By Jarrod M. Shapiro, DPM
Although it’s difficult to predict future developments, one might extrapolate, to some extent, large changes to a specialty of medicine by looking back on the history of the field and combining it with recent developments and trends.
In the field of podiatric medicine and surgery, 4 major changes occurred in the past:
- creation of a surgical arm to the profession over the past 60 or so years
- the ever-changing involvement of technology
- changes to the insurance industry
- slow evolution of the podiatric educational system—to that of a physician, with an emphasis on the foot and ankle, rather than simply a “foot doctor.”
Because podiatric medicine and surgery is a young profession, each of these historical changes continues to have an effect today and will likely do so into the future. However, if one had to choose the biggest change to the field that would have an effect on patients, it appears that agent would be changes in technology.
The ability to create and utilize new materials, for example, has improved the quality of foot orthoses, allowing lighter-weight but stronger and thinner devices to help patients walk more comfortably. The same holds true for shoes, which have improved greatly over time.
The ability to use these devices in increasingly flexible ways will be the next step. Other technologies, such as 3D scanning, allow us to capture the appearance of the foot with less reliance on older materials, such as plaster. This new technology goes hand-in-hand with 3D printing, which has the potential to revolutionize the creation of foot orthoses. It is not difficult to imagine a time when a podiatrist can create an orthosis in the office the same day the patient’s molds were taken—much the way some eyeglasses are made today.
Prior imaging modalities in use for years are being modified, allowing novel methods to evaluate patients and perform research, and answering questions that were unanswerable in the past. Weight-bearing computed tomographic (CT) scanning has opened an entire arena of biomechanical evaluation for many pathologies, and magnetic resonance imaging (MRI) is used ever more often for many diseases. In fact, these advanced imaging modalities allow physicians to diagnose new disorders such as stress response, a precursor to stress fracture; novel minimally invasive surgical treatments are being developed as a result.
New point-of-care ultrasonographic systems are allowing doctors to rapidly diagnose disorders in seconds instead of in days, as was required in the past. And it won’t be long before we see imaging technology like MRI and CT entering into the operating room for use by podiatric physicians. Last, it is easy to envision CT and MRI taking the next step: acquiring images of moving—rather than stationary—patients.
New technologies have revolutionized how we approach foot and ankle procedures. New plating technologies, for example, allow patients to bear weight and perform physical therapy much sooner after surgery than before, which improve long-term outcomes. These newer technologies have also spurred novel surgical procedures that are changing how we approach previously challenging pathology.
Clearly, technological innovation over the past 50 years has driven a monumental change in the practice of podiatric medicine and surgery. Expect to see a continuation of this trend, with ever-increasing flexibility and universality in the use of technology.
Jarrod Shapiro, DPM, is a podiatrist and foot and ankle surgeon in Pomona, California. He is an associate professor at the Western University of Health Sciences College of Podiatric Medicine, program director of the Chino Valley Medical Center Podiatric Medicine and Surgery residiency and is an active member of the American College of Foot & Ankle Orthopedics & Medicine (ACFOAM). He serves as its liaison on the LER Editorial Advisory Board and as the Editor of its content contributions, which will commence next month.