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Biomechanics for the non-specialist AKA "stop being intimidated by biomechanics using one weird tip".

As discussed in a previous column, Biomechanics scares people. It's not like any other aspect of podiatry, falling well outside of the "if it's wet, dry it, if its dry, wet it and if it shouldn't be there cut it off" aphorism which can be applies to a good proportion of what we do.

And it's complex. Biomechanics involves a good deal of physics, and quite a bit of anatomy (everybody's favourite). There are a dizzying array of paradigms, many of which are mutually contradictory, and even the "experts" seem to spend most of the time disagreeing with each other.

All of this has traditionally served to put people off this area of Podiatry. And that's a shame, because it misses a rather important point.

You don't need to be an expert in biomechanics to effectively treat your patients with musculoskeletal pathologies.

Really, you don't. And that's because what most people think of as biomechanics is not ACTUALLY biomechanics. Its Musculoskeletal (MSK) Podiatry. And that's a very different thing.

Biomechanics is defined in the dictionary as: "The study of the mechanical laws relating to the movement or structure of living organisms." (1)

There are, of course other more nuanced definitions in the podiatric literature, but they have the same essential meaning. That is, they are all THE STUDY of something. The science of biomechanics is how we seek to understand human gait and locomotion.

But is this what happens in clinic? Is this what we do when a patient comes to us with a broken metatarsal or an inflamed sesamoid? Are the patients there to be studied, or to be diagnosed and treated?

The study of a field of medicine is often distinct from the practice of that field.

If I may offer an example in a related field. A study was published in the British journal of dermatology in 2010 describing the precise cellular process by which callus is formed. It describes how:

The stratum corneum in the DF showed a splitting phenotype by conventional haematoxylin and eosin staining, while the stratum corneum was normal in the AH. Cells of the stratum corneum in the AH were nonsquamous. Expression of cornification-related molecules including involucrin, filaggrin, caspase 14 and calcium-sensing receptor was higher in the AH

Did you catch that? Because I didn't. First time I'd ever heard of "Filaggrin". Sounds like a Game of Thrones character to me. But I'd be willing to bet that everybody reading this is capable of TREATING callus, probably better than the authors of the study! And although it may be helpful, one does not NEED to understand callus in that level of detail to treat it effectively. So it is with Biomechanics and MSK podiatry.

So what of musculoskeletal podiatry. Well, it's a different discipline altogether. One might define it as the clinical discipline of diagnosing and treating musculoskeletal pathology. And although it's not always EASY it is really quite simple. Whilst an understanding of the biomechanics, the STUDY of how exactly the lower limb works is undoubtedly an advantage, it's not always necessary. In the same way one does not need to know the precise histological process by which callus forms to remove it, one does not need to know every detail of how a pathological force came to happen to counter it.

We shall hopefully expand on this in future articles, but the teaser trailer is this. Musculoskeletal Podiatry follows a fairly straightforward path.

Presentation. What the patient is complaining of

Diagnosis. Which structure is damaged or otherwise causing problems.

Aetiology. Why we think that structure is damaged

Treatment. What we are going to do to allow that structure to heal / function better.



(2.) Kim SH, et al, Callus formation is associated with hyperproliferation and incomplete differentiation of keratinocytes, and increased expression of adhesion molecules. Br J Dermatol. 2010 Sep;163(3):495-50l
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Author:Isaacs, Robert
Publication:Podiatry Review
Article Type:Column
Geographic Code:4EUUK
Date:Jul 1, 2017
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