Tuesday, 1 January 2008

Teaching podiatry from an evolutionary perspective.

The article, Medicine and Evolution by Bob Longworth and Andrew Horwood,[1] reports the comments by Paul O’Higgins, ‘…that teaching anatomy from an evolutionary aspect brings it alive and makes it a lot easier to understand.Teaching the origins of podiatric problems from an evolutionary standpoint may well do the same.’ It is noted that evolutionary studies within podiatry are provided as part of the undergraduate curriculum of the La Trobe University, in Australia.

They remind us that bipedal gait is unique to man and our locomotion is a relatively recent phenomenon when considering the time the Earth has existed. There is a considerable volume of research evidence that may be pertinent to podiatry practice and research that to date has remained within the professions of archaeology and anthropology. As a profession we are continually looking forward; perhaps it is time to take a retrospective approach to find those ‘nuggets’ of knowledge that may reintroduce or instigate new research that may be beneficial to our patients.

Understanding the changes that have occurred to the morphology of the foot reflects its use within the context of its environment.First, the action of standing on two feet,bipedality; Rodman&McHenry[2] state that bipedality may have been the result of an adaptation due to a resultant change in the distribution of the dietary requirements ofearly hominids. Around 3-4 million years ago the African forest environments were declining in favour of savannah, thereby forcing early hominids to travel over greater areas to exploit their environment. Standing in an erect stance enabled the hominids to see for greater distances for food and for dangerous predators.

As a consequence, bipedality has proved to be a more energy efficient process, acommodity essential to survival in the scavenging/gatherer clans. Comparative locomotion studies with our closest related relative the chimpanzee estimateb a75%reduction in energy use as a result of bipedality.[3]

As the tree of human life expanded over the millennia, there is physical evidence of
several distinct families of human species that have existed, sometimes co-existing, e.g.Homo sapiens and Homo neanderthalensis.Looking at the skeletal evidence of later
human communities, changes of the foot structure can be observed from the fossilised evidence. An interesting interpretation by Professor Eric Trinkaus,[4] University of Pennsylvania, in which his work of comparative biomechanical analysis of the proximal pedal phalanges shows a marked reduction in the robusticity of the lesser toes in Palaeolithic humans. Should we be seeking to return to a more robust foot use?

Major sporting shoe manufacturers such as Nike and Swiss Masai have already made studies of bare foot running and have designed their footwear to function in a similar fashion, increasing the use of intrinsic muscles.[5] What implications could this have from a podiatric perspective – should we be designing the optimum effective footwear that will protect and strengthen our contemporary weakened foot structure?

It is not only the evolutionary process that is important but also the pathological
presentation of the structures that are found, which provides evidence of the
systemic disorders and traumatic stories that osseous remains provide.
One such example is that of an ancient prosthetic toe belonging to a mummified
Egyptian woman, discovered in the tomb of Merry, a priest of Amun in the reign of
Amenhotep II.[6] What does her story tell us of the psychosocial requirements that were
addressed as part of her treatment? When one considers that a psychosocial approach is thought to be a relatively new discipline, archaeological evidence suggests otherwise.

Examination of ‘Oetzi’, the Tyrolean iceman presently the oldest European mummified human body (5200 years old) has revealed 15 well-preserved tattoo groups on his back and legs; are there any podiatrists who practice accupuncture who are able to demonstrate any evidence to support or disprove the theory of the authenticity of such marks on his lower leg?
There are many opportunities for the podiatry profession to have an input into
other academic disciplines – after all we are the experts in the lower limb.
My interest within this area has instigated a ‘blog’, as an introductory educational resource for researchers in the field of human evidence, which may be of particular interest to podiatrists. I have coined the term ‘Palaeopodiatry’; here you
can view the subject matter that I have discussed earlier: if you wish to comment on the resources you can have your opportunity by visiting the site at http://paleopodiatry.blogspot.com/

A dedicated website will be available soon for you to take advantage of full-text
research papers donated by leading experts in this area. Many of you may remember
Dr Robert Kidd, who lectured in podiatry within the UK. He is now the Associate Professor of Human Anatomy at the School of Biomedical and Health Science,
University of Western Sydney, and he has kindly donated several of his research
papers, available soon. The teaching of podiatry, therefore, from an evolutionary perspective may have its origins here. I hope you find interest in this resource and gain insight into the wider applications of our profession. There
is a contact email address if anyone finds any new and relevant articles of interest to the site and the podiatric community.

1. Longworth R, Horwood A, Medicine and
evolution. Podiatry Now 2007; 10(3): 32.
Available [Online] http://www.members.
2. Rodman P S, McHenry H M. Bioenergenics of
hominid bipedalism. American Journal Physical
Anthropology 1980; 52: 103-106, In Lewin, R.
Human Evolution: An Illustrated Introduction, 5th
Edition. Oxford, Blackwell Publishing, 2005.
3. Pontzer H, Raichlen D, Sockol M. Chimpanzee
locomotor energetics and the origin of human
bipedalism, 2007. Eurekalert press release.
Available [Online] http://www.eurekalert.org/
4. Trinkaus E. Anatomical evidence for the
antiquity of human footwear use. Journal of
Archaeological Science 2005; 32: 1515-1526.
6. Foster J B. Barefoot-like designs challenge
footwear conventions. Biomechanics online,
2007. Available [Online]http://www.
6. Nerlich A, Zinck A, Szeimies U, Hagedorn H.
Ancient prosthesis of the big toe. The Lancet
2000; 356: 2176-2179.

Source:Podiatry Now, December 2007.
Roger N Gregory DPodM, MChS, Podiatry Lecturer, Birmingham School of Podiatry

1 comment:

  1. I know this is years later, but I happened upon this website while looking for something else. Paul O'Higgins above talks about how teaching anatomy from an evolutionary perspective brings it alive...... Well he is not wrong. I know Paul, he was my first PhD supervisor, and friend, in Western Australia in the very early '90's. However, I would go further; anatomy makes no sense, not at all, unless viewed from an evolutionary back drop. Evolution is not what you believe - it is what we measure, every day in our work - that is what anatomy is and does. To study anatomy without evolution is analogous to studying arithmetic without numbers - it cannot be done. One last phrase; just because you really really want it to be true, doesn't make it true...... Evolution is, get over
    it and move on. Rob Kidd