Podiatrists are Foot Mechanics
Podiatrists are Foot Mechanics, specialising in what is termed Musculo-skeletal (MSK) Biomechanics. They are using all the skills they have in their experienced ‘toolbox’ to fix presenting foot related lower limb painful pathologies. They aim to improve individual’s biomechanics to negate or fix unwanted pathomechanics. To be a foot mechanic it is important to encompass the knowledge and understanding of biomechanics and pathomechanics.
Biomechanics and pathomechanics are not the same, but are intertwined with each other. Thus, understanding the concepts of both biomechanics and pathomechanics, is of equal importance during an MSK Lower Limb/ Foot assessment. Think of Newton’s 3rd Law of motion:
‘Every action has an equal and opposite reaction…’
In podiatry biomechanics applies to the mechanical, structural and functional systems involved in healthy movement/ mobility. The understanding of how muscles and joints interact together to create stability and propulsion during the gait cycle. Pathomechanics in contrast focuses more on how mechanical stresses can predispose and lead to foot pathologies e.g. disease, injuries and deformity. Biomechanically sound, to pathologically unsound.
Podiatrists are concerned with pathomechanics on a daily basis. A patient presents with a recurring corn, has a foot ulcer that won’t heal. There is a pathological reason for the patient’s problem which is often biomechanical in origin. The daily applied stresses into the foot have overloaded, breached the threshold of the tissue’s mechanical properties. The proverbial sponge that cannot soak up anymore, an elastic band overstretched which snaps!
It is important to take a global, holistic approach in ascertaining the etiological reasons for the presenting problem. Both the biomechanics and pathomechanics of the foot have to be evaluated in unison and not singularly. An experienced podiatrist will not only treat the problem conservatively for short term results, but look at long term management. How can the painful, damaging pathomechanics be addressed? Will fixing the biomechanics achieve a better asymptomatic outcome.
Evaluating muscle strength, function, joint alignment, along with balance and proprioception, general health of patient is important. Causative reasons can be multi-factorial. Biomechanics is concerned with trying to mitigate abnormal mechanical stresses that lead, or could lead to unwanted pathomechanical consequences. Better footwear, specific exercises, functional and supportive orthotics can help tip a ‘patho’ foot into a more biomechanically sound one.
www.iocp.org.uk vol. 80
There is a new emphasis on looking at the interaction between muscle and joints, in dynamic motion. Getting muscles to perform better, in their role at stabilising and positioning joints throughout the gait cycle. Aiming to get a joint at rest, to be in a more centred (neutral) position. This will help to reduce tension and compression within lower leg and foot structures. The foot has over 30 separate articulations. Think of an engine with lots of mechanical parts. One faulty part could lead to engine failure.
When trying to explain to a patient in simple terms, and draw the connection between biomechanics and pathomechanics I say:
“You have been walking in the wrong gear ratio. You are trying hard to be in 5th gear, but actually due to mechanical issues, stuck in 2nd. This is causing the damage”.
My job is then to see if I can affect an adjustment, tweak, facilitate a positive change. A functional orthotic can significantly change the timings, pressures and stresses throughout the foot, up the kinetic dynamic chain. Put patient into a better gear ratio. Less wear and tear. This combines both biomechanical and pathomechanical understanding.
This probably oversimplifies on what is a complex and often complicated subject. When asking a mechanic “what is wrong with my car?” one doesn’t always get a clear understanding, or even worse the car fixed! It is important to find the right mechanic, in the same way you should with a medical expert. Chose the expert who has experience and the skill set to undertake an MSK Biomechanical Assessment. Get the right ‘foot mechanic’.
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