Podiatric biomechanics
In the 1970s, two schools on opposite coasts answered the same clinical question differently. Their debate still shapes how orthoses are made today.
The two founders
New York College of Podiatric Medicine
A teacher and clinician in New York whose approach to examination and casting became known as East Coast biomechanics.
Known for
California College of Podiatric Medicine
A teacher and clinician in San Francisco whose theory of normal and abnormal foot function became the foundation of West Coast biomechanics.
Known for
Where they started
Before they disagreed, Schuster and Root agreed on the starting point. Both traditions examined the foot with the subtalar joint in neutral, neither pronated nor supinated.
From that shared reference, the question became how to treat the forefoot. That is where East and West parted.
The fork in the road
Both traditions evaluated the foot with the subtalar joint in neutral. One account of where they separated centers on a single question.
How should we understand the forefoot–rearfoot relationship?
Root · West Coast
The forefoot is examined and cast with the midtarsal joint held maximally pronated while the subtalar joint sits in neutral. This became the reference for the non-weightbearing, neutral-position cast and the functional orthosis that followed.
Schuster · East Coast
Schuster questioned assessing the midtarsal joint at the end of its range. His approach is associated with capturing the forefoot in a more resting state, semi-weightbearing casting, and flexible, non-compressible orthoses.
Common ground: subtalar joint neutral as the starting reference. The difference sits in the forefoot.
Schuster · East Coast
Schuster questioned assessing the midtarsal joint at the end of its range. His approach is associated with capturing the forefoot in a more resting state, semi-weightbearing casting, and flexible, non-compressible orthoses.
Root · West Coast
The forefoot is examined and cast with the midtarsal joint held maximally pronated while the subtalar joint sits in neutral. This became the reference for the non-weightbearing, neutral-position cast and the functional orthosis that followed.
Common ground: subtalar joint neutral as the starting reference. The difference sits in the forefoot.
Side by side
| SchusterEast Coast | RootWest Coast | |
|---|---|---|
| Institution | New York College of Podiatric Medicine | California College of Podiatric Medicine |
| Reference position | Subtalar joint neutral | Subtalar joint neutral |
| Midtarsal joint in exam | More resting state | Maximally pronated, end of range |
| Casting | Semi-weightbearing | Non-weightbearing, neutral position |
| Orthotic tradition | Flexible, non-compressible | Functional orthosis from a neutral cast |
These distinctions reflect how the two traditions are commonly described. How Schuster's methodology should be characterized is still debated.
In the clinic
Archival photographs of Schuster and Root at work.
What the record shows
The AAPSM describes the two theories as alike in some respects and different in others.
Successful clinical devices came from both traditions, and both trained generations of practitioners.
Whether the difference matters in practice is being asked again today. It remains a live question.
Dr. Merton L. Root founded Root Functional Orthotic Laboratory in 1974. In 2020 it merged with the lab of Kevin B. Rosenbloom, C.Ped, and became KevinRoot Medical.
We carry the Root legacy forward. Doing that well means being willing to examine every idea, including our own.
Schuster Memorial Biomechanics Seminar
R. Daryl Phillips, DPM, traces the history behind the two philosophies of midtarsal joint function, weighs the strengths and weaknesses of each, and outlines the research still needed toward a unified theory.
Part of a two-day seminar hosted by the New York College of Podiatric Medicine, where Schuster taught.
Register for the seminar
Sources