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Department
of Podiatry
Past,
Present and Future of Podiatric Biomechanics
What
is Podiatric biomechanics?
importance of "Podiatric" biomechanics to the profession
as a "brand" name
traditionally Podiatric biomechanics is based on two key concepts:
i) the
concept of the neutral position of the subtalar joint.
ii)
the concept of the locked position of the midtarsal joint
Early
theoretical contributions:
1845
- Durlacher
1874
- Thomas
1888
- Whitman
1916
- Roberts
1920
- Schuster
1940
- Morton
1948
- Schreiber & Weinerman
1950
- Levy
What
Root et al. contributed:
foot as a dynamic rather than static structure
a protocol for measurement (does this make it scientific?)
derived the defined position of the subtalar joint
derived the concept of the locked position of the midtarsal joint
used
these concepts to reinterpret published research and clinical observations.
Root
et al. gave us a protocol for clinical management based on:
deviations from the defined normal that can be measured
variations from normal alignment causing abnormal foot function, resulting
in a particular set of signs and symptoms depending on the nature
of the variation
the variation is measured
a cast of the foot is made to capture these deviations in alignment
functional foot orthoses constructed with posts to restore normal
function
Problems
with traditional theory
use and understanding of terminology
criteria for the definition of normal
validation of subtalar joint neutral
position of STJ at midstance
reliability / reproducibility of placing foot in neutral
reliability / reproducibility of measurements
reliability / reproducibility of casting
static measurements
hinge joints
the two axes midtarsal joint model
aetiology and diagnosis of forefoot varus
knee pathomechanics
Spinal pathomechanics
clinical trials
'abuse'
of orthoses
What
has happened since? :
Widespread adoption into clinical practice
Developments and modification of the theory
Scientific testing comparing the fit between the theory and reality
Clinical success
Confusion
over what is theory, fact and science
Emerging
alternatives:
interpreting alternatives through the wrong "lens"
they are attempting to explain the same set of facts and clinical
observations
they can not yet explain everything we see and have a lot of development
to go before widespread adoption
they
are informing clinical practice
Future
directions:
No major change - traditional theory is modified/changed to account
for the problems
the sagittal plane facilitation of motion of model
centre of pressure and the position of the subtalar joint axis
neurophysiological explanations
the tissue stress model
another,
as yet, unknown alternative
What
and how are we now supposed to teach students ?
The course
manual:
starts with the controversy
goes through traditional theory
reviews the "uncertainty" in the knowledge
goes through some of the alternatives
finishes
with a debate between different points of view
If, at
the end of the year you are confused then your lecturers have done
their jobs!
It is
being able to resolve the confusion in your own minds which will allow
you to make 'contextually appropriate decisions' and become the kind
of critical thinkers that make good clinicians. We hope that this
course gives you the tools to do this.
 References
Payne
CB (1998) The past, present and future of podiatric biomechanics Journal
of the American Podiatric Medical Association Vol 88 No 2 pgs
53-63 1998
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