument is that we need to reclaim our position as the true experts of the foot and ankle and vigorously hold onto this part of our practices.


Our last Superbones East conference at the Atlantis in the Bahamas for awhile included our signature Exhibit Hall and Workshop Contests. We are pleased to announce the following grand prize winners. Congratulations, Drs. Nack and Fusco ! We're excited to bring this great conference to Miami Beach next year, to the Loew's. Stay tuned for announcements about the great family activities available to you nearby the hotel.

James Nack, DPM Mankato, MN	Carmina Fusco, DPM Converse, TX

I'm somewhere in between. I want podiatry to remain the "true experts," but I want us to deserve it. This, of course, must be done through high quality research. I also want us to work with our physical therapy, pedorthist, prosthetist, and engineering colleagues to create better treatments for our patients. Working as a community holds much better prospects for success than remaining in our respective "silos."

It's time for us to host an international biomechanics summit. It's time to bring all of the experts together and have a significant conversation about biomechanics. I challenge all of our leaders to come and present the best evidence that supports their particular theory. Once the community hears the evidence and decides which theories have even some legitimacy, the next step would be to discuss a research framework. What is the best research method to gather the highest quality evidence? What protocols would allow testing of these theories to determine legitimacy? How can orthotic therapy be appropriately tested to prove once and for all its superiority over OTC inserts? What is the place of biomechanics in the surgical realm? How can our biomechanics knowledge improve our surgical outcomes? What about prevention? What current methods work to prevent complications such as diabetic foot ulcers? Where do shoes fit into this? Is it possible to have a unified theory of biomechanics?

Granted, some of these are big questions with no simple answer. Granted, many of our biomechanics experts have a lot of money at stake. Granted, the chances of getting all of them at one symposium at the same time is likely an impossible task. But isn't it also granted that we in podiatry are moving down the wrong track? Shouldn't we be pushing biomechanics as a necessary and integral part of all of our practices? We should be leading the way to answering these important questions, not sitting back complacently. In nature complacency leads to death. Where will our complacency lead us? I hope to see you soon at the first annual International Lower Extremity Function Conference..