100 years of Pedorthics in Germany

“The orthopedic shoe is one of the most important treatment meas­ures in the hands of a medical specialist.”, pedorthist Max Sahm proclaimed nearly 60 years ago. Today custom orthotic shoes, as they are called now, are still an important field of work for ­pedorthists in Germany.

On April 8, 2017, the Central Association for Pedorthics in Germany (Zentralverband für Orthopädie­schuhtechnik, ZVOS) could celebrate its 100 years founding anniversary. Many things have changed within these 100 years. But the basic idea of the founding fathers is still valid: To help people with foot problems being mobile again.

by Wolfgang Best

When the “Bund orthopädischer Schuhmacher Deutschlands” (Asso­ciation of Orthopedic Shoe­makers of Germany) was founded in Leipzig on April 8, 1917, the First World War was already in its third year. It has not been recorded if this was the concrete occasion for the foundation of the association.
Already since the turn of the century companies were founded within the German speaking area that specialized in the treatment of foot diseases with orthopedic shoes and foot orthotics. In the years before the First World War there have repeatedly been attempts to organized those shoemakers who further ­educated themselves in pedorthic treatments of feet in their own association. Probably the rising number of soldiers with foot injuries that needed to be treated with orthotic footwear since 1914 by the existing companies was one important motivation to finally put this plan into action. The aim was to better represent their own interests as against public bodies, for example the reimbursement of aids and appliances, but also regulation of the education and quality assurance of treatments. Already few years after the foundation of the ­association, the education program for ­pedorthists could be established at the University of Applied Sciences in Siebenlehn/Saxony.Therapy shoes for the rehabilitation after the rupture of the achilles tendon or the rupture of ligaments were developed in close cooperation between orthopedic surgeons and pedorthists in the nineteen-eighties. Left: The first model, produced in cooperation with adidas. Right: Today’s design from Orthotech.
The foundation of the Association of Orthopedic Shoemakers of Germany was, in retrospect, the crucial step towards the development of the allied health profession pedorthics the way it is known today.
The founding fathers had recognized that craftsmanship alone is not sufficient for the treatment of foot problems. To be pedorthist means to understand how diseases of the locomotor system develop, how they impact motion and how we can cause a positive change with orthopedic appliances. This idea is still decisive today for pedorthics – regardless of all changes and innovations that has formed it in the past 100 years.

From victims of war to lifestyle diseases
The treatment of war victims ruled the work of pedorthists in Germany for many years, especially after World War II. With their work they could give back not only mobility, but also the capacity to work to many people injured during the war. Other important fields of activity of pedorthics were feet with congenital or acquired deformities that did not fit into a ready-made shoe. In this case usually only the custom orthotic shoe could maintain or restore the ability to walk.
Pedorthic solutions have decreased in the second half of the 20th century more and more. Due to progress in foot surgery, many foot deformities could be corrected in the past decades in a way that treatment with custom orthotic shoes is no longer mandatory.
The tasks of pedorthists however have not dimished. Foot problems and foot deformities caused by shoes not suitable for feet have been an important field of activity within pedorthics for more than 100 years. With the increasing spread of lifestyle diseases new tasks came in addition. People suffering from rheumatism and diabetes often depend on pedorthics in order to walk without pain or to prevent foot injuries or even amputations. Furthermore, many companies in Germany specialize in sports and enable athletes the pain-free exercise of their sport and an improvement of their performance.Celebrating 100 years: Werner Dierolf, president of todays Zentralverband Orthopädie­schuhtechnik, the successor of the Bund der Orthopädieschuhmacher, cuts the cake at the jubilee celebration. It took place on April 8 , 2017, at the Thüringer Hof in Leipzig, where to the day 100 years earlier the first assembly of the newly founded association was held.
During the last hundred years the materials and aids have been adjusted to the state of the art again and again. In the seventies leather and steel were ­replaced for example with new plastics that enable lighter and still stable constructions of aids and appliances. Lately new technologies have found their way into pedorthics. Today measures of feet are often taken digitally with scanners. Foot orthotics and lasts can be milled based on digital data. Many companies use foot pressure measurements – especially in the diabetic foot syndrome – as well as video cameras for motion analysis in order to detect loads and overloads. But we are still a world away from the time when technology will replace knowledge and expertise of pedorthists. Analyses need to be interpreted, and the milled foot orthotics and lasts are only as good as the data used for the milling. Without the knowledge on suitable measures and the correct form of the aids and appliances even the best mill is useless.

Orthopedics and craftsmanship need each other
The development of pedorthics in Germany is characterized by a close cooperation with medical specialists of pedorthics. In the year 1951 the German Association for Orthopedics and Orthopedic Surgery (Deutsche Gesell­schaft für Orthopädie) founded the advisory committee for pedorthics, until today staffed with physicians and craftsmen. But also in the German Democratic Republic orthopedics and craftsmen were closely linked (see box on the history of pedorthics in both German states). This resulted from the insight that medical specialists and craftsmen have to cooperate in an interdisciplinary way for the treatment of a difficult patient case. “No other specialty of medicine needs the support of excellently educated allied health professions and supporting professions as urgently as orthopedics”, the director of the professional school in Frankfurt, Max Sahm, wrote on the occasion of the foundation of the advisory committee. “The orthopedic shoe is one of the most important treatment meas­ures in the hands of a medical specialist.”
Since its foundation, the advisory committee has taken a stand on many important topics for pedorthics and has established crucial rules for the treatment of foot problems and orthopedic aids and appliances of the foot. Due to the close cooperation ­between craftsmanship and medicine ­also innovations have been developed that substantially improved the treatment of patients. When in the eighties plaster as treatment measure after ligament injuries of the ankle joint was ­replaced by early functional therapy ­concepts, essential impulses for the ­development of suitable orthoses and therapeutic shoes came from the pedorthic trade.
“We can consider ourselves very lucky in Germany that these craft skills exist in orthopedic treatments, the local tradition is unique within Europe and decisively enriches the treatment options. It is necessary to preserve this treasure”, Prof. Bernhard Greitemann, current chairman of the advisory committee ­emphasized on the occasion of the ­anniversary.
This treasure of craft skills is based on the system of a dual education concept, proven in Germany for decades in craftsmanship. During an apprenticeship period of three and a half years the ­apprentices receive the practical education in a company. At the same time ­theoretical knowledge and occupational and cross-professional competence is transferred to the apprentices in vocational schools. This has the aim to quali­fy them for the independent exercise of the specific tasks within the profession.A new era begins: In 1992 the first CAD/CAM-system for foot orthics is presented at a pedorthic-symposium (left). 25 years later, the  designing and milling of foot orthotics and shoe lasts with the help of a computer is a common way of production (middle). The latest  technology that is about to take root in pedorthics is 3D-printing of foot orthotics and lasts (Photos far right).
The condition needed to run one’s own company is the title of master craftsman that can be achieved after ­finishing the basic education. To this end students usually attend a preparation course for several months with ­specialized, practical and business-management parts before they take the master exam before a Chamber of Crafts.
In times when all over the world many professions are studied at universities, also pedorthics has advanced. Since 2007 the University of Applied Sciences Münster Steinfurt has offered a dual professional education and a bachelor degree in technical orthopedics, combined in one education course. Apart from that, the studies can also be carried out after the apprenticeship certification exam. Additionally there is a broad further ­education offer on medical, bio-mechanical or technological issues enabling companies to be always up to date.
With a solid education in craftsmanship and the connection of craftsmanship to universities of applied sciences – and thus also to research in this area – the craft pedorthics is well equipped for the future development.

Two Germanys – two professional associations  

After World War II, Germany was divided into four occupation zones. In 1949 The Federal Republic of Germany was founded within the territory of the French, British and American occupation zone. In the same year the German Democratic Republic (GDR) was founded in the territory of the Russian occupation zone.
This way a period of 41 years followed where two German states existed as a consequence of World War II. During that time also pedorthics developed differently in both states. In the Federal Republic of Germany in 1951 the Association of ­Pedorthists (Verband der Ortho­pädie­schuhmacher, VOSM) was founded with the aim to establish the profession as an acknowledged and independent profession. This was finally successful in 1970 and the VOSM was replaced by the Bundesinnungsverband Orthopädie­schuh­tech­nik (German Federal Guild ­Association ­Pedorthics) as a joint representation of the guilds founded in the federal states.
In the GDR the crafts belonging to ­orthopedics organized themselves first in professional group associations in ­order to organize education and further education in the fifties. The close cooperation with medical specialists for ­orthopedics acquired an official frame with the foundation of the study group pedorthics. Common further education events and compulsory courses for physicians on the treatment with orthopedic aids showed the closeness between medicine and craftsmanship. Although the authorities in the so-called democratic socialism in the GDR did not approve of it, the connections within the craftsmanship of the two states never ceased to exist. Personal visits, but also the interchange of professional literature made sure that both crafts worked on the same level, even if many modern materials were not available in the GDR.
With the peaceful revolution in the year 1989 and the unification of both German states in 1990 the study group ended. In 1991 the guilds founded in the new federal states joined the German Federal Guild Association Pedorthics.
After more than 40 years pedorthists in Germany were reunited again.