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Friday, April 12, 2019

8:00 am – 9:00 am Keynote

Mechanics and Energetics of the Human Foot: Do Intrinsic Foot Muscles Facilitate the Adaptive Function of the Foot?
Luke Kelly, B.Hlth Sci (Pod), PhD
The human foot is uniquely stiff to enable forward propulsion, yet also possesses sufficient compliance to act as an energy store, recycling mechanical energy during locomotion. Historically this dichotomous function has been attributed to the passive contribution of the plantar aponeurosis. However, much of what we know about the function of the human foot is based on studies of constant speed locomotion, when the body centre of mass (COM) performs net zero mechanical work. However, we rarely move at constant speed and we need to continually dissipate and generate mechanical energy to slow-down and speed-up, adapting the speed and direction in which we move. This is generally achieved by muscles of the lower limb performing eccentric and concentric contractions. As the interface between our body and the ground, the foot plays an important role in facilitating application of forces generated by the large muscles of the leg to the ground. Therefore it may also be important that the mechanical function of the foot can be adapted to suit the requirement of the COM when speeding up, slowing down or changing direction.
The plantar intrinsic muscles of the foot span the longitudinal arch, coursing a similar anatomical pathway to the plantar aponeurosis. Until recently little has been known about the mechanical function of the intrinsic foot muscles during locomotion. As contractile tissues, these muscles have the capacity to dissipate and generate mechanical energy, to aid in the adaptability of human locomotion. This presentation will provide an overview of how the intrinsic foot muscles contribute to the mechanical and energetic function of the human foot.

9:00 am – 9:45 am Plenary

The Roles of Fundamental Foot Theories in Dynamic Movement
Lauren Welte, B.A.Sc.
The human foot is a complex structure that is remarkable in its ability to manage loads and adapt to terrain during locomotion. An integral component of this adaptation is the longitudinal arch, a structure composed of numerous bones, muscles, tendons and ligaments. The foot is thought to function dichotomously as mobile adapter to absorb load and return energy, and as a stiff lever to facilitate propulsion through the windlass mechanism. However, technological limitations to date have limited our ability to measure in-vivo dynamic bone motion in the small bones of the foot. Using technology such as bi-planar x-ray videoradiography, the dynamic movement of these bones can be measured and coupled with fibre models to elucidate the roles that the various fundamental theories of foot function play.

10:15 am – 11:00 am Plenary

Free Moment Application Between the Foot and the Gorund in Human Locomotion
Steffen Willwacher, Institute of Biomechanics and Orthopaedics, German Sport University Cologne
In any movement, performing well depends upon a proper control of the whole body or specific body parts. Movement is often comprised of linear and rotational components. While a change in linear velocity of a body requires forces to be applied to the environment, a change in rotational velocity of a body requires the application of a moment around its center of mass (CoM). Within the transverse plane of motion this can be achieved by applying a free moment to the ground if a sufficient amount of friction is provided.
In many motions, ground reaction forces and free moments are the most dominant sources of the load experienced by our biological tissues (bones, cartilage, muscles, tendons, ligaments. While ground force application has been studied extensively in many sport and everyday movement tasks, there have been only limited amounts of research performed on FM application.
Therefore the purpose of this presentation is to show the functional relevance of free moment application and its relationship with lower extremity loading during typical sports and general locomotor tasks. I hope that this presentation will enhance the understanding of movement control and load management in human locomotion.

11:00 am – 11:45 pm Plenary

Beyond Moving Bones: A Scoping Review on Foot Orthotics and Lower Limb Electromyography
Kelly Robb, C. Ped (C) MKin
Foot orthotics research has traditionally focused on biomechanical analysis via three techniques: kinematic, kinetic, and plantar pressure analysis. What about our muscles, or the role of sensory feedback on motor output? Skeletal muscle function may have a more complex role in injury recovery, but has minimally been studies as an outcome measure to foot orthotic interventions. The purpose of this presentation is to synthesize the current literature on foot orthotics and plantar foot sole sensory manipulations and lower limb electromyography. In 2018, a scoping review was conducted with intent of identifying gaps in current literature, and to answer the following research question: what does the current literature tell us regarding foot sole modifications (via foot orthotics and/or sensory augmentation) and lower limb electromyography? Delegates can expect to leave the session with a summary of our current knowledge on foot orthotics, sensory augmentation, and lower limb electromyography.

1:15 pm – 2:00 pm Plenary

Does Our Somatosensory System Have Input Into Why We Choose the Running Shoes We Do?
Kathryn Mills, BPhty PhD
The plantar surface of the foot is richly innervated with cutaneous and deep somatosensory receptors, which provide important afferent information to the central nervous system. Manipulating sensory acuity or receptor sensitivity has been demonstrated to result in marked changes to standing and walking balance, although very little literature exists on potential ramifications of altered sensory input for runners. Multiple studies have suggested that footwear has important effects on somatosensory information through increasing or dampening sensation. Further studies indicate that alterations in the hardness and cushioning of shoes directly impacts on sensations of comfort and footwear tolerance. This suggests that plantar foot sensitivity may play a role in footwear comfort, but this has never been quantitatively examined.
This presentation will report results from a longitudinal study of 76 runners as they transitioned from a cushioned shoe to barefoot condition for their weekly running scheduled over a 6 month period. Forty-three participants successfully transitioned to barefoot running throughout the study.
The primary outcome measure was the mechanical battery of a validated quantitative sensory testing protocol involving measurement of mechanical detection, sharp detection, vibration decay detection and pressure pain threshold. This battery measures the adaptations along the entire neuroaxis. The primary outcome measures, footwear comfort and gait parameters (footstrike angle and cadence) were measured after every successful transition through the intervention footwear (cushioned shoe and minimal shoe) as well as barefoot.

2:00 pm – 2:45 pm Plenary

Health Insurance, Your Patients and Pedorthic Services
Joan Weir
How do health insurance plans get changed?  Who is involved in managing plans?  How can you get involved in making change?  Joan will give an overview of health insurance, speak to the common questions that pedorthists have regarding prior approval and claims criteria, provider credentialling, audit, to just name a few topics.  Make sure you bring your tough questions!

3:15 pm – 4:00 pm Breakout Sessions

Taking a Stand: Developing Instrumented Insoles to Prove Association Between Weight Bearing and Foot Pain
Evan Macdonald, BASc.
Overuse injuries such as Plantar Fasciitis are common in employees who are on their feet for most of the day. Unfortunately, current methods of tracking activities in the workplace like self reporting and fitness trackers are either inaccurate or cannot capture critical activities such as sitting and standing. This has resulted in knowledge gaps in the cause of these injuries and how we can prevent them. We have developed a low-cost insole technology capable of accurately tracking common workplace activities. Our study aims to use this technology to enable research into the prevalence and prevention of overuse injuries in the workplace. This talk will present on the development of our device and our findings after pilot testing.
Custom Footwear Casting Workshop
Daan Peters, C. Ped (C), C. Ped MC
*This is a hands on session with a maximum capacity of 20 people.
Thinking of providing custom made footwear at your clinic? Always wanted to know how to take an accurate cast, manual measurements and footprints for custom made footwear? Get a hands on experience using STS casting socks in this custom footwear casting workshop. Clinicians can practice casting techniques and refresh their hands on skills. Proper casting positioning, cast alignment as well as different casting methods using STS socks will be discussed and demonstrated. Furthermore, custom footwear style/model selection and most common problems will be discussed.
Study on Foot Mobility Changes with Minimalist/Barefoot Running Conditions
Kathryn Mills, BPhty PhD
Compared with a traditional running shoes, minimal shoes and barefoot running proffer substantially less support. How transitioning between these different types of footwear, or lack thereof, affects the posture of the foot is unknown. This study examined static and dynamic foot posture of 21 runners who completed 8 weeks of running barefoot after transitioning from a traditional cushioned running shoe. The foot assessment platform measures arch height and midfoot width in both weight bearing and non-weight bearing positions to give a metric of mobility. Longitudinal differences will be presented and related to experiences of injury and comfort throughout the barefoot running period.

4:15 pm – 5:00 pm Breakout Sessions

Become the Family Pedorthist and Grow Your Business
Ermin Pagtakhan, C. Ped (C)
Part 1: Learning
From simple strategies such as a hand shake when you introduce yourself to taking the time to actively listen to their deepest concerns and knowing what to say. There are a multitude of strategies to build rapport and increase loyalty, but none better than my personal must do’s that never fail me. The biggest secret is building Trust! When your patient speaks, are you listening to what they are not saying? The key to reading between the lines takes a deeper understanding of who they are as a person first, then as a patient second. There’s much more you can do to help outside of a pair of Custom Foot Orthotics. Whether you are flying solo in your own clinic, or you have a team of specialized experts, you can make small changes to help more people. Getting out into the community, time saving strategies and teamwork are the secret to growing your business.  How I grew 50% in revenue over 3 years and increased the number of patients assessed from 566 to 1000 (64%) over those same 3 years.
Part 2: Practice/Hands-on

  1. Networking other medical professionals
  2. Community Engagement- Elevator Pitch
  3. Asking your patient for business

Custom Orthopedic Last Making, Art or Science? 
Johan Steenwyk, C. Ped (C), C. Ped MC
Custom Orthopedic last making starts with several important clinical aspects. It starts with providing 2D and 3D data that needs to be processed properly in order to achieve a proper fitting and functional footwear.  Providing custom made footwear for patients is a collaborative afford between the Clinician, the Footwear engineer and the manufacturing facility. Understanding the last engineering is important.

Saturday, April 13, 2019

8:30 am – 9:30 am Keynote

Reducing the Energetic Cost of Walking and Running by Technological Advances in Footwear
Wouter Hoogkamer, PhD & Shalayla Kipp
Walking and running demand metabolic energy. The shoes we wear can influence this energetic cost substantially. This is particularly relevant for athletes aiming to run faster and for patients aiming to ambulate without excessive fatigue. The effects of shoes on the energetic cost of walking have not been studied extensively, but over the past 50 years, steady improvements in running shoes have reduced the energetic cost of running. With each foot strike, our leg muscles must generate force to cushion the impact with the ground. Shoe cushioning can reduce the muscular effort needed for softening impacts and thus can reduce the energetic cost. During each ground contact, mechanical energy is dissipated as heat in the foot. Shoes with increased longitudinal bending stiffness, from carbon fiber insoles or midsole plates, can limit energy losses in the foot, but may require additional muscular work at the ankle joint. While both increased cushioning and stiff plates might make it “easier” or energetically “cheaper” to run, their additional mass is not negligible, since every 100 grams added to each shoe is known to increase the energetic cost of running by ~1%. Recently, we studied a newly developed shoe that integrated all these features and we observed that this new model reduced the energetic cost of running by a substantial 4%, as compared to two other established marathon racing shoes.

9:30 am – 10:15 am Plenary

Foot Surface Interactions Influencing Footwear Design
Luke Kelly, B.Hlth Sci (Pod), PhD
The capacity to store and return energy in legs and feet that behave like springs is crucial to human running economy. Recent comparisons of shod and barefoot running have led to suggestions that modern running shoes may actually impede leg and foot-spring function by reducing the contributions from the leg and foot musculature. However, conflicting evidence suggests that running shoes with thick compliant midsoles actually improve distance running economy. The conflicting nature of evidence and the arguments made by proponents and opponents of modern athletic footwear, highlight the lack of understanding of how footwear influences foot function. This presentation will explore the role of footwear and cushioning on the mechanical function of the foot and the intrinsic foot muscles.

10:15 am – 10:45 am Panel

Panel Discussion
Luke Kelly, Steffen Willwacher, Shalaya Kipp, Wouter Hoogkamer

11:45 am – 12:30 pm Breakout Sessions

60 Years of Pedorthic Experience and Wisdom
Brad Gibbs, C. Ped (C), R.Kin. & Freeman Churchill, C. Ped (C)
Freeman Churchill and Brad Gibbs team up to reflect upon and share in over 60 years of pedorthic experience and wisdom, addressing anecdotes, their paths to establishing successful businesses, and the critical tools essential for a career in pedorthics. Their combined knowledge covers difficult patients, challenging conditions, business foundations and some of their biggest wins and losses in pedorthic practice, how to recognise them and seize the opportunities or avoid the pitfalls.
Custom Footwear Casting Workshop (REPEAT)
Daan Peters, C. Ped (C), C. Ped MC
*This is a hands on session with a maximum capacity of 20 people.
Thinking of providing custom made footwear at your clinic? Always wanted to know how to take an accurate cast, manual measurements and footprints for custom made footwear? Get a hands on experience using STS casting socks in this custom footwear casting workshop. Clinicians can practice casting techniques and refresh their hands on skills. Proper casting positioning, cast alignment as well as different casting methods using STS socks will be discussed and demonstrated. Furthermore, custom footwear style/model selection and most common problems will be discussed.

2:45 pm – 3:30 pm Breakout Sessions

Custom Made Footwear 2.0
Olav Toornend
The future of orthopaedic shoes is now!
Traditional shoe making is a rigorous and very manual process that has long needed an update. Keeping that in mind, the R&D technicians of Nimco Made4You developed an alternative way.
Their proposition is that you start thinking in a more ecological and rational way. Why start from scratch every time you make a new shoe?
MCO is the Modular Concept Orthopaedic method that NM4Y is a new vision for the customization of shoes.
You can start from a wide range of special orthopaedic shoe lasts, then adapt the measurements with special Add Ons to create space and better fit. The MCO method allows you to add 11 different modules that alter the last to make space where the feet most need it.
Simple, easy, environment friendly and very competitive!
Biomechanical and Comfort Effects of Laterally Wedged Insoles With and Without Custom Arch Support in Healthy Individuals and Patients with Knee Osteoarthritis
Calvin Tse, M.Sc.
Osteoarthritis (OA) is a chronic degenerative condition of articular joints that burdens sufferers with pain, physical impairments, and diminished quality of life. In tibiofemoral knee OA, a major risk factor for advancing disease progression is increased knee joint load distribution. The knee adduction moment (KAM) is one metric of knee joint load and is a common target of conservative treatments for managing OA symptoms without surgery or pharmaceuticals. Meta-analyses have revealed that lateral wedge insoles (LWI) are effective at reducing KAM during walking, however, the magnitude of change varies greatly between individuals. Additionally, LWI commonly increase ankle eversion which may lead to increased ankle joint loading or discomfort with extended use. Medial arch-supported LWI have been investigated as a method to reduce KAM while mitigating ankle eversion with medial arch support. We evaluated the effects of various LWI designs with and without medial-arch support of varied material density in healthy individuals and those with knee OA. Our discussion will highlight the immediate changes in lower body gait mechanics and comfort between different LWI designs, and how these effects differ between healthy and knee OA participants.  Intervention with LWI designs offer an appealing option to conservatively manage knee OA because of their low cost and ease of implementation. However, pedorthic care of knee OA needs to consider biomechanical modification in conjunction with patient-reported outcomes of comfort to maximize the likelihood of patient adherence to intervention with LWI designs.

3:45 pm – 4:30 pm Plenary

Using Minimalist Footwear to Strengthen Intrinsic Foot Muscles: One Step at a Time
Sarah Ridge, PhD
Over the past decade, interest in wearing minimalist footwear has increased. This wave of interest began in the running community, but recent research has shown that many people may benefit from wearing minimalist footwear daily. During this session, we will discuss the role of intrinsic foot muscles in foot mechanics, the importance of the midfoot during loading activities, methods of strengthening the intrinsic foot muscles, and potential benefits of minimalist footwear for relief from various lower extremity pathologies.
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