FRIDAY, APRIL 13TH
9:00 am – 10:00 am
Keynote 1: John Embil – Quality of Life of Adults Living with Diabetic Foot Disease
By attending this session, the participants will be able to:
- Outline the concept of “Quality of Life”
- State how diabetic foot disease influences quality of life
- State how we can have a positive influence on quality of life
10:30 am – 11:15 am (choose one of three)
BO1: Kathleen Klement, MClSc-WH, C. Ped (C) – Ebb and Flow – Understanding Vascular Disorders in the Lower Limb
Vascular disorders of the lower limb are present, in varying levels, in all healthcare practices across Canada. Presenting frequently with other co-morbidities, vascular disorders can present significant challenges when managing a patient’s foot care. This presentation will act as a primer on vascular disorders with a focus on the effect on and complications within the of the foot and lower limb. The etiology of each pathology, relevant diagnostic tests, treatment protocols with be discussed, with a focus on the effects that these pathologies have on the ongoing foot health of the patient. Pedorthic management strategies, evidence-based treatment options, concurrent treatments and contraindications will be discussed throughout the presentation, with Q&A at the conclusion of the lecture.
BO2: Rob Verwaard, BSc. – Indication Matrix Model – A Systematic Approach for Setting Up Treatment Plans for the Provision of Pedorthic Footwear
Before one can supply pedorthic footwear to a patient, it is important to set up a treatment plan that helps the pedorthist, the client and the prescriber to determine the goals and the approach for the treatment. When it comes to determine what functionality the pedorthic footwear treatment needs, the method of the indication matrix can be helpful. In this presentation, the systematic approach for setting up the treatment plan by using the indication matrix, is explained.
The indication matrix model is a decision-making model that describes the different relationships between the medical indication, the effects of the disease, the requirements of the treatment and technical specifications of the pedorthic footwear. The indication matrix helps to develop and transfer knowledge, provides an objective and transparent way of working, reduces variations in practice, provides a unity of language and can be a source for research and development.
Although the Indication Matrix Model is based on the Dutch situation, the model itself (possibly adapted) can be used in every situation and, therefore, is important for all foot professionals.
BO3: Célia Fischer & Nour Zeenni – Inventory of the Various Technical Possibilities to Reduce Pressure on the First Metatarsal Head in Case of Diabetes
- Definition of a clinical examination protocol based on a sample of approximately 650 subjects.
- Clinical and podoscopic examination should serve in defining the circumstances promoting the appearance of a high-pressure area under the first metatarsal head.
- Classification of degrees of involvement based on skin condition, pain intensity and pressure.
- Details concerning response measures to each type of involvement with a view to eliminating pressure or minimizing its intensity. Description of devices.
- Testing of three devices on three subjects with diabetes using plantar pressure analysis tools.
The size of the reference sample allowed comprehensive analysis of subjects ranging from young athletes to the elderly including subjects with diabetes or rheumatoid arthritis.
The variety of devices, ranging from podiatric appliances to mass-produced or custom-made therapeutic footwear, shows the importance of the pedorthist’s role in managing orthopedic foot deformities.
11:30 am – 12:15 pm (choose one of three)
BO4: Kelly Robb, MSc, C. Ped (C) – Why Does Texture Matter? Preliminary Evidence Supporting the Use of Textured Orthotics in Parkinson’s Disease
Why does texture matter? In hopes to address this question, Kelly’s presentation will begin with a review of mechanoreceptor anatomy, relevant neural pathways, and explain the future of somatosensory integration in orthotic fabrication. A brief literature review will highlight our current understanding of the somatosensory system’s role in balance and gait. Current research is goaled at determining if orthotics, with and without a textured top cover, can improve dynamic stability, muscle activity, and turning performance in individuals with Parkinson’s disease. Recently, distinct areas of plantar surface mechanoreceptor topography are being evaluated for specific lower limb muscle activation in healthy individuals.
BO5: Dominik Rudolph, Cert. Prosthetist & Orthotist – Range of Motion Analysis of the Metatarsophalangeal Joint 1 (MTP joint 1) Using a Gait-Analysing Software and a New Wound-Care Shoe
Post-operative immobilization is of extraordinary importance to secure the result of a surgical correction of the hallux valgus.
The often practised KIRSCHNER-wire-osteosynthesis stabilizes the bones during the rehabilitation process and afterwards when the patient will be mobilized with orthopaedic aids such as crutches and wound-care shoes.
Analysing the human gait by subjective observation is often not sufficient and should be proofen by a gait analysing software. By using the gait analysing software the individual motion phases in detail of a subject are visible while wearing no shoes, a traditional wound-care shoe and a new wound-care shoe model. In this analysis the view onto the medial MTP joint I will be clarified, and demonstrate the range of extension and flexion while normal and changed gait sequence.
BO6: Mariam Botros – Wounds Canada and You
Approximately 15 per cent of people with diabetes, will develop leg or foot ulcers in their lifetime as a consequence of their disease, with 14 to 24 per cent of them eventually requiring amputations. This is a tragic statistic given more than 50 per cent of these amputations could be prevented if those with diabetes knew how to prevent or manage their foot ulcers.
To reduce the prevalence of these amputations the Wounds Canada has developed a division (Diabetic foot Canada) dedicated to t supporting patients, front line clinicians and policy makers in the care of patients living with diabetic foot disease.
This session will provide delegates with an overview of available tools and programs through Wounds Canada and explore and their role in evidence based care and improving patient outcomes.
1:45 pm – 2:30 pm (choose one of three)
BO7: Thomas Stief – A New International Nomenclature Used in the Field of Foot Orthotics/Pedorthics
Until now, no internationally accepted terminology and method exists to describe devices applied to the foot and lower leg to address neuromusculoskeletal impairments. On behalf of the Working Groups (WGs) of Technical Committee (TC 168) of the ISO we would like to bring to your attention the work that the Groups have done regarding standards for the field of Orthotics and Prosthetics as well as Foot Orthotics/Pedorthics. The objectives of this work are the creation of uniform internationally accepted terminology to describe the processes, the personnel and the technology used within the fields to ease communications and to discourage the use of incorrect and inaccurate language. In the presentation, we will give a profound insight in the new ISO Standard ISO 21064:2017 Foot orthotics – Uses, functions classification and description. The content will be the terms and definitions, the clinical objectives, classification and description of devices: foot orthoses, orthotic footwear, adaptations (modifications) to footwear.
BO8: Kevin Fraser, C. Ped Tech (C), C. Ped (C) & Gordon Ruder, C.O.(c), F.C.B.C., M.Sc., B.Sc. – The Multidisciplinary Approach of Management of Lower Limb and Foot Dysfunction
The foot is a complex anatomical structure. As such, effective treatment of foot dysfunction often requires a multidisciplinary approach. Professional partnerships and collaborations are the foundation of the multidisciplinary model or patient care. This presentation will examine the multidisciplinary approach to clinical care as it relates to the management of lower extremity and foot dysfunction. It will explore the potential role that Canadian Certified Pedorthists and Orthotists can play on the team. It will discuss the benefits of employing this model; including the potential improvement in treatment outcomes, patient satisfaction, expansion of clinical resources and support, and even the broadening and diversification of referral sources. Lastly, this presentation will seek to develop useful strategies that Orthotists, Prosthetists and Pedorthists can employ within their own practices and communities.
Panel 1: Kelly Robb, MSc, C. Ped (C), Karl-Heinz Schott, CPed CM, OSM, Podologe, Klaas Postema, MD, PhD, Rob Verwaard, BSc. – Somatosensory System/Sensorimotor Orthotics
Sensorimotor orthotics are currently used across Germany and central Europe; however, minimal acceptance has spread into Canada. The purpose of this speaker panel is to increase our understanding of the role of the somatosensory system and the use of sensorimotor orthotics in pedorthic care. Topics include the theoretical principles behind sensorimotor orthotics and the status of current sensorimotoric insole research in European countries. In Canada, the use of texture and facilitative insoles are being used to facilitate mechanoreceptor activity in healthy and neurological populations. Research supporting the use of somatosensory systems/sensorimotor orthotics and pedorthic care is ongoing, with promising results leaning towards future knowledge translation into clinical practice.
3:00 pm – 4:00 pm
Keynote 2: Klaas Postema, MD, PhD – Vibrating Insoles: Effects on Balance and Vibration Pressure Threshold
Older and diabetic people are often confronted with decreased somatosensoric information. Joint position sense and the pressure sense get worse. This results in worse balance performance and higher chance of falling. The decreased pressure sense also increases the risk of ulcers. These are all challenges for the pedorthist, because with the current pedorthic interventions unloading is quite possible, but these interventions are contrary to balance performance. For increasing balance performance it lacks the pedorthists on useful interventions.
Sensoric insoles are becoming popular. One of those types is the insole with vibration. The current literature about vibrating insoles will be discussed. In the University Medical Center Groningen we developed insoles with stochastic vibration. Stochastic resonance is a white noise, meaning that the frequency is continuously changing. The amplitude is put on 90% of the amplitude that was sensed by the subject. The noise is added on the pressure sensoric input and together they are supposed to pass the sensation threshold, resulting in better sensoric perception. We performed several studies with the vibrating insoles.
- In diabetic subjects and healthy controls we looked at different balance parameters.
- In 12 elderly we looked to balance during walking by studying the COP-displacement in single stancephase.
- In 40 patients with diabetic neuropathy we measured the vibration perception threshold before and after applying stochastic vibration.
- The results of these studies will be presented and discussed.
4:00 pm – 5:00 pm
Plenary 1: Cal Harrison, BA, MBA, CMC – Separating Your Practice from Other Footwear and Orthotic Providers
In a market place crowded with low-quality, low-price footwear and orthotics providers, how can you make your professional practice stand out, without resorting to price competition?
The strategy is an easy one to define – position your practice as one that has superior expertise and quality over other footwear and orthotics providers and therefore allow you to charge premium prices. While the strategy may be obvious, executing it can often be a challenge. In this presentation Cal will provide the framework for executing the “position yourself as an expert strategy” in the market place.
Attendees will learn how expertise is evaluated by consumers, so you can define, communicate, and prove your expertise in a way that makes it easy for a potential new patient to choose your higher value, higher quality option over competitors attempting to encroach on your market. This simple structure of a positioning statement and related benefits is easy for you and your staff to use and results in greater conversion of opportunities to clients, and at a price point that reflects your added value. It also makes “selling” respectful and comfortable for your professional staff.
As well as explaining how to create and communicate your position as an expert in the market, Cal will discuss the top four methods for translating this position into a higher number, of higher margin, client acquisition opportunities for your practice.
- Making it easy for referrers to refer you (without price discounts or referral fees)
- Shifting from “entertaining” to “educating” to drive client acquisition
- Implementing marketing processes that your pedorthists and technicians will want to be a part of
- Helping Google direct potential clients to you (I will show you how other experts turn their websites into client education destinations and then how Google turns that into new customers)
SATURDAY, APRIL 14TH
8:30 am – 9:30 am
Keynote 3: Thomas Michaud, DC – The Role of Foot Strengthening in the Management of Lower Extremity Injuries
Strengthening specific small muscles of the foot and ankle can play a huge role in performance enhancement and injury prevention. Numerous studies have shown that foot/ankle strengthening exercises can improve balance, increase arch height, enhance jump performance, and increase gait velocity. Because forces on the foot peak during push-off, weakness in the toe and/or arch muscles may lead to a variety of injuries including plantar fasciitis, stress fractures, bunions, and Achilles tendinitis. Maintaining strong toes and arches is especially important as we age, because older adults have toe strength declines of more than 35%, and the resultant toe weakness has been correlated with an increased risk of fall. Falls in the elderly are common and the likelihood of a person over 70 experiencing a fall is almost 40%. In a prospective study of 300 senior citizens by Mickle et al. (1), non-falling seniors had 20% more toe strength than the seniors who fell. In another study, the same author confirmed that the hallux is key to fall prevention: for every 1% body weight generated beneath the big toe, a senior’s fall risk is decreased by 14% (2). This lecture reviews lower extremity muscle anatomy relates this information to preventing falls in the elderly and treating/preventing injuries in athletes.
- Mickle, K, et al., ISB Clinical Biomechanics Award 2009.Clinical Biomechanics. 2009. 24:787-791.
- Mickle K, et al. Clinical Biomechanics. December 2016;40:14-19.
9:30 am – 10:15 am
Plenary 2: Michael Ryan, B.H.K., M.Sc., PhD, C. Ped (C) – Do Foot Orthosis Work? Reporting from a Large Multi-Clinic Dataset on Clinical Effectiveness, Comfort, and Compliance
The objective of the present study is to report on preliminary effectiveness and comfort outcomes in patients seen in 9 pedorthic clinics in Vancouver, Canada in 2016 using a prospective clinical software management system (Kiwi, Surrey, Canada). The outcomes from this analysis offer important insights into the clinical effectiveness of custom foot orthoses for lower extremity injuries on a large-scale sample. There is also good support from this study on the overall usage and perceived comfort of custom foot orthoses. Further research in this area will examine patient-centered factors (anthropometry, activity level, chronicity, etc.) that are correlated with orthosis success, as well as improving sampling methodology to optimize data integrity.
This study will be the largest repository of clinical effectiveness for foot orthosis outcomes to-date and could play an important role in defining best practices approaches to orthotic management of lower extremity injuries, and verifying the economic utility of these devices.
11:15 am – 12:00 pm (choose one of two)
BO9: Karl-Heinz Schott, CPed CM, OSM, Podologe – Unique Selling Point and Key Competency for Pedorthists (Custom) Footwear and Orthoses
I established my Pedorthic clinic in 1988 in Sydney Australia. I focused first on custom foot orthoses only as they were the most profitable. I soon realised that in that this market was and is highly competitive due to its high margins. Pedorthics was not an established health care profession at that time and I was constantly undermined by other providers in the foot orthoses market challenging my Pedorthic qualification. A long discussion led to the conclusion that we as Pedorthist have a unique selling point in the footcare market which was underserviced.
I started to look at footwear and orthotic combination. Here especially the custom footwear for complex foot and ankle issues. With this new focus I endeared our service to the orthopaedic foot and ankle surgeons who finally had someone to refer to for their complex foot and ankle issues. Because we not only offered a foot orthosis or an AFO, but also the complete package including custom footwear for the most complex cases. The support of the orthopaedic surgeons led to a greater acceptance by other health care providers. It was and is important to offer the Pedorthic services with a unique selling point in an economical viable way to assure such services are available to patients and provide future employment for Pedorthic University graduates. The presentation will be about the journey the lessons learned, Pedorthists being the market leader in foot health/orthoses/footwear and the future prospects.
BO10: Reed Ferber, PhD, ATC – The Research Evidence Behind an Effective Clinical Gait Analysis
1:45 pm – 2:30 pm (choose one of two)
BO11: Benoit Boyer, BSc(Kin), C. Ped Tech (C), C. Ped (C) – A Broad Look at Underlying Technologies in Foot Scanning Systems
Many different foot scanning systems are used in the production of foot orthoses. Some of these systems are consistent with Pedorthic standards, while others are not. The Pedorthic Association of Canada recently published guidelines to help insurers know which scanners can produce true anatomical orthoses and which cannot. This session will explore several different technologies in the context of these guidelines. Attendees will gain a better understanding of the physics and math of various types of 3D imaging. The session will take a broad look at underlying technologies rather than an in-depth focus on specific models or implementations of scanners. This information will help you to make informed decisions about implementing scanning technology in your practice or lab.
BO12: Sayed Ahmed, C Ped CM Au, PhD Candidate, B.Sc. in Footwear Eng., MBA – The Bridge Between Current Literature and Practice in Diabetic Footwear: Clinical Practice Guideline for Optimum Offloading of the Diabetic Foot
In diabetic patients, significant offloading can be achieved at high risk foot regions by following a data driven approach. The goal of this study was to systematically review the literature for footwear prescriptions for ulcer prevention and reduction.
Results & Discussion
The goal of diabetic footwear is to redistribute and reduce plantar pressures and avoid mechanical stress on the dorsum of the foot.
This can involve the fabrication of total contact accommodative insoles, fully customised orthopedic footwear incorporating arch supports, metatarsal bars and pads, rigid forefoot rocker or rocker sole with specific pivot point location and angle. Further studies will be conducted in order to inform the clinical and scientific communities regarding the effects of these aspects of footwear design in diabetic populations.
2:45 pm – 3:30 pm
Panel 2: Reed Ferber, PhD, ATC, Chris Lawrie, Fred Holtkamp, Ing. MSc. B.p., Geert Jos van der Maazen, Dominik Rudolph, Cert. Prosthetist & Orthotist – Innovations in Pedorthics
Websters defines innovation as a new method, idea or device. Innovation is essential to the long term health of any industry or business and for us as pedorthists to continue to grow we must innovate. This panel brings people from around the world together to share ideas and experiences and to continue to drive pedorthics to be the leaders in foot care worldwide.
3:30 pm – 4:30 pm
Keynote 4: Reed Ferber, PhD, ATC – The Role of Wearable Technology in Clinical Practice
Wearable technology is a growing multi-billion dollar industry as the result of an exponential increase in the availability of cost-effective wireless sensors. However, these various sensors are not aimed at healthcare in general and while the output from current sensors provides helpful summaries of motion, they fall short of detailed data that can predict injury and disease and inform rehabilitation and recovery.
Wearable sensors can play an important role in healthcare by monitoring an individual and potentially enabling early detection of illness, injury, and disease, leading to early intervention, treatment and improved patient outcomes. However, there are two gaps within the current sensor market and within academic research: (1) the user generates a profound amount of data that is largely ignored and (2) the information derived from sensor data is not placed within a contextual narrative for healthcare providers or their patients.
The purpose of this talk is to provide an overview of wearable-sensor research and how a practitioner can take advantage of wearable sensors to help improve their daily practice by making evidence-informed decisions. We will also discuss the future of wearable technology and how the field of pedorthics will be transformed in the very near future.