What I Learned At The Best Biomechanics Conference That Hardly Any DPMs Attended

Actually, the best and brightest in the biomechanics community attended the 2018 International Foot and Ankle Biomechanics (i-FAB) Conference this past week in New York City. Unfortunately, only a few podiatric physicians were there. Yes, even though many in our profession profess that we are the “experts” of the foot and ankle and that we understand biomechanics of the lower extremity better than anyone else, podiatry was very underrepresented at this premier meeting of the best researchers in the world in the area of lower extremity biomechanics.

The i-FAB is an international collaborative community of all individuals who are interested in foot and ankle biomechanics. According to the website, i-FAB launched in 2007 and now has over 800 members worldwide and has brought together over 1,000 people to its congress activities.¹ Members of i-FAB cross all professions, including academic researchers, MDs/physicians, podiatric physicians, physical therapists and engineers.

Since 2008, there have been six scientific i-FAB conferences at various locations around the world where speakers have presented significant new research about foot and ankle biomechanics. You can see the listing of the conferences and also gain access to all of the abstracts by visiting the conference page on the i-FAB website.²

For those who think a meeting like this is not relevant to the true “foot and ankle surgeon,” consider that Michael Coughlin, MD, delivered the opening keynote address. Dr. Coughlin is an eminent foot and ankle orthopedic surgeon who described his challenges with gaining Food and Drug Administration approval for the Scandinavian Total Ankle Replacement (STAR). His address followed with a lecture from Keith Wapner, MD, showing complications and solutions with total ankle joint replacement surgery. Other biomechanical lectures on this subject alone included gait studies of patients before and after ankle joint replacement and comparisons of gait between patients with ankle joint fusion versus ankle joint arthroplasty.

There were several papers studying adult acquired flatfoot using weightbearing computed tomography imaging. These studies provide fascinating insight into various levels of the foot affected by this deformity and suggest which surgical procedures would be most appropriate.

In the area of pediatrics, there were several papers studying the asymptomatic pediatric flatfoot. This is a controversial area that has a significant impact on most podiatric physicians in clinical practice. The gait studies provided further justification to treat certain children with flatfoot deformity.

Other sessions included topics such as ankle injuries, sports injuries, neuropathy, hallux valgus and hallux rigidus. Although some lectures were very “laboratory oriented,” the majority of the presentations I saw had significant clinical implications for both surgical and non-surgical treatment interventions.

Only two podiatric physicians, Jinsup Song, DPM, and Erin Ward, DPM, presented original research from the podium. Another podiatric physician, Daryl Phillips, DPM, made a poster presentation. The only other podiatric presence at the podium at the i-FAB meeting was provided by Russell Volpe, DPM, and Michael Neary, DPM, who served as moderators for two sessions.

As a Fellow of the American College of Foot and Ankle Surgeons (ACFAS), I continue to be baffled by the absence of any sessions devoted to research and new understanding of lower extremity biomechanics at the ACFAS Annual Scientific Meeting. The Journal of Foot and Ankle Surgery has numerous special interest sections, but none devoted to biomechanics. There were no leaders of ACFAS presenting or even in attendance at the i-FAB meeting. On the other hand, there were several prominent members of the American Orthopedic Foot and Ankle Society (AOFAS) who not only attended the i-FAB meeting but also presented original research from the podium.

We are seeing a trend where the ACFAS designates its members as “foot and ankle surgeons,” and not as podiatrists. The podiatric profession has a rich history of studying the function of the lower extremity and developing treatment interventions that use biomechanical principles to achieve optimal outcomes. Researching and teaching biomechanics has become a critical element of training competent foot and ankle surgeons for our orthopedic colleagues. Yet training programs and educational symposia within our own profession seem to ignore this critical element of competency in foot and ankle surgery.

If members of the podiatric profession proclaim themselves as “experts” in the surgical treatment of ankle joint arthritis or the adult acquired flatfoot, why would they not be staying on top of cutting-edge research about the biomechanics of these pathologies? Why are these “experts” not performing and publishing their own research on the biomechanics of these pathologies? Why have the surgical experts of our profession not chosen to present at an International biomechanics conference?

In my mind, a premier international foot and ankle biomechanics conference staged in New York City should have drawn well over 100 podiatric physicians. We like to say we are the experts of the foot and ankle because we know biomechanics better than any other discipline, but when it came time to showcase that expertise, we were sorely absent.

References

1. International Foot and Ankle Biomechanics Community. Available at https://www.i-fab.org/index.html .
2. International Foot and Ankle Biomechanics Community. Available at https://www.i-fab.org/congress.html .