IVO-Congress shows variety of topics on international scale

When the world of orthopedic shoe technology meets at the IVO-congress every three years, traditionally the most different national issues and treatment concepts as well as international approaches around foot and shoe come together. That was also the case in Paris on 19 and 20 March.

Every three years the IVO-congress offers orthopedic shoemakers from all over the world the possibility to exchange experiences and to get further education. Serge Mathis, president of the French association UPODEF, host of the congress this year, could welcome 856 guests from 16 countries in the congress area of Disneyland Paris. 56 companies presented their products and services in an area of 762 square meters.

"The delegates were very happy with the congress and the exhibitors could establish the contacts they wanted, " Maud Breton, project manager and responsible for the organization, said. Participants from Australia, Germany, Japan, Austria, Switzerland, the Netherlands, Canada, Belgium, Nigeria, Luxemburg, Algeria, Vietnam, Denmark, the Czech Republic and Gabon came to Paris - the biggest part, as usual with IVO-congresses, being the locals. And thus also the workshops, which were organized three times each, and which started the specialized program on Thursday morning, were in French. Topics were motion analysis, esthetic and modern design of orthopedic custom-made shoes or the trend topic 3D-print. Concerning proprioception the French perspective was contrasted to the German one, there was a workshop on equipping palsied patients with orthopedic custom-made shoes and also a case study on quantitative gait analysis - each without simultaneous interpretation into German or English, completely different from the lecture program in the big conference room.

They could enjoy a smooth course of action and a successful event: (from l.) Congress president Prof. Emmanuel Coudeyre, Serge Mathis, president of the French association UPODEF, Philippe Kaeufling, president of the event committee COJAP and Karl-Heinz Schott, who passed the IVO-presidency on to Serge Mathis at the end of the congress.

Extracts from the lecture program

Congress president Prof. Emmanuel Coudeyre could present a broad spectrum of topics. One meeting was on neurological lesions and multiple palsies. Also the diabetic foot, its prevention and treatment, as well as the rheumatic foot were focused in Paris. In the two sections on free topics the whole variety of what keeps researchers, physicians and craftsmen occupied could be seen.

Marc Weil, France, resourcefully presented his works for the competition "Meilleur ouvrier de France", showing the manufacturing of a lady's shoe, a man's shoe and a child's shoe. This is a workmanship competition, done every four years. The title "Meilleur Ouvrier de France" (Best craftsman in France), short M.O.F., is given to an excelling representative of different crafts – for the first time in the year 1924. For some years now also podo-orthésistes, French orthopedic shoemakers, are allowed to participate in the competition. Weil was the first one among them to get this prestigious award.

Evidence with sensorimotor insoles

One of the speakers with the longest trip to Paris probably was Katrin Wegener, originally from Germany, but meanwhile working in Australia as an orthopedic shoe maker. She presented a research project for the treatment with sensorimotor insoles according to Jahrling in case of the Charcot-Marie-Tooth-disease. Using a case study, she explained how important the evidence is for the recognition of the treatment. "In Australia people often ask: How does this work or function? And where is the corresponding publication?" Wegener said. Since so far there have not been any English publications on the topic, Footpower decided to initiate one itself and could start a pilot program together with the university in Sydney.

With the help of 3D-motion analyses it could be detected that sensorimotor insoles raise the eversion of the midfoot and the plantar flexion, as well as the eversion of the ankle. They caused slight but significant alterations to knee and hip, indicating a higher inner rotation. Concluding Katrin Wegener said that the examined sensorimotor insoles lead to changes in adults with Charcot-Marie-Tooth in kinematics, kinetics and the amount of pressure and are regarded as more comfortable, more cushioning and stable during walking.

Minimizing the risk of falling

Karl-Heinz Schott, still acting IVO-president during the congress, addressed the orthopedic shoe technological treatment of patients with high risk of falling in his lecture. Scientific studies showed that high heels and soft soles are not recommendable for such patients. Within a research project with the university in New South Wales some time ago a basic shoe, on purpose designed in a simple way, was developed and had only one element (component of shoe) changed.

"You can reach substantial stabilization with the help of orthopedic shoe technology - for example in elderly people who get balance problems by nature and thus have a higher risk of falling. But also in patients that have balance problems due to their disabilities and that have a corresponding risk of falling," Schott summarized the results of the variety of different test series and case studies.

Education project in Vietnam

How can you educate orthopedic shoe technicians in Southeast Asia? Prof. Fred Holtkamp concerned himself with this question. He presented a joint project between the Netherlands and Vietnam, where an education was devise, that corresponds to the international standard "Level 2". An extensive curriculum was designed enabling the students within only 18 months to establish an adequate orthopedic shoe technological treatment in their home country. Holtkamp did not question that this education cannot communicate everything with the same intensity as a 3 to 3,5-year education in Europe. Nevertheless he can see a good level in the first existing courses.

Different terms for same feet

Dr. Kris Cuppens of the Belgian Thomas More University College presented a project where foot types of healthy people and of patients with diabetic foot syndrome are measured and analyzed by a number of different experts. The aim was to harmonize the practitioners' common expert knowledge in categorizing or description of feet. This way the researchers found out that the experts typified the same feet with different terms. Typically the practitioners described here the position of the foot arch, the midfoot and the calcaneus. Agreements should arise hereof in connection with the collected measuring values about the definition of foot types, leading to a standardization of descriptions and thus to a better scientific usability of categorizations.

Treatment of ulcers in India

Diabetes has long since become an important topic in health care in India - and thus also the treatment of the diabetic foot. The requirements there are the same as everywhere in the world: Wounds have to be relieved in order to heal, Dr. Lakshmi Schankhdhar from India explained. Health care does not have the financial means to prescribe scientifically recognized aids such as the total contact cast or ready-made orthoses. Additionally, walking barefoot is still common in many regions in India and it is also important for religious ceremonies. This also makes the acceptance of foot treatments more difficult.

He discovered his method to relieve wounds rather by coincidence, Shankhdhar said. It is mainly based on a foam roller that is positioned directly behind the ulcer with the bandage. The roller is supposed to prevent loading of the ulcer. This self-made roller mainly reduces the force-time-integral, Shankhdhar claims, who was very successful with wound healing, according to his own words. The roller is applied fast and changes the gait pattern only slightly. Due to the kind of manufacturing it is low in price and thus also affordable for the poorer classes of population.

 

What makes treatment with shoes in Japan difficult

Hideki Endoh talked about the difficulties of the treatment of patients with the diabetic foot syndrome in Japan. According to statistics from the year 2013 the number of amputations at the lower extremities in diabetic patients caused through lesions has increased to more than 10 000 cases per year. Apparently there is not enough awareness for a health management at the foot. This is also caused by peculiarities of the Japanese society: On the one hand shoes only have a short tradition and on the other hand even today only few people wear shoes from morning to night. Also people do not spend a lot of money on shoes. The high temperatures and the humidity are an additional problem.

A study, presented by Endoh, showed that most Japanese diabetic patients with PAD were convinced that they wore fitting shoes - even if these caused ulcers and ulcerations. From that he concluded that physicians, therapists and orthopedic shoemakers have to explain to patients better what fitting shoes exactly are. He also appealed to look for a better solution for patients regarding the Japanese peculiarities. For example it is often sufficient to use a shoe instead of a boot as treatment due to the physical condition.

 

In preparation for Canada

"We look forward to welcoming you and your colleagues from all over the world in Canada in three years for the IVO-congress in 2018!" Jonathan Strauss said, the executive director of the Canadian association PAC. He thanked for the hospitality that the guests could experience in France. Apart from the hosts from the French association UPODEF, he also explicitly thanked the outgoing IVO-president Karl-Heinz Schott, who had prepared the way for the Canadian membership in the IVO: "We would like to thank Karl for the fact that he brought us to the IVO-congress in Basel in 2006. For us that was a great opportunity to see how orthopedic shoe technology is carried out world-wide. Now he looks forward to showing the international colleagues at the congress in 2018 how people treat feet in Canada.

The exact date and venue for the next IVO-congress have not been determined definitely.

By Kathrin Ernsting and Wolfgang Best