The current status of biomechanics (Functional Lower Extremity Biomechanics or FLEB) for podiatry is not rosy.

In 1977, Merton Root, D.P.M., through his publications, teaching and his orthotic laboratory, developed the foot orthotic. Along with the publication of Normal and abnormal function of the foot by Merton L. Root, William Phillip Orien and John H. Weed, he accomplished two things that year:

First, the Foot Orthotic replaced the arch support as the gold standard for shoe inserts, and second,  the profession of podiatry was vaulted to the top of the biomechanical pyramid. Dr. Root passed on in 2007, but his neutral foot casting and his diagnostic and treatment terminology live on.

The problem for podiatry is that the current research has shown that STJ Neutral is not reliable location and Root’s theories are not reinforced by physics and engineering studies performed by The International Biomechanics Community. In summary, Root needs upgrading and expansion (or replacement) and without major advances to biomechanics, podiatry has been joined by other professions claiming orthotic superiority and diluting our importance in the field.

After thirty years, biomechanics and orthotic are still considered misspellings on Word spell check. Uncompensated rearfoot varus, partially compensated forefoot varus foot types are not household words and the superior foundational education in FLEB that every DPM enjoys as a head start is being wasted in foam, scanners and short cuts that a twelve year old can do at a Mall Kiosk.

We are THE closed chain specialist of the foot and posture in our own minds, but the future of biomechanics rests in our ability, in the near future, to start convincing the foot suffering public and the medical community of that fact. We need a new strategy for biomechanics.

In future editorials in PRESENT eZines, I will define closed chain medicine, review some of the current theories receiving attention in the literature and offer some new upgrades that expand Root Biomechanics language, diagnosis and treatment that keep the podiatrist in the box instead of us being replaced by a scanner or a foam box and allow biomechanics to be marketed and practiced in a more understandable and acceptable manner by the podiatry community.

The following is a guest editorial that I wrote for the June 1989 Biomechanics issue of The Journal of Current Podiatric Medicine edited by Justin Wernick, D.P.M. Some of the names have changed but the problems are the same, as is the course podiatry must set in order to once again reign as the Kings and Queens of Biomechanics.

In my opinion, the future of podiatry lies in the practice of Biomechanics. Biomechanical evaluation, gait analysis and the casting and fabricating of orthoses can be the cornerstone of success for the podiatrist. If what we believe is true, that the effects of gravity, hard, unyielding shoes and ground surfaces, poor posture and poor foot mechanics will eventually lead to pain, deformity and reduced quality of life then biomechanics should be easy to promote to the public. Orthoses should be accepted like eyeglasses and both we and our patients would benefit from wider use of prescription inserts.

Yet, while other professions are taking advantage of the opportunity in biomechanics, podiatrists have not kept in stride. We appear to be losing our 'foothold' as foot function experts. Physical therapists, chiropractors, orthopedic shoe stores and ski shops are fabricating orthotics from casting foam and less than custom prescriptions.

If we are to remain leaders with them, we must take steps to correct our own complacency. We must educate other professionals and the foot suffering public about orthotics biomechanics and neutral foot casting, just as we have taught them about lasers and same day surgery. We must especially find a way to speak to the lay person in simple, understandable terminology that enhances their awareness of the podiatrist’s role in treating feet biomechanically.

As a teacher at one of the colleges of podiatry and someone who works closely with preceptees, externs and residents as well, I can see that one of the problems associated with our being “upstaged” by other professional biomechanists, is the insufficient clinical exposure to the subject that our students receive in school and at the postgraduate level. We must pay more attention to cultivating enthusiasm in our young podiatrists for this specialty.

Also, there have been few additions to the podiatric literature on the subject of biomechanics. Fundamental scientific research into foot types, mechanical and postural pathology and clinical control of the foot has been largely conducted by other professions.

Foot and Ankle, Orthopedic and Sports Physical Therapy and The Journal 0f the American Chiropractic Association all have published research of the kind that should also be published by podiatrists.

To hear us talk, the podiatric community contains experts in sports medicine, podopediatrics, biomechanics and orthotic fabrication. If this is true, we should be more visible at seminars and publishing more regularly on the subject. I believe The American College of Foot and Ankle Orthopedics and Medicine is missing a golden opportunity to publish a journal and sponsor seminars, pamphlets and public relations programs that would enhance the field and the opportunities for all of us.

At present, there are no true standards to the science of biomechanics. Today, the same patient, examined by ten different practitioners, would get ten different diagnoses and ten different orthotics. It is crucial that podiatrists be able to assess patients accurately in order for the credibility of biomechanics to broaden. Podiatrists must step to the forefront of this issue. We must invest more time and effort in upgrading our expertise and set the standard for biomechanical diagnosis and treatment.

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