Back in 2000-2003 I was taught to assess a treat a foot according to a model/paradigm that was conceived in 1977. Incredibly cursory summary: it consisted of criteria of normalcy for the human foot and was a tiny bit STJ centric. Fast forward 40 years to 2017 and students are still being taught it as the primary approach to foot and ankle biomechanics. Whilst it should still be taught in a historical context (as the quote at the bottom of this post affirms) there are significant enough flaws with it that it is certainly surprising it is still the front runner. Sadly, this then transfers to practice where a large proportion of the profession subscribe to these rather outdated concepts, which are easily refuted with even the shallowest of dips into the evidence based waters.
The work from Dr Hannah Jarvis’ PhD is something that needs to be taken notice of. Some of the papers published by the same team from Salford (here and here) should also be essential reading for all students and graduates alike. However what is even more fascinating is that almost these exact same concerns were documented in an excellent edition of the now defunct Australsian Journal of Podiatry Medicine in 1997 – the halfway point in this four decade story. Professor Menz has kindly uploaded a PDF of this entire edition to his blog and I can’t recommend reading it highly enough. For me, it is eye opening to read something which was published before I even began studying the human foot and for it to challenge everything I had been subsequently taught.
What does this tell us? Well, it may seem like we are not making any progress. Are we to predict that in 2037 there are papers being published about this 1977 model being out of date and failing to stand up to scientific scrutiny? Despite this will it still be the prevailing model being taught and practiced 60 years on from its conception? Let’s hope not.
They say it can take 17 years for published research to translate to clinical practice. Well its 40 years and counting so far…
