Successful completion of an orthopaedic footwear training

The 2nd cohort of students had their exam and graduation in the 2nd week of December at VIETCOT in Hanoi, Vietnam. VIETCOT is the Vietnamese Training Centre for Orthopaedic Technologists (VIETCOT) in the Vietnamese Capital Hanoi. 8 students from different countries successfully completed an 18 month full time educational program. The course was developed and delivered by Fontys University of Allied Health Professions (Fontys Paramedische Hogeschool, Eindhoven the Netherlands) with cooperation and support from VIETCOT in Hanoi. By Karl-Heinz Schott

The program was initiated by the Netherlands Leprosy Relief (NLR) and Liliane Foundation (LF) and received support from the Dutch Postcode Lottery. Also in 2017 this programme will be supported by all partners and Fontys University together with the VIETCOT and aims at a long-lasting durable collaboration on ortho­8paedic footwear – pedorthic orthotics and prosthetics.
There is no other similar program in South East Asia and there is just as much need for footwear as assistive technology as it is in every other country. The program started in 2014 with the first group of students from different countries of the South East Asian region graduating in December 2015. Typically the students are sent and supported by a healthcare or welfare organisation of their home country and are expected to start work in their sending organisation upon their graduation. The students get individual funding support from the Dutch Postcode Lottery. In the programme budget, supported by the Dutch Postcode Lottery a scholarship is foreseen that includes tuition fees, costs for living and a ticket from and back to home.

Second course
Now the 2nd group had completed the 18 month full time training program and went for the examination. At the beginning of the examination process the students were given a patient with a need for orthopaedic footwear and orthotic element. All patients had a significant foot health issue. Those included pes equino varus, post polio, partial foot amputations, diabetes mellitus, leprosy to name just a few.
The student started with the assessment of the patient’s related medical history, needs and wants. This included a gait evaluation, muscle strength test and other functional tests that may impact the management of the patient. Out of that information the student ­developed a treatment plan and discussed it with the patient. The student took all required measurements, a ­profile drawing as well as the plaster cast negative. This was followed by the creation of a cast positive / last for the patient using a PU foam resin method. The student then designed and built the orthotic element. The patient was then called in for a diagnostic fitting. During the fitting the student reviewed and if required amended the treatment plan, the cast positive and the orthotic element.

Design, report and patterns
The student moved on to design, do the patterns and make an upper for the footwear based on the medial needs and the wishes of the patient. The upper was then hand lasted by the student and the footwear was finished.
The student wrote a detailed report about the patient, including research about the deficiency and background of the problem, the assessment outcome, the pathology he/she was confronted with as well as the solution that was developed and made. The report contained pictures of the patient’s foot as well as of stages showing the production of the trial fitting and footwear.
The finished work as well as all supporting documentation was handed over to the examination committee. This consisted of all assessment and measurement records, a detailed profile drawing, the cast positive / last, trial fitting shoe, patterns, the orthotic element and the finished footwear.

Presenting to the examination board
The examination board consisted of Tran Doanh orthopaedic medical doctor from Hanoi Vietnam, Nguyen Hai Thanh, director of the VIETCOT, Joel Nininger Head of ICRC-SFD (International Committee of the Red Cross, Special Fund for the Disabled) Office for Asia, A.J.M. Dehing, Fontys University, ing. Fred Holtkamp MSc., Associate Lector, Fellow, Chair Health Innovations & Technology, Fontys University, and Karl-Heinz Schott, OSM, IVO observer and Lecturer in Pedorthics Southern Cross University, Australia, Nguyen Anh Tuan, Prosthetist & Orthotist and Orthopaedic shoemaker, lecturer at VIETCOT and Rianne Van Pijkeren, orthopaedic shoemaker acted as advisors.
The board excluding the orthopaedic surgeon but with support from OST head teacher Rianne van Pijkeren, Orthopaedic shoemaker inspected all the presented work individually. The treatment plan and documentation was compared to the actual orthoses and footwear to look for consistencies or inconsistencies. The concept and workmanship was evaluated in detail.
The next day the examination board reconvened this time with the orthopaedic doctor. It was the day students were presenting their patient and their work to the examination board. The presentation started with a PowerPoint presentation by each student outlining the patient’s issues and their treatment concepts, followed by a fitting of the finished footwear with the patient. Members of the board asked questions to the students after the presentation about the case the student presented and about the work that was done. The patient was asked to walk with the footwear in front of the board with the student discussing the outcome. This included reflection on what could be improved.
8 out of the 9 students graduated with a full diploma in orthopaedic shoemaking. The quality of the presented work was overall good or very good with a couple of outstanding performances.

Fontys and Vietcot developed and delivered a high quality program and head teacher Rianne van Pijkeren did an outstanding job delivering the teaching on the ground in Hanoi. Fontys sent a number of lecturers over to Hanoi throughout the course to deliver a number of intensive workshops and lectures on a variety of subjects like biomechanics. Fred Holtkamp from Fontys was the man behind the concept and monitored the delivery at a high standard. The delivery of the program, the competency the students achieved were of a high international standard. The examination process and task were of a high international standard and consistent with other examinations the writer of this article has attended. The 18 month intensive program produced a competency that seems consistent with the IVO educational standards at level 2.