Chiropody/Podiatry: Interprovincial Differences in Profession Formation

The regulation of foot health care professionals varies across provinces in Canada. In Ontario, the regulated health profession is chiropody. Chiropodists are foot specialists with a limited scope of practice. In contrast, British Columbia and five other provinces regulate podiatrists, who are highly trained foot physicians with an extensive scope of practice. This article explores the history of chiropody/podiatry in Ontario and British Columbia from the early 1900s through the 1980s in order to understand how professional development in this field took such divergent paths within Canada. In so doing, it not only sheds light on a health practice that has received little scholarly attention, but it also highlights the centrality of inter-professional conflict and state actors' agendas to professional regulatory outcomes.

Pan-metatarsophalangeal joint arthrodesis for the severe rheumatoid forefoot deformity

The standard approach for correction of severe painful rheumatoid forefoot deformities has involved resection of the metatarsal heads with realignment of the lesser toe deformities and first metatarsophalangeal joint (MTPJ) arthrodesis. Modifications of this procedure may include a pan-metatarsal head resection, including the first metatarsal head, or resection of the lesser metatarsal heads in conjunction with an interpositional arthroplasty of the first MTPJ. The authors describe a novel surgical approach that involves the correction of severe rheumatoid forefoot deformities through a pan-MTPJ arthrodesis. Arthrodesis of all five MTPJs for the surgical treatment of the painful rheumatoid forefoot deformity with chronic plantar callosities and dislocated digits has yet to be reported in the scientific literature. The goal of this article is to provide the treating physician with another alternative and safe surgical approach when dealing with the painful rheumatoid forefoot deformity.

Future of gait analysis: a podiatric medical perspective

Despite the plethora of information on human gait analysis, its continued use as a clinical tool remains uncertain. Analysis of gait dysfunction has become integral to podiatric medical practice, and, like many specialized fields, it is rapidly changing to meet the needs of the future. Practice in the 21st century is predicated on the concept of multidisciplinary working approaches and a growing trend toward evidence-based practice, in which gait analysis could play a prominent role. This article provides a historical synopsis of instrumented gait analysis and its associated subcomponents and discusses the salient issues concerning its future role in podiatric medicine.

Glancing back, striding ahead. The history of the American Academy of Podiatric Sports Medicine: part 1

This article provides a succinct but comprehensive review of the history of the American Academy of Podiatric Sports Medicine. Three time periods are described: the pre-academy era, the early years of podiatric sports medicine leading up to the academy's founding, and the academy's founding and the 1970s. An appreciation of the academy's past facilitates understanding of its present state and future direction.

Reconstructing Root. An argument for objectivity

Substantial evidence suggests that complete rejection of the Root model may be premature, given the inherent logic in an Aristotelian interpretation of its core philosophy. Although critics have focused on a Platonic interpretation of Root's criteria for normalcy and surrounding theories, recent theoretic shifts towards a more flexible view of the factors which can combine to produce pathologic conditions suggest that the Root model retains usefulness. Although it has been suggested that Kuhn's approach may contain a destructive element, one of its propositions--that a phase of normal science is characterized by a common vision of the research required within the paradigm--seems to hold the key to the future success of podiatric biomechanics. The approach of Lakatos seems to provide the required "modicum of self-confidence which enables us to live and practice" to smooth the transition between established and emergent approaches. Although the approaches of Kuhn and Lakatos remain incommensurable, it is certain that Kuhn would agree with one particularly relevant comment by Lakatos, that "blind commitment to a theory is not an intellectual virtue: it is an intellectual crime."

What future direction should podiatric biomechanics take?

With researchers from many scientific and medical disciplines currently devoting countless hours trying to solve the mechanical mysteries of the foot, it is important that the proper direction for research be established. The author of this article believes that one of the most important directions in podiatric biomechanics will focus on the development of accurate models of the human foot and lower extremity. Accurate models will be useful because they provide relatively accurate predictions of the magnitudes of loading forces that occur in the structural component of the human foot and lower extremity during weight-bearing activities. From its beginnings in the early 1960s, podiatric biomechanics has developed from a fledgling collection of thoughts and observations from Merton Root and his colleagues to an internationally recognized clinical science with numerous researchers, past and present, contributing to its growing base of knowledge. With an emphasis on accurate modeling of the foot and lower extremity to allow better prediction of the internal forces that create pathologic conditions during weight-bearing activities, podiatric biomechanics will continue to provide valuable insight into many of the painful syndromes that plague children and adults of the world.

Podiatric biomechanics. An historical appraisal and discussion of the Root model as a clinical system of approach in the present context of theoretical uncertainty

This article attempts to review comprehensively the development of the established Root Model and to appraise dispassionately its place and role in today's field of clinical podiatric biomechanics. It also discusses several important emergent models (the models of Dananberg, Kirby, Fuller, McPoil, Hunt, and Demp) that have gained increasing popularity among the podiatric and nonpodiatric clinical communities over the last 10 to 15 years. All of these models (the Root model and emergent models) have been analyses against the background of the Kuhnian concepts of "paradigm" and "preparadigm." Discussion has been provided as to whether the domain of podiatric biomechanics presently resides in a paradigm driven normal science phase, or whether it is still functioning within a preparadigm phase with its defining hallmark of community nonconsensus. Suggestions are then made as to possible ways for research to progress within the present ferment of debate and theoretic uncertainty.

Biomechanics: A mathematical perspective

This article is the author's perspective of his firsthand experience with Dr Merton Root and the methodology that Dr Root founded. Included are the chronology of events that occurred and the author's impressions of their impact on the profession. A short critique of Dr Lee's work is also included.

The change in orthotic making techniques with the development of current biomechanical theories

In the early 1960s, a few orthopedic practitioners, following the work and example of Dr Merton Root, decided to pursue new orthopedics, which became known as biomechanics. In the 1970s, after years of encountering resistance, a few laboratories were available to fabricate the Root orthotic and offer advice and education on the management of the orthopedic patient. Eventually, runners turned to podiatrists for conservative care so they could continue to participate in their sport; biomechanics had become established. Presently, podiatrists have not performed the research necessary to document and further Root's work; however, as stated in one of life's axioms, the only credentials one needs are results. William Eric Lee's article is a thorough, comprehensive documentation of events and background of Root and his theory. Lee set out to provide a detailed picture of Root's clinical system of approach toward the treatment of mechanically induced foot ailments. His article is a splendid achievement.

1998 William J. Stickel Bronze Award. Antifungal activity of Melaleuca alternifolia (tea-tree) oil against various pathogenic organisms

Tea-tree oil (oil of Melaleuca alternifolia) has recently received much attention as a natural remedy for bacterial and fungal infections of the skin and mucosa. As with most naturally occurring agents, claims of effectiveness have been only anecdotal; however, several published studies have recently demonstrated tea-tree oil's antibacterial activity. This study was conducted to determine the activity of tea-tree oil against 58 clinical isolates: Candida albicans (n = 10), Trichophyton rubrum (n = 8), Trichophyton mentagrophytes (n = 9), Trichophyton tonsurans (n = 10), Aspergillus niger (n = 9), Penicillium species (n = 9), Epidermophyton floccosum (n = 2), and Microsporum gypsum (n = 1). Tea-tree oil showed inhibitory activity against all isolates tested except one strain of E floccosum. These in vitro results suggest that tea-tree oil may be useful in the treatment of yeast and fungal mucosal and skin infections.

1998 William J. Stickel Gold Award. The effects of extrinsic muscle forces on the forefoot-to-rearfoot loading relationship in vitro. Tibia and Achilles tendon

The effects of muscular activity on the distribution of forces under the foot, as well as within the foot, are of great importance for determining the mechanisms of foot pathologies. Limited data exist concerning muscle forces during the gait cycle and the effects of muscle forces conveyed to the ground-reactive forces of the foot. The authors developed a cadaveric loading system to determine the effects of force applied to the Achilles tendon on the forefoot-to-rearfoot loading relationship in eight cadaveric specimens. The study indicated that, during axial loading of the tibia, force was inherently transferred from the rearfoot to the forefoot. However, the observed forefoot-to-rearfoot loading relationship did not match the predicted loading relationship from a rigid-body diagram, as would be observed in a class I lever. The results indicated that, as the force was increased on the Achilles tendon, the change in loads on the forefoot and rearfoot was not linear. Specimens with calcaneal inclination angles greater than 20 degrees demonstrated a more linear increase as compared with those with inclination angles less than 20 degrees.

1998 William J. Stickel Silver Award. Mechanically assisted, delayed primary closure of diabetic foot wounds

The authors evaluated the time to healing and prevalence of complications in patients undergoing mechanically assisted, delayed primary closure of diabetic foot wounds compared with a similar population who received standard wound care. A total of 55 patients were enrolled for study, with 25 in the experimental group and 30 in the control group. Patients in the experimental (stretch) group underwent mechanically assisted primary closure of their wounds using a skin-stretching device. There was no difference between the stretch and control groups with regard to any descriptive characteristics, including wound chronicity. Although the wounds were over three times as large on average in the stretch group (P < .001), the stretch group reached full epithelialization approximately 40% sooner than the control group (26.4 +/- 16.0 versus 42.5 +/- 19.9 days; P < .002). Eighty-eight percent of patients in the stretch group experienced wound dehiscence, at a mean time of 1.8 +/- 0.6 weeks following mechanically assisted closure. However, patients who experienced dehiscence in the stretch group healed significantly faster than patients in the control group (27.4 +/- 16.7 versus 42.5 +/- 19.9 days; P < .007). The results of this study suggest that mechanically assisted closure of diabetic foot wounds may result in reduced healing time compared with healing by secondary intention.

The past, present, and future of podiatric biomechanics

The author places the history and development of podiatric biomechanics, as well as current thinking about its underpinnings and future, in the context of a theoretical framework drawn from the philosophy and sociology of science. This analysis sets the stage for an exploration of the possible future directions in which podiatric biomechanics could develop.

1997 William J. Stickel Silver Award. The anti-inflammatory action of locally injected ketorolac

Locally injected steroids are used to treat inflammatory conditions, in spite of the complications associated with their use. Ketorolac tromethamine, an injectable nonsteroidal anti-inflammatory drug, has not previously been evaluated for treatment of musculoskeletal inflammatory conditions via local administration. Eighty Achilles tendons of rabbits were traumatized in a controlled fashion. At the time of trauma, a single dose of ketorolac (1, 3, or 5 mg/kg) or normal saline was administered peritendinously. Three days later, the tendons were harvested and examined histologically to evaluate the degree of inflammation present in the tissue. No statistically significant difference was found between the experimental and control groups. The authors conclude that locally injected ketorolac does not prevent the onset of an inflammatory process.

1997 William J. Stickel Gold Award. Morphological and biochemical properties of metatarsophalangeal joint cartilage

Although there is sparse information concerning the properties of foot-joint cartilages, knowledge of the morphology and biochemistry of these cartilages is important in the study of changes that occur in the development of osteoarthritis. Normal first and fifth metatarsophalangeal joints were chosen for comparison because of the difference between these two joints in the prevalence of osteoarthritis, particularly with advancing age. The authors' study shows that there is no age-related decrease in articular-cartilage thickness; however, there is an age-related decrease in the chondrocyte density in the superficial zone in both joints. There is, however, a difference between the two joints in the level of expression of matrix-degrading enzymes. This difference may indicate differences in specific chondrocyte activity that precedes or accompanies the development of osteoarthritis or other degenerative morphological changes.

1997 William J. Stickel Bronze Award. Comparison of strategies for reducing pressure at the site of neuropathic ulcers

Few scientific data are available on the effectiveness of commonly used modalities for reducing pressure at the site of neuropathic ulcers in persons with diabetes mellitus. The authors' aim was to compare the effectiveness of total contact casts, half-shoes, rigid-soled postoperative shoes, accommodative dressings made of felt and polyethylene foam, and removable walking casts in reducing peak plantar foot pressures at the site of neuropathic ulcerations in diabetics. Using an in-shoe pressure-measurement system, data from 32 midgait steps were collected for each treatment. There was a consistent pattern in the devices' effectiveness in reducing foot pressures at ulcer sites under the great toe and ball of the foot. Removable walking casts were as effective as or more effective than total contact casts. Half-shoes were consistently the third most effective modality, followed by accommodative dressings and rigid-soled postoperative shoes.

A personal revolution in the development of clubfoot correction

This article presents the author's experience of having worked in London, England, under Denis Browne, whose method of treating equinovarus in the newborn involved manipulation of the baby feet until full correction had been achieved at the very first visit. The feet were then strapped to the sole plates of the Denis Browne splint, which ensured that the baby's normal kicking action maintained mobility at the subtalar joints and also a basic plantigrade posture. When he transferred to India, the author found a large population of children who had been born with talipes equinovarus, but who had never had treatment. He worked at obtaining correction without strong manipulation, using serial plaster casting followed by Denis Browne's splints. His personal reactions to the problems and the merits of the two methods forms the subject of this article.

History of residency selection issues in podiatric medicine

Issues related to residency interview and selection processes have concerned the podiatric medical profession for nearly 20 years. This article presents a chronology and summary of efforts undertaken to address these problems, including a discussion of legal ramifications of residency approval requirements related to establishment of a uniform notification date and participation in a resident-matching service.

The residency in podiatric medicine. A brief historical overview

The author provides a general overview of the development of postgraduate residency training in podiatric medicine since 1956. The evolution of residency standards and requirements of the Council on Podiatric Medical Education are discussed. Integration of specialty organizations in the residency evaluation process also are reviewed. The author notes that the current positive number of entry level residency positions available to graduates of colleges of podiatric medicine may be a dubious facade in view of increasing college enrollments and the potential conversion of rotating podiatric residencies to residencies in primary podiatric medicine. He cautions the profession not to overlook these events as it considers the development of the PGY-1 concept in the restructuring of entry level residency training.

Inhalation of nail dust from onychomycotic toenails. Part I. Characterization of particles. 1984

Nail dust particles were analyzed by scanning electron microscopy for size and topography. The percentage of "fines" that could be inhaled and deposited in the alveoli and bronchioles were determined by quantitative particle size analysis. Distribution representing the largest total mass was graphed between 1 and 2 microns. The authors found that 86% of nail dust would reach the bronchioles and alveoli, and 31% could be expected to deposit in these areas.

Nail dust aerosols from onychomycotic toenails. Part II. Clinical and serologic aspects. 1984

The podiatric procedure of burring hyperkeratotic fungal infected toenails results in large quantities of nail dust aerosols. An extremely large percentage (31%) of podiatrists who were analyzed for immunoglobulin E (IgE) by antibody radioimmunoassay were found to have abnormally high levels. Incidence of precipitin antibodies to Trichophyton rubrum in sera of those in practice from 0 to 15 years was 23%, and those in practice 16 years or more was 29%. In this study, podiatrists who were chronically exposed to nail dust aerosols after years of practice presented with symptoms of conjunctivitis, rhinitis, asthma, coughing, hypersensitivity, and impaired lung function.

[Activities of the podiatric group in the Lublin orthopedic departments under the direction of Professor Stanisław Piatkowski]

The development of podology in the Lublin society as well as the personal achievements of prof. Stanisław Piatkowski have been presented. The originated in the 60-ies activities concerning podology have included scientific research, cooperation with shoe industry institutions, and wide prevention of the foot health in the Lublin region.

Podiatry: a medical care specialty in quest of full professional status and recognition

Podiatry as a medical specialty has received little sociological attention. This omission leaves a sizeable gap in our understanding of the total health care system. Given the functional importance of this speciality and the growing need for the services of podiatrists this report represents an attempt to increase our knowledge in this area. The paper attempts to fill that gap by presenting a discussion of the development of podiatry as a health profession; documenting the educational and political development and attempting to explain the reasons which have inhibited the process of professionalization. Our findings suggest that podiatry as a profession has been unable to attain full autonomy over its anatomical area of expertise and this along with other factors has prevented podiatry from attaining full professional status and recognition.