IVO-Congress 2018: Exchange of knowledge and ideas

Karl-Heinz Schott (r.) received a Canadian hockey jersey as a gift from Jonathan Strauss for introducing the PAC to the IVO.

For the first time a congress of the International Association of Pedorthics (IVO) took place in the English- speaking part of Canada from 12 to 14 April 2018. The Pedorthic Association of Canada (PAC) was the host of the congress in Toronto, where the international community of pedorthics met for three days.

Twelve years ago a German pedorthist living in Australia had announced his attendance of the annual congress in Winnipeg, Jonathan Strauss, mana­ging director of the Pedorthic Association of Canada (PAC) narrated at the beginning of the congress. Nobody had known him and his request had been unknown at that time. The pedorthist was Karl-Heinz Schott. The reason for his visit was to present the International Association of Pedorthics (IVO) and to suggest to the PAC to become a member of the association.

Schott’s mission was successful, since only shortly after the PAC actually became a member of the IVO, where it cooperated very actively right from the start and where they applied for hosting the IVO-congress in 2018 some years ago. This congress constitutes the preliminary peak of a rapid development. The PAC was founded only in 1990. Brian Scharfstein, one of the first members of the PAC, said that at the first events in the beginning of the nineties there had been four exhibitors and 50 participants. But within few years the PAC managed to establish an education system with its own college and state-approved degree and to become a negotiation partner of the health insurance companies with the help of active corporate policies and a clear strategy.

Visitors from 25 countries

The PAC today consists of about 650 members from all over the English-speaking Canada. The French-speaking part of Canada has already had its own association, the AOPQ, that hosted the first IVO-congress in Canada 25 years ago. Members of the associations PAC and AOPQ account for the majority of the around 500 visitors of the congress. 106 visitors came from abroad, the biggest part thereof from Europe. Altogether there were participants from 25 years attending the congress, among others from Vietnam, Thailand, Bangladesh, China, the Bahamas, Saudi-Arabia and Japan.

The fact that so many countries were represented shows how big the need is for knowledge of the treatment of foot problems world-wide. In many countries there has not been any education or recognition of the profession yet. But also for this purpose international congresses are important. With the help of the communication with colleagues you can learn how to create the respective structures in your own country. Also the specialized exhibition was a lot bigger this year. 80 companies exhibited their goods and services at altogether 102 stands, 25 of the companies were from abroad. Jonathan Strauss said, “Never before did we have so many exhibitors at an event”.

As a special guest, the PAC could welcome Edward Lamaire, president-elect of the ISPO-International (International Society of Prosthetics and Orthotics). He affirmed in his greeting how important it is to exchange views and to visit each other. Lamaire considered it a posi­tive and important step that the IVO did a session on foot-care at the last ISPO-congress in South Africa. He encouraged the IVO to become involved in the elaboration of international standards for foot-care and invited the IVO to participate again in the next ISPO-congress in Kobe, Japan, in 2019.

Combining science and practice

Delegates, exhibitors and speakers from 25 countries attended the IVO-Congress in TorontoThe PAC composed a manifold specialized program for the IVO-congress, big parts of which were interpreted simultaneously into German and French. The selection of the topics and speakers showed the self-conception of the PAC. Already at an early stage the PAC sought contact with science. Not only the training is established in the college. An essential goal of the association’s work is to scientifically examine and confirm its own experience. This was also reflected in the congress program, where repeatedly references to findings from research could be found.

Dr. Tom Michaud, sports physician from the USA, showed in his lecture on muscular activity and muscle training in case of pain at the lower extremity that there is a lot of proof in science for a positive effect of training, from muscle strengthening in case of knee arthrosis to stabilizing and unloading the joint to the training of the toes that play an important role in the fall prophylaxis. Dr. Michael Ryan, sports physician and pedorthist explained how difficult it is to gain scientific findings on foot orthotics, since not only the concepts of foot orthotics but also the studies differ very much from each other. Can we therefore relinquish science? As a practitioner you never know how good the foot orthotics really are, according to Ryan.

If the foot orthotics are not effective, the customers could simply not come any more or go to a competitor. Even if the state of the studies is contradictory, Ryan requires that also practitioners should be able to read and evaluate studies. And the state of the studies actually is not that bad at all. Ryan presented first results from his own multi-center study that show that foot orthotics for the most part remove pain or at least contribute to an essential improvement. Kelly Robb is a pedorthist trained in Canada, who dedicates herself to science and who currently does her PhD on neural mechanics, muscular activity and foot orthotics. She presented in her lecture findings on the effect of foot orthotics with structured surfaces for gait improvement in Parkinson patients. Also Klaas Postema, professor for rehabilitation from the Netherlands, dealt with studies on foot orthotics providing a sensory input to the foot via their surface or vibration. His focus was on the effect of structured surfaces of foot orthotics for the fall prophylaxis in older people.

In spite of all the science the practical experience did not come up short. Kevin Fraser, a pedorthist who heads the technical orthopedic department in the Sunnybrook hospital in Toronto, showed with various examples how the interdisciplinary cooperation can be successful for the treatment of patients. “Each of us has to know, when he or she should send the patient to a different specialist and you have to ask yourself if you indeed know the other specialist,” he considered as the most important condition for a successful cooperation. Fraser said that it was also scientifically proven that the interdisciplinary approach improves the treatment. Together with his colleague Gordon Ruder, a trained orthopedic technician, Fraser showed with three case studies how pedorthists and orthopedic technicians can cooperate in the treatment of patients.

Dr. John Embil, a diabetologist from Winnipeg, Canada, explained in his lecture that it is not only important within the treatment of diabetes to acquire the efficiency of the medical therapy, such as for example the duration of the wound healing. The benchmark should be the patients’ health-related quality of life. Here not only the physical health is important, but also to what degree the disease impacts and limits daily life. Concerning the cooperation of the patients Embil emphasized that the patient has to understand that there is a problem and that he himself can be part of the solution. To scare patients does not help at all. You should keep the message simple, repeat it over and over again, but also allow time for decisions if you want to get the patients to cooperate.

Edward LemaireTom MichaudMicheal RyanJohn Embil

Karl-Heinz Schott talked about his experience when he started his com­pany in Australia 30 years ago. The start had been quite difficult, since his profession was practically unknown there and foot problems had only been treated with foot orthotics or orthoses. Over the years however he has managed to establish as a therapy a combination of an individual foot orthotic and an individually manufactured shoe that also can have an effect of an orthosis. Using different examples, Schott showed which treatment options orthopedic shoes can provide. Today also in Australia the custom orthotic shoe is known, even if it still not as much accepted as other therapies. But a custom orthotic shoe is a low priced care, Schott emphasized, if you consider how many costs it can save elsewhere.

There are more and more analyzers being worn on the athletes’ bodies. Already today many runners used supporting technologies when doing sports that collect data on their behavior and their movements, Reed Ferber from the University Calgary explained. Due to these data the athletes changed their behavior, also to avoid injuries. Ferber can imagine a similar development in patients’ care. “Practitioners used to have an advantage in the knowledge of what helps a patient”, Reed said concerning the wearable. But science caught up and the advantage was shrinking, Ferber said.

Will this help to detect what is wrong with the athlete before he notices it himself, as Chris Lawrie of Fitfoot360 phrased it at the panel discussion innovations in pedorthics? And does this technology make the pedorthist redundant?
There were different opinions on this topic during the discussion. Stephen Paris, a pedorthist from Vancouver, warned with all technology around not to neglect the direct relationship to the customer that also played a decisive role for the success in a treatment. We will have much more data, Reed Ferber believed.

The social night at the Hockey Hall of Fame in Toronto turned out to be one of the highlights  of the congress. Many visitors showed up in their own hockey jerseysBut we need people to implement these data. “The expert knowledge will stay,” Fred Holtkamp from the Netherlands was convinced, he developed a glove for the collection of 3D-data. Also Chris Lawrie does not think that technology substitutes experts. Treatment should be supported by technology and not be driven by technology. Further topics of the congress were the motion analysis, an indication matrix for footwear and foot orthotic care, wound care, the international nomenclature, sensorimotor foot orthotics and the pressure reduction in the treatment of diabetic feet.

Further education and networking with colleagues

The PAC proved to be the perfect host during the entire congress that offered ideal conditions for further education and networking for the international community of pedorthists. The hotel and the congress centre were under the same roof, so all participants had only short ways. And a direct hit was the venue for the festive evening. In the Hockey Hall of Fame in Toronto everything important related to Canada’s national sport is shown and it provided the suitable environment for the event. Instead of suits the dress code was “ice hockey jerseys”. Not only many Canadians, also foreign guests followed this invitation and showed up in the ice hockey jerseys of their local clubs.

The next IVO-congress will take place in 2021. After 21 years Germany will be the host once more. The Central Association for Pedorthics (Zentralverband Orthopädieschuhtechnik) and C. Maurer Fachmedien will then invite everyone to Cologne, where the IVO-congress will take place on 22 and 23 October 2021 together with the trade fair “ORTHOPÄDIE SCHUH TECHNIK” (“PEDORTHICS”).

80 companies in 120 booth presented their products and services at the exhibition