Celebrating Biomechanics, Gender Equality and Research in Foot and Ankle Surgery

I just attended the International Foot and Ankle Biomechanics (I-FAB) meeting which took place April 11-14, 2021 in São Paulo, Brazil. Fortunately, this meeting was held virtually so I did not have to take a trip out of the country to attend this large scientific conference on lower extremity biomechanics. Having attended the previous I-FAB conference in 2018, I was impressed by the volume of new research and insights into lower extremity function and its impact on all aspects of treatment of foot and ankle disorders.

Even more impressive is the emergence of women as thought leaders and accomplished researchers in the field of biomechanics. The conference chair was Isabel de Camargo Neves Sacco, PhD, Associate Professor in the Department of Physiotherapy, Speech Therapy and Occupational Therapy at the Medical School of the University of São Paulo (FMUSP) who became the first woman to hold the position of President of the International Foot and Ankle Biomechanics Congress. In her opening address, Dr. Sacco proudly boasted that women chaired the majority of the lecture sessions at this conference. Indeed, 37 women chaired the 18 oral sessions during the conference.(1) In contrast, out of the 39 sessions at this years’ upcoming 2021 American College of Foot and Ankle Surgeons (ACFAS) scientific conference, only four will be moderated by women.(2)

Previously, I blogged about the fact that very few podiatrists tend to participate in the I-FAB conferences.(3) That trend continues. This year, the only podiatric presenter from the U.S. was David Armstrong, DPM, MD, PhD, who delivered a keynote address titled: “Surgical Offloading and Biomechanical Wearables.”(1) for attendees, I personally counted only five podiatric physicians from the U.S. among over 400 registrants.

I’ve heard opinions that biomechanics is not a proper fit for surgical journals, because it is an academic field devoted to the study of foot orthotics. Furthermore, in my observation, there is a trend amongst academic and foot and ankle surgeons in the podiatric profession to diminish the importance of biomechanics in our training. This year’s ACFAS Scientific Conference does not appear to have any session devoted to the subject of biomechanics.(2) At the same time, the Council on Podiatric Medical Education is currently considering reducing the number of biomechanics cases by one-third in the completion of a three-year residency training program.(4)

If biomechanics has no relevance to foot and ankle surgery, consider some of the lecture topics from this year’s I-FAB conference. Each of these oral presentations were based upon original research conducted by the speaker, not yet published in the scientific literature. Most of the lectures, I believe had direct relevance to the medical and surgical treatment of lower extremity pathologies. Many of the original research studies were conducted by orthopedic foot and ankle surgeons. None were conducted by podiatric surgeons. Here are the titles (in italics) of a few of my favorite oral presentations at this years I-FAB conference:(1)

Studies Of Weight Bearing CT Imaging Of The Foot And Ankle:

Distal Tibiofibular Syndesmotic Widening In Progressive Collapsing Foot Deformity

The Efficacy Of Surgical Treatment In The Correction Of Adult Acquired Flatfoot Deformity: A Three-Dimensional Biometric Weightbearing CT Evaluation

3D Joint Space Width From Weight Bearing CT Detects Progressive Narrowing After Tibial Pilon Fractures

Studies Of The Effects Of Diabetes On The Foot And Ankle:

Importance Of Measuring Foot Intrinsic And Extrinsic Muscle Forces In Diabetic Subjects

Biomechanics Of Midfoot Charcot Neuroarthropathy In People With Diabetes

Studies Of Surgical Treatment Of The First Ray:

Biomechanical Evaluation Of Arthroplasty In The First Ray Of The Foot Contralateral Ankle Complex Kinematic Compensations After Unilateral Tibiotalar Arthrodesis

Percutaneous Distal Metatarsal Mini-Invasive Osteotomy: Comparison Between Standard Versus Modified Intraosseous Approach - A Cadaveric Study

The Influence Of Calcaneal And First Ray Osteotomies In The Contact Pressures Of The Ankle Joint

Studies Of Chronic Ankle Instability:

The Effect Of Attending Physical Rehabilitation After The First Acute Lateral Ankle Sprain On Landing Forces In Patients With Chronic Ankle Instability

The Influence Of Footwear On Lower-Limb Electromyography In Individuals With Chronic Ankle Instability During Walking

Studies Of Total Ankle Replacement:

Load-Based Functional Recovery Following Total Ankle Arthroplasty

Implant Fixation Influences Tibial Bone Strain After Total Ankle Replacement: A Finite Element Study

The Use Of Three-Dimensional (3D) Biometric Measurements To Predict Additional Alignment Procedures In Total Ankle Replacement

Studies Of Trauma To The Foot And Ankle:

Objective Mechanical Measures Predict Post-Traumatic OA Risk After Intraarticular Fracture Of The Hindfoot And Ankle

Twelve Weeks Of Eccentric Training Do Not Improve Calf Muscle Isometric Torque After Achilles Tendon Rupture

In Vivo Changes In Distal Interosseous Tibiofibular Ligament Elongation Under Static Loads And During Dynamic Activities After Syndesmosis Repair

Clearly, biomechanics provides a critical foundation for all aspects of foot and ankle surgery. I urge my colleagues to expand biomechanics research and training at all levels of podiatric education. If we fail to stay current with the rapidly expanding knowledge in the field of biomechanics, we cannot boast of superiority or even parity compared to other specialties who treat foot and ankle disorders.

A more immediate call to action is the need to change the appearance of gender bias in selecting speakers and moderators at our premier surgical conference. Is the subspecialty known as foot and ankle surgery not encouraging the participation of women based upon a misperception that females lack skill or interest in this technical field?

It is refreshing to see that the academic discipline of biomechanics, heavily weighted upon principles of engineering, mathematics and physics, has included and showcased the contributions of its female members at a premier educational symposium.  It is time for podiatric foot and ankle surgeons to do the same.

Dr. Richie is an Adjunct Associate Professor within the Department of Applied Biomechanics at the California School of Podiatric Medicine at Samuel Merritt University in Oakland, Calif. He is a Fellow and Past President of the American Academy of Podiatric Sports Medicine. Dr. Richie is a Fellow of the American College of Foot and Ankle Surgeons, and the American Academy of Podiatric Sports Medicine. Dr. Richie is the author of a new book titled "Pathomechanics of Common Foot Disorders," which is available from Springer at https://www.springer.com/us/book/9783030542009 .

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References

1. International Foot and Ankle Biomechanics Meeting. Final Program and Book of Abstracts. Available at: https://www.i-fab2021.com/wp-content/uploads/2021/04/ifab2021_bookabstracts_site.pdf . Accessed April 22, 2021.

2. American College of Foot and Ankle Surgeons. Annual Scientific Conference. Available at: https://www.acfas.org/asc/ . Accessed April 20, 2021.

3. Richie D.  What I learned at the best biomechanics conference which hardly any DPMs attended.  Podiatry Today. Available at: https://www.podiatrytoday.com/blogged/what-i-learned-best-biomechanics-conference-hardly-any-dpms-attended  . Published April 19, 2018. Accessed April 19, 2021.

4. Richie D. Proposed CPME 320 changes may dramatically reduce required biomechanics cases in residency training. Podiatry Today. Available at: https://www.podiatrytoday.com/blogged/proposed-cpme-320-changes-may-dramatically-reduce-required-biomechanics-cases-residency . Published December 2, 2020. Accessed April 20, 2021.