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It's Not Your Father's Podiatry School
Advances in Podiatric Medical Education
This paper discusses the innovative changes in podiatric medical education found in today's schools and colleges of podiatric medicine, including changes in philosophy, resources and technology, curriculum, delivery methods, the role of faculty, and assessment tools, and the changing expectations of the students themselves. There is an emphasis on the shift from a teacher-centered approach to professional education to a student-centered approach. Technological advances have had a tremendous impact on the educational process and have opened doors to many new forms of educational delivery that better meet the needs of today's students. We believe that the podiatric medical education of today is the equivalent of allopathic and osteopathic education in quality and depth. The future holds the promise of many more exciting changes to come.
Background:
Goniometric measurement is currently being used as a diagnostic and outcomes assessment tool for ankle joint dorsiflexion. Despite its common use, its interrater and intrarater reliability has been questioned.
Methods:
This is a prospective study examining whether the experience of the examiner or the technique used affects the interrater and intrarater reliability for measuring ankle joint dorsiflexion. Fourteen asymptomatic individuals (8 male and 6 female) with a mean age of 28.2 years (range, 23–52) were enrolled into this study. The years of clinical experience of the five examiners averaged 10.4 years (range, 0–26). Four examiners used a modified Root, Weed and Orien method of measuring ankle joint dorsiflexion. The fifth examiner utilized a nonstandardized technique. A standard goniometer was used for bilateral measurements of ankle joint dorsiflexion with the knee extended and flexed. All five examiners repeated each measurement three times during each of the three sessions, with each session spaced at least 1 week apart.
Results:
The interclass correlation coefficient reveals a moderate intrarater and poor interrater reliability in ankle joint dorsiflexion measurements using a standard goniometer. More importantly, further analysis indicates that the use of a standardized technique for measurement of ankle joint dorsiflexion or years of clinical experience does not increase the intrarater or interrater reliability.
Conclusions:
The utility of the goniometric measurement of ankle joint dorsiflexion may be limited. (J Am Podiatr Med Assoc 101(5): 407–414, 2011)
Background:
There are no conclusive data to support the contention that diabetic patients have an increased frequency of ankle equinus compared with their nondiabetic counterparts. Additionally, a presumed contributing cause of foot ulceration is ankle joint equinus. Therefore, we sought to determine whether persons with diabetes have a higher prevalence of ankle joint equinus than do nondiabetic persons.
Methods:
A prospective pilot survey of 102 outpatients (43 diabetic and 59 nondiabetic) was conducted. Demographic and historical data were obtained. Each patient underwent a standard lower-extremity examination, including the use of a biplane goniometer to measure ankle joint range of motion.
Results:
Equinus, defined as ankle dorsiflexion measured at 0° or less, was found in 24.5% of the overall population. In the diabetes cohort, 16 of 43 patients (37.2%) were affected compared with 9 of 59 nondiabetic participants (15.3%) (P = .011). There was a threefold risk of equinus in the diabetic population (odds ratio [OR], 3.3; 95% confidence interval [CI], 1.28–8.44; P < .013). The equinus group had a history of ulceration in 52.0% compared with 20.8% of the nonequinus group (P = .003). Equinus, therefore, imparted a fourfold risk of ulceration (OR, 4.13; 95% CI, 1.58–10.77; P < .004). We also found a 2.8 times risk of equinus in patients with peripheral neuropathy (OR, 2.8; 95% CI, 1.11–7.09; P < .029).
Conclusions:
Equinus may be more prevalent in diabetic patients than previously reported. Although we cannot prove causality, we found a significant association between equinus and ulceration. (J Am Podiatr Med Assoc 102(2): 84–88, 2012)
