Australia: Pedorthics Striding Ahead

This year’s conference of the Pedorthic Association of Australia at Coogee Bay Hotel in Sydney between 19 - 21 September was a big success, with an overall 15% increase in registrations.

Starting with a pre-conference workshop on Thursday morning, Ernie Tye informed us in an interactive way about the challenges of working as an Allied Health Practitioner, including accommodating patient goals and responsible use of wearable technology with the effectiveness, efficiency and satisfaction of the end-user in mind.

Our keynote presenter from Germany, Nora Grabowski, continued the interaction in the afternoon with a workshop titled Orthopaedic footwear modifications - biomechanics meets practical application. She gave a demonstration showing the effects of force and pressure changes when applying foot orthoses and/or rocker sole modifications using two different measurement systems. Nora highlighted which biomechanical competencies are required in order to select the correct measuring system, how to interpret the results correctly, and which system is optimal for individual treatments in daily practice.

In the evening, we officially opened the conference with a Welcome Reception in the exhibition area. It was exciting to have exhibitors from the Netherlands, the United States of America and five states in Australia, in addition to many new organisations exhibiting at the Pedorthic conference for the first time. Joining long-standing supporters of the industry - Gadean Footwear (Gold Sponsor for the second year in a row) and Leffler (Bronze Sponsor), we had four new faces supporting us through sponsorships. Newcomers included CYS and ProClinicx who undertook Silver Sponsorship and new Bronze Sponsors InStride and Momentum Health Technology.

On Friday, we kicked off the conference with our keynote presenter Nora Grabrowski discussing biomechanical aspects of orthotic footwear construction. She spoke about how different treatment options influence the effects of force and torque, and how these act on the human body during upright standing, walking, running and other activities.

Following Ms Grabowski’s presentation, members of the industry presented case studies arising from daily practice. David Sutton and Adam Smith each demonstrated how an incorrect treatment plan results in a negative experience for the end user and what needs to be done to attain the best possible outcome for the patient.

Community member Stephen Black, himself a user of orthopaedic footwear due to the effects of Spina Bifida, shared his experience of how custom footwear has positively impacted his life and stopped the cycle of time off work, time spent in doctors’ waiting rooms and in hospital undergoing surgery. He closed with the final statement, “While the medical profession has helped me when I got sick, Pedorthists have improved my quality of life”.

Ms Grabowski then returned to explain the importance of the biomechanical effects of orthopaedic footwear, the importance of focussing on primary treatment objectives, and how this can be achieved through targeted use of proven and new measuring technologies.

The next presenter was Emma Holloway, who energetically guided us through the NDIS provider registration renewal and NDIS audit processes. She highlighted common mistakes to avoid and pointed out areas where companies fail the audit assessment.

Peter Reeves presented the results of the industry survey. The survey sample comprised 42% modified pedorthic footwear, 27% prefabricated footwear, 23% custom orthoses and 7% custom made pedorthic footwear. The medium investment in a pedorthic business is $66,500 with an investment mid-range of $38,700 to $144,000. The average total area of a pedorthic practice is 174 m² with mid-range of those surveyed having between 87 m² and 257 m².  It was interesting to observe that the average time taken for minor to major modifications was 2.1 – 3.5 hours and for custom footwear ranging from medium complexity to high complexity was 14 – 20 hours. 

The day finished with the social highlight of the conference; dinner at the iconic restaurant Barzura overlooking Coogee Beach and the Pacific Ocean.

The Saturday program began with excitement when the fire alarm sounded, and we had to evacuate the building while Fred Holtkamp’s presentation was underway. Receiving the all-clear after 10 minutes, we returned to the conference centre and Fred continued his presentation about understanding user practices when drawing up requirements. He highlighted the importance of considering all aspects of a patient’s life including work, home, sport, spiritual beliefs, leisure and cultural circumstances when developing a treatment plan. He emphasised that in a recently conducted study, only one third of these lifestyle factors were discussed between the practitioner and patient.

PhD student Antoni Fellas described a randomised control trial in Juvenile Idiopathic Arthritis (JIA) involving the physical, psychosocial and financial impact of JIA on those affected. A total of 66 participants from 3 different hospitals were recruited with the aim to investigate the effectiveness of customised prefabricated foot orthoses in reducing lower limb pain, swollen and tender joints, and in improving quality of life and gait parameters in children with Juvenile Idiopathic Arthritis.

Karl Schott and Ernie Tye gave a presentation on the pathway to Pedorthics. Karl listed the requirements needed to obtain a Bachelor’s degree at Southern Cross University. Core units include functional anatomy of the lower limb, biomechanics of gait, orthoses and bracing, lower limb medicine, management and treatment of the high-risk foot and small business and entrepreneurship for allied health, fitness and sport. Ernie Tye outlined the necessities for a company to become eligible to take on students for placement and the expected outcome for students on placement.

After morning tea and in her final presentation, Nora Grabowski offered insight into how customised rocker sole modifications improve human gait, optimise mechanical stress and reduce and/ or prevent pain by taking advantage of changing moments and the rollover, thus changing the acting stress on the foot.

Susan Nancarrow gave an engaging talk about finding your niche and what it takes to be successful in the Pedorthic profession. Her key point established that the health workforce is constantly evolving either due to new opportunities or threats. She pointed out parallels with optometry and exercise physiology fields, identified where risks and opportunities exist for Pedorthics, and highlighted the increasing demand for scientific evidential basis of interventions.

Andrew Stephens elaborated the effect of foot deformity on normal gait. His lively presentation of the biomechanics of the foot in its separate components generated an engaging session sprinkled with laughter. He explained how the primary focus of interventions to correct gait should be on alignment, stability and maximising the propulsive forces through the foot.

After lunch, our presenters gathered for a panel session which provided the audience with an opportunity for extended question time.

Karl Schott then summarised the changing world of Pedorthics with reference to the collaboration between the International Pedorthic Association, IVO, the Pedorthics program in Vietnam and increased global awareness of Pedorthics.

As president, it was my pleasure to conclude the conference , thank everyone for their participation, and announce that the next conference will be in Perth in 2020. This year’s conference demonstrated once again that the industry is positively looking ahead to the future. The auction during the dinner raised $1,455 to support students to fly to Perth for next year’s conference.

To be part of the only Pedorthic conference in the Southern hemisphere in Perth next year, please save the date: 15 - 17 October 2020.  

Katrin Wegener
President, Pedorthic Association of Australia