Symposium Sessions
Wednesday, October 30, 2013
OFT1: Optional Pre-Symposium Fieldtrip
Educational Fieldtrip to the Vibram/Quabaug Laboratory and Factory in North Brookfield, MA
Enjoy lunch at Quabaug before learning more about the Quabaug factory and laboratory and taking a tour of the facility. The program will conclude with a Q & A period and wrap-up. Participants on this educational fieldtrip will learn about the various types and physical characteristics of EVA and the effects of lighter weight material; explore different slip resisting materials and learn about slip resistance standards in the US as set by the SATA; discover Gumlite compounds, see the material being manufactured, and view the final result at the end of the manufacturing process; and, learn about the differences between EVA, Gumlite and Newflex compounds.
This program is open to practitioners, product retailers and non-rubber manufacturers.
Optional Happy Hour with the Board
Join the PFA Board of Directors for a networking happy hour at Boston’s historic Union Oyster House. Spend time with your friends and colleagues and those fellow practitioners who volunteer their time to make PFA and the pedorthic profession the best that it can be.
Fee for this event includes round trip transportation, one complimentary drink ticket and hors d’oeuvres.
Thursday, October 31, 2013
OGS1: Opening General Session (S)
Speaker and topic to be announced soon!
GS2: General Session (B)
Title: Medicare DMEPOS Documentation and RAC Audits: An Overview of Recent Findings and an Update on What to Expect Next
Zita Upchurch
This session will provide attendees with a high-level overview of recent findings of RAC audits of Medicare DMEPOS claims, including those related to the Therapeutic Shoes for Diabetes benefit. Also to be discussed is what pedorthists and other DMEPOS suppliers/providers and anticipate in the future.
GS3: General Session (S)
Pedorthic Assessment and Treatment of Sagittal Plane Deformities
Dr. James B. McGuire, DPM, PT, C. Ped.
This session will examine sagittal plane osseous deformities and their affect on the biomechanical function of the foot. Traditional “Rootarian” biomechanics will be challenged and a new “lens” introduced for foot evaluation and treatment.
Learning objectives:
1. Know the various regional sagittal plane foot deformities.
2. Understand how these deformities affect foot function and compensation.
3. Formulate a treatment plan using shoes and orthoses to address pathological complications.
GS4: General Session (S)
Title: Speaker and topic to be announced soon!
A1: An Indepth Review of Medicare Documentation Issues, Findings of RAC Audits, and Best Practices Using Actual Case Studies (B)
Zita Upchurch
This breakout session will build upon the earlier general session, exploring in more detail Medicare's documentation requirements for certain DME, exploring the findings of RAC audits across the country, and learning how to keep as compliant as possible through reviews of actual case studies of claims and audits. This program contains an interactive analytical component where attendees will review claims from the perspective of a RAC auditor and determine whether the claims should be paid or not. The session will wrap up with a review of the actual outcomes of the claims attendees "audited".
A2: Essentials of Business Anatomy: An Introduction to Core Structural Aspects – Legal and Tax – of the Principal Life Stages of a Privately Held Business (B)
Allan J. Weiner, Esq.
With real life case studies, you will examine how you might decide whether your family or a trusted manager should own and run the business or whether it is time for an outsider to come in. Then, with more everyday examples, you will gain an appreciation of how broad and varied are the ways that these transition events can occur and how the differences will affect the business and tax planning issues you will face. It is never too early to think about the future of your private business. This session will give you the framework to begin your plans.
Learning Objectives:
1. Become familiar with general legal and tax considerations regarding the acquisition or sales transaction. This portion of the presentation will review several case studies involving succession planning.
2. Become familiar with the various forms of transactions, processes, agreements, etc.
3. Become familiar with the important legal and tax considerations regarding the start-up of a new business
A3: Marketing Your Pedorthics Facility (B)
Karen Henry, Doug Chartier
Marketing today isn’t what it used to be. Regardless of whether your business is well-established, just getting started, or struggling in the current economy, marketing is no longer optional for pedorthic facilities. This presentation will provide an overview of some of the factors that make marketing essential for today’s pedorthic businesses, outline the basic tenets of an effective marketing program, review some of the primary materials your business needs in its marketing arsenal, and discuss some new and effective ways to use newsletters and other marketing materials to cut through the clutter and market your facility to referral sources and patients.
Learning Objectives:
1. Identify the factors that make marketing essential in today’s pedorthic field.
2. Discuss the pros and cons of various marketing media in terms of investment and effectiveness.
3. Determine ideal uses of marketing media for different pedorthic businesses and facilities.
B1: Physician/Supplier Requirements to Accurately Submit Therapeutic Shoe Claims to the Jurisdictional DMEMAC (B)
John Shero, COF, C. Ped.
This session reviews the physician/supplier requirements needed to accurately submit Therapeutic Shoes for Diabetes benefit claims to the Jurisdictional DME MAC. Attendees will review the coverage criteria for the certifying physician and an in-person evaluation of the patient requirement; coding examples; utilization limitations of coverage; required modifiers; documentation requirements of a typical beneficiary file, orders, Statement of Certifying Physician, and medical records; Comprehensive Error Rate Testing (CERT), which includes the audit process and responding to a request from the CERT contractor; and, Jurisdictional DME MAC resources and events.
Learning Objectives:
1. Requirements, coverage requirements and coding for therapeutic shoes.
2. Limitations and modifiers of claims to the Jurisdictional DME MAC.
3. Complete and appropriate documentation and CERT requirements.
B2: Retail Pedorthics: Pedorthic Referrals Outside of the Diabetic, Medicare and Private Insurance World (B)
Robert S. Schwartz, C. Ped.
There is a large universe that pedorthists can take advantage of that doesn’t involve the diabetic patient, Medicare, private insurance or crushing regulations. The fact is, many people would happily pay out of pocket for custom orthotics, shoe modifications and other pedorthic modalities to treat an uncommon or minor pathology to enhance comfort or performance. Add to this a retail footwear component – whether it is athletic, comfort, Euro, etc. – and you have the opportunity to utilize your pedorthic scope of practice in many, more profitable ways while minimizing your exposure to regulations and escaping the trap of public and private insurance.
Learning Objectives:
1. Increase physician referrals and customer loyalty for a wider range of pedorthic products and services at little to no cost.
2. Utilize your existing customer base and “cash and carry” retail model to achieve a double digit increase in revenue.
3. Understand the benefits of a hybrid pedorthic business model which doesn’t include an insurance component.
B3: Do Private Insurance Contracts Have a Place in Pedorthics? (B)
Aaron Sorensen, CPO
Has your practice shied away from pursuing private payer insurance contracts? This presentation will take the “mystery” out of private contracting and will demonstrate how your company can benefit financially through having these payers as a revenue stream. Being in-network with private payers also helps improve your customer service by offering privately insured patients the option of conveniently using their health insurance benefits to cover portions of their treatment.
Learning Objectives:
1. Provide an understanding of the financial and patient service opportunities of being on contracts with private payers.
2. Overview of the steps to take to secure private contracts; how to find the information, information to understand about the process ahead of reaching out, how to negotiate reimbursements and, once the contract is secured, how to ensure that the terms – particularly the reimbursement terms – are followed by the payer.
3. Identification of key areas/language to be aware of in private contracts and how to address them for the best benefit of your practice.
C1: Alternative Management for Foot and Ankle Conditions (S)
Frank Caruso, CO, LO
This presentation offers treatment choices for dysfunctions in Achilles, PTTD, pronation/supination, arthritis and other conditions involving the foot and ankle. New innovative treatment options will be introduced for achieving foals of reduced pain, gait improvement and better patient outcomes utilizing dynamic suspension adjustable AFOs or other devices. Review patient trials with different clinical indications. Attendees will leave with a new perspective on managing soft tissue injuries, foot deformities and pain with effective techniques to use with patients in their practice.
Learning Objectives:
1. Gain a better understanding of medical conditions resulting in foot and ankle pain, deficits and deformities. Realization of progression with and without treatment.
2. Have a better understanding of muscle function and anatomy relating to the biomechanics of gait involving the foot and ankle. Can achieve goals of pain reduction, improved posture, balance and functional movement with dynamic suspension system AFOs and other types of orthoses and shoes.
3. Learn how to perform an appropriate evaluation and assessment on patients with different clinical indications and have the knowledge of proper devices to fit for management.
C2: A Tale of Two Pathologies: CTEV Fifty Years Apart (S)
Dean Mason, C. Ped., CO
This session reviews the cases of two male patients, born about fifty years apart, both with the same resistive CTEV, with spectacularly different outcomes. Both patients had great difficulties with management issues of their condition, and both were greatly aided by pedorthic modalities. Trace the progression from how the condition was treated in the 1950’s to today’s modern management, including surgical and non-surgical modalities. Learn evaluation techniques and methods to effectively manage this condition. Club foot, once a curse, now is highly manageable with the right medical and pedorthic interventions that bring life back to these two patients. Video interviews with both patients give an individual perspective on how real people live with this once debilitating disease.
Learning Objectives:
1. Trace the history of CTEV and its various modes of management over the years.
2. Discover how two patients, fifty years apart, have similar and strikingly different results.
3. Learn about surgical and non-surgical management along with long-term pedorthic management.
C3: The Foot Bone’s Connected to the Hip Bone (S)
William Smith, MSPT, C. Ped.
One of the key components to proper posture and functional mobility is the ability of our feet – which are the “foundation” of our bodies – to communicate and work properly with our hips and pelvis, which are the “core” of our bodies. Pathology, poor alignment and weakness can adversely affect how these two components work together and be the cause of pain and impairment. It is imperative that, as clinicians, we have a clear and consistent understanding of how these two systems work together when evaluating our patients.
This presentation will provide an overview of the complex relationship between foot and hip biomechanics and to give practical evaluative tools and insight that clinicians can utilize immediately with their patients. Topics covered will include the effect of hip weakness and/or joint restriction on proper foot function; the effect of pathological foot function on knee and hip arthrokinematics; differential evaluation and pedorthic treatment of leg length discrepancy vs. pelvic obliquity; a discussion of orthotic design and shoe modification that takes both foot and pelvic function into consideration; and, the use of foot orthotics as a proprioceptive tool to improve posture and gait quality.
Learning Objectives:
1. Discuss and review the direct relationship between foot and hip functional biomechanics.
2. Provide a comprehensive checklist for clinicians to utilize when assessing their patients.
3. Provide specific case study examples of pedorthic interventions that clinicians may utilize with their patients in conjunction with a functional hip strengthening and flexibility program.
4. Review orthotic design that takes hip function and/or limitation into account when assessing postural alignment and gait.
D1: Modern Athletic Shoe Construction and How Pedorthists Can Reduce Increasing Injury Rates (S)
Jeremy Long, BOC Pedorthist
Changes in footwear design and construction have not kept up with the physical changes of today’s team sports. Modern athletes are bigger and faster than ever, often sustaining injuries previously unheard of in these activities. In addition to uncovering the differences in performance footwear now compared to in years past, this session will review how to overcome the challenges presented to team sports participants in their communities, as well as how to help reduce injury rates and keep athletes actively engaged in competition.
Learning Objectives:
1. Present paradigms in footwear distributed and worn in team sports.
2. Review the numbers and types of injuries occurring now, and how they differ from years past.
3. Look at how pedorthists can manage modern footwear deficiencies in order to reduce injuries.
D2: Core Casting Management of the Pro-Athlete (S)
William Meanwell, C. Ped.
Dealing with the pro-athlete is no different than working with everyday people’s needs. The pro-athlete may be larger and faster than other patients, but feet are still feet. Finding out those needs and focusing on what the athlete wants versus what you may think you want is the key to success.
Discover that normal casting processes need to be reexamined when casting the pro-athlete. Casting in normal fashion puts pressure on different parts of the body. Casting should be looked upon in a more functional position or core cast for the pro-athlete. These concepts can help your practice move into the athletic community, building a new customer base and revenue stream.
Learning Objectives:
1. Learn observation and analysis of player position, movement and evaluation (same feet, different needs).
2. Review materials selections, shoe fitting, casting and lab techniques.
3. Meeting the expectations of the pro-athlete and the importance of follow-up.
D3: The Vertical Foot Alignment System (S)
Neil Smith, C. Ped.
The Vertical Foot Alignment System – or VFAS – is a device which allows a practitioner to apply vertical, translational and rotational forces to the plantar surface of the foot to redirect load, change the foot’s posture, and alleviate stress from forces which can stress and damage tissue. The mold, cast or direct mold that is produced, is an exact replica of the foot’s corrected position. This means there are no modifications to be done to the positive model and, in the case of a direct mold orthotic, material can be added to the medial or lateral sides to increase resistance forces.
Learning Objectives:
1. Gain a greater understanding of supination and pronation resistance and the forces required, on the plantar foot, to obtain better foot posture.
2. Review news assessment protocols to gain a better understanding in real time what happens to the body’s posture when the feet are held in weight bearing neutral.
3. Gain a more practical understanding of kinetic force and kinetic movement and its relationship with the amount of force required on the foot to relieve stress on damaged tissue.
Friday, November 1, 2013
GS5: General Session (S)
Energetic Consequences of Forefoot and Rearfoot Running
Dr. Allison Gruber, Ph. D.
The forefoot (FF) running pattern, typically observed with barefoot running, has been advocated to improve running economy compared to the rearfoot (RF) pattern as a result of increased elastic energy utilization of the plantar flexor muscletendon complex. However, these claims have not been supported by empirical evidence. We investigated the advantages of RF and FF patterns to improve running economy in 20 habitual RF and 20 habitual FF runners. We also used a muscle model to determine the difference in elastic energy utilization and gastrocnemius and soleus muscle metabolic energy expenditure between footfall patterns. No differences in steady state oxygen consumption (VO2 ) or the relative contribution of carbohydrate to total energy expenditure (%CHO) were detected between groups when running with their habitual footfall pattern at 3.0, 3.5, and 4.0 m•s-1. However, when both groups performed the RF pattern at 4.0 m•s-1, this pattern resulted in significantly lower VO2 and %CHO compared to FF running. Although FF running resulted in greater elastic energy utilization in both the gastrocnemius and the soleus, FF running did not result in lower muscle metabolic cost of either muscle because this pattern required greater muscle force production, negating any benefit of elastic recoil. These findings indicate that the FF pattern does not result in greater running economy or lower muscle metabolic energy expenditure despite increased elastic energy utilization compared to the RF pattern. Contrary to previous speculation, these results suggest that RF running might confer benefits in endurance events in both habitual RF and FF runners.
GS6: General Session
It Really IS All About Quality…The Government’s Pursuit of Medical Necessity and Quality of Care Cases (B)
George Breen, Esq.
As you assess your risk exposure for government enforcement, there is increasing concern with the government’s pursuit of quality of care and medical necessity cases. Clearly, the pursuit of healthcare providers is at an all-time high – just in February of this year, the Department of Health and Human Services (HHS) and Department of Justice (DOJ) reported recoveries of $4.2 billion for FY 2012 in False Claims Act settlements and judgments, as well as healthcare fraud administrative actions.
Recently, HHS and DOJ announced that they were teaming up with private insurance organizations in pursuit of healthcare fraud. Reportedly, this will include a sharing of information for the purposes of detecting and preventing payments for allegedly unlawful or fraudulent healthcare billings – putting a spotlight on medical necessity issues. MAC and ZPIC auditors are already focusing their sights in this arena.
Moreover, certain federal healthcare programs require adherence to standards of quality, including the measurement and reporting of quality indicators making quality of care a likely target of increased enforcement efforts.
Learning Objectives:
1. Review the government’s theory of liability in “quality of care”, “worthless services” and “medical necessity” cases against providers.
2. Learn how to challenge and defend against the government’s enforcement efforts.
3. Learn what providers can do proactively, and how compliance programs should be adapted to address these heightened risk areas.
GS7: General Session
Minimalist Shoes and Barefoot Running: A Final Verdict? (S)
Dr. Roy Lidtke, DPM
This session is sponsored by Dr. Comfort
Barefoot running and minimalist shoes have been around for several years now, but do we know any more now about the results and success versus failure rate of minimalist shoes? Our research group has completed many years of research on various shoes and running styles to show this may not always be the best approach. This, coupled with evidence from elite runners, clubs and shoe stores, is producing compelling evidence on who should try this and how to go about getting into this style of running – and who should stay clear of it.
This presentation will review research data from several studies on the mechanics of barefoot and shoes. Additional evidence will be presented from leading runners and running clubs as well as running shoe stores on the current methods for those who wish to start barefoot running.
You will see that there was a statistical difference in the mechanics of those who could potentially benefit from minimalist shoes and those who may react negatively to such styles. Simple clinical techniques can be utilized to evaluate patients for variations in lower extremity biomechanics. Methods to gradually transition into barefoot or minimalist shoe use demonstrate greater success.
Knowledge of barefoot running and minimalist shoes is needed by today’s practicing pedorthist. Considerable data and knowledge is available to assist patients who may be considering this style, are using this style, or have tried it and failed.
Learning Objectives:
1. Understand the pros and cons of the various running techniques and how to evaluate and consult patients who may be interested in this style.
2. Understand how minimalist footwear influences lower extremity biomechanics and what is needed for a successful conversion to minimalist or barefoot style of running.
3. Become familiar with the latest research on barefoot running and minimalist shoes.
E1: Biomechanics of the Foot and Knee: Treating Knee Osteoarthritis (OA) as a Pedorthist (S)
Dr. Roy Lidtke, DPM
This session is sponsored by Dr. Comfort
There are over 30 million people in the United States with knee osteoarthritis. There is mounting evidence that the biomechanics of the foot is integral in the pathomechanics of knee OA. Current mechanistic research is shining new light on the effects of the foot and knee.
This session will review the latest research from Rush University Medical Center showing how the medial column of the forefoot may play a key role in medial knee OA. Attendees will discover how pressure and gait data show how mobility of the medial column of the foot increased knee adduction movements, knee angular impulse and subchondral bone density
Knowledge of foot mechanics and how to manipulate lower extremity biomechanics at the foot ground interface may be critical in treating patients with medial knee OA. This opens up a new area of therapeutics for pedorthists.
Learning Objectives:
1. Understand the biomechanics of the foot on the knee.
2. Become familiar with how gait analysis data is used to determine the foot-knee relationship.
3. Understand how manipulation of the foot ground interface can influence the mechanics of the knee and how, as a pedorthist, you may be called on to do this.
E2: Triple Arthrodesis: When Patients Consider It (S)
Nancy Naftalin, C. Ped., Surgical Assistant
Using before and after x-rays of the feet pre- and post-triple arthrodesis surgery, this session will review the procedure and explore why surgeons offer it to patients with severe deformity. We will also review which deformities respond best to triple arthrodesis, including severe flatfoot and cavus with deformity to the mid-foot.
Learning Objectives:
1. Review the need for triple arthrodesis surgery and why this fusion will give patients better movement without pain.
2. Determine when orthotics or bracing is not working to the patient’s satisfaction and when surgical intervention may be considered.
3. Review the surgical procedure, learning precisely what the surgeon fuses, and what is expected post-surgery in terms of movement and footwear.
E3: Functional Gait Analysis & Foot Typing Methodology (S)
Dr. Louis J. DeCaro, DPM
This program will provide the student/attendee with an over-view of normal and pathological foot biomechanics, an introduction to a simple, inexpensive method of video gait analysis and a common sense approach to foot orthotic selection and design. Six major foot types will be presented with their typical clinical conditions and how each foot-type may correlate specific rehabilitation goals.
Learning Objectives:
1. Identify the basic biomechanical principles of the foot and lower extremity as a function of gait, and recognize the affect pathological foot conditions have upon normal gait.
2. Be able to differentiate between a compensated and uncompensated rearfoot varus deformity and their affect on gait.
3. Recognize the affect forefoot varus and valgus deformities have upon gait.
4. Be able to differentiate between common pathological foot-types.
5. Be able to recognize the relationship between pathomechanical foot-types and various differentially diagnosed foot conditions.
6. Demonstrate the ability to recognize key weight-bearing compensations specific to rearfoot and forefoot deformities.
7. Demonstrate the ability to select the appropriate orthotic design and selection based on pathological foot-type, as well as fit pre-fabricated devices specific to foot-type in a lab setting.
F1: Effects of Specialized Footwear on Joint Loads in Osteoarthritis of the Knee (S)
Dr. Roy Lidtke, DPM
This session is sponsored by Dr. Comfort
Dynamic joint loads are important in the pathophysiology of knee osteoarthritis and biomechanical interventions aim to reduce these loads in the hopes of improving symptoms and delaying disease progression. Recent evidence suggests that footwear can influence dynamic knee loading. This session will review a study of the longitudinal effects of mobility footwear compared to a control shoe on a knee over a six month period.
In the study, subjects with radiographic and symptomatic knee OA were randomized to a mobility shoe or identical appearing stiffer “control” shoe. Investigators and participants were blinded to shoe assignment. Baseline gait analyses were performed in subjects’ “own shoes”, study shoes, and barefoot.
Attendees will discover how this double-blind randomized controlled trial suggests that the use of mobility shoes over six months results in significant reductions in medial knee loading compared to a control. Thus, attendees may conclude that they use of flexible footwear may be an effective biomechanical intervention for the management of knee OA.
Learning Objectives:
1. Understand the pathophysiology of knee osteoarthritis.
2. Become familiar with gait parameters that influence knee osteoarthritis.
3. Understand how mobility shoes can be utilized in the continuum of treatment for knee osteoarthritis.
F2: Age Specific Orthotic Protocols for the Podopediatric Patient: From the Time They Walk Until High School Graduation! (S)
Dr. Louis J. DeCaro, DPM
This session will review age specific protocols in the treatment of flat feet, in-toeing, low tone, neuromuscular child-specific diagnoses and more. It will include a general overview of the most common foot and ankle pathologies associated with podopediatrics involving orthotic treatment. Attendees will learn the normal ranges of forefoot and rearfoot varus and valgus from infancy to the teen years and uncover the mysteries and misperceptions of when it is appropriate to treat both. This presentation is ideal for those who see patients from ages 1 to 17 as it draws the practitioner’s attention to focusing on the essentials of how to treat each age easily and effectively; and, even if you don’t treat this age group, it will open your mind to each and every encounter of “every day adult foot pathologies” that you treat and how those conditions may be linked genetically to your patient’s offspring.
Learning Objectives:
1. Understand age specific protocols of orthotic treatment for various podopediatric pathologies.
2. Understand the normal ranges of forefoot and rearfoot varus and valgus from infancy to the teen years.
3. Discover how common adult foot pathologies may be linked genetically to your patient’s offspring.
F3: Total Contact Casting for Charcot Management (S)
Dr. Louis N. Iannuzzi, PT, DPT, C. Ped.; Adam Dreyfus
This session will discuss the indications, applications and expected outcomes of incorporating total contact casting into the pedorthic clinical practice.
Learning Objectives:
1. Review the principles of total contact casting, including indications and contraindications, history and application.
2. Understand the pathomechanics of ulceration and neuropathy, and the biomechanics of total contact casting.
3. Discuss the clinical integration of total contact casting into the clinical environment of a pedorthic practice.
G1: Medicare Policy Overview-Practical Applications (B)
Aaron Sorensen, CPO
Keeping current with Medicare guidelines can be a job in itself. In this presentation, attendees will learn the finer points of compliance with Medicare regulations. Attendees will also be exposed to ways and means of working in compliance with these rules that are proving effective for a wide spectrum of type and sizes of companies. Geographic nuances that may affect your practice will also be discussed.
While audits may be inevitable, being prepared ahead of the game is your best defense. Tips regarding how to best handle RAC and CERT audits will be an integral part of this presentation, starting with best practices on the front end. Information and statistics will help spotlight current trends in the various regions on what items and areas are being scrutinized the most by the Centers for Medicare and Medicaid Services (CMS)
Learning Objectives:
1. Learn the most current CMS guidelines and regulations for pedorthic practices and how to best manage compliance with these policies.
2. Discover the geographic nuances of how CMS and their contractors interpret guidelines and regulations, and how you can be affected by them.
3. Prepare for facing a RAC and CERT audit, and learn how to manage these types of audits when they occur.
G2: Weird Diagnoses: You Have What??? (S)
Erick Janisse, CO, C. Ped.
This session will familiarize credentialed pedorthists with some highly unusual diagnoses that they may come across over the course of their career treating patients with foot disorders. It will explore the pathophysiology of a number of rare disorders, such as Ehlers-Danlos (also known as cutis hyperelastica), Marfan Syndrome, and Osteogenesis Imperfecta, to name a few. The presenter will also offer guidance for the conservative treatment of a number of these conditions.
Learning Objectives:
1. Gain a better understanding of the etiology of several rare disorders.
2. Understand the terminology used by physicians to describe these diseases and syndromes.
3. Learn how to provide appropriate care for many conditions which lie outside a traditional pedorthists’ comfort zone.
G3: Current Healthcare Economics and Market with Positive Response from the VA Perspective (B)
Dr. Anthony Lazzarino, DPM
This session will provide an overview of the gait restoration process from the perspective of a high volume provider – the Veterans Administration Healthcare System. The presenter will provide a description of the type of pathology dealt with on an ongoing basis, focus on the expected positive outcomes from the treatment regimen provided, and discuss the negative outcomes that also occur. The session will also focus on resolution strategies, including the co-creation of pedorthic solutions with private (i.e. outside of the VA system) vendors and how the VA develops their technical standard of care to achieve the maximum value per tax dollar spent on patient care. Finally, the presenter will review first-hand experiences in the co-creation arena, contrasting outcomes that have utilized this model, and those outcomes that have not utilized the co-creation model.
Learning Objectives:
1. Review biomechanical and metabolic issues limiting normal gait from the perspective of a Veterans Administration healthcare system podiatrist.
2. Examine the technical resources available to enhance positive outcomes through joint research and development projects with private suppliers and the co-creation of restoration services.
3. Learn about reimbursement issues from the perspective of the VA, with an emphasis on reliability and service from the products that are procured from outside partners, all with the goal of accountability and most value for the tax dollar spent.
Saturday, November 2, 2013
H1: Using Social Media to Develop Relationships with Baby Boomers (B)
Dr. Melodie Phillips, Ph. D.; Aaron Sorensen, CPO
Competing in an ever-changing marketplace has become more and more difficult for independent P & O firms. Not only has Obamacare and changes in Medicare and Medicaid policies made competing more difficult, but increasing problems with cash flow management have made budgeting an effective promotions plan virtually impossible. Fortunately, changes in technology, patient behavior and relationship marketing have made social media an affordable and effective method of promoting your company, new technologies in prosthetics and orthotics, and maintaining relationships with patients and doctors. Come and seize this affordable tool!
H2: The Modern Financial Challenges in Working with the Therapeutic Shoe Benefit (B)
Jeremy Long, BOC Pedorthist
Pedorthists now face several challenges when fulfilling prescriptions under Medicare’s Therapeutic Shoes for Persons with Diabetes (TSD) benefit. Shoe material costs are higher and construction is curtailed compared to previous times, contributing to both reduction in cost for service and quality or service to patients. Attendees will discover how to differentiate among Medicare Pricing, Data Analysis and Coding contractor (PDAC) approved products in order to maximize treatment efficacy, and how to realize sustainable profitability.
Learning Objectives:
1. Review the challenges involved in Medicare’s reimbursement for benefits provided under the TSD.
2. Discover how materials costs have altered footwear construction in recent years.
3. Find out how pedorthists can be profitable, while still providing quality made therapeutic footwear.
H3: Taking Steps in the Right Direction: Building Your Pedorthic Practice (B)
Dr. John Mina, DPM; Tara Evans, C. Ped., L. Ped.
Focusing on good business strategies, this session will review the importance of developing relationships of professional trust in the podiatric/pedorthic field and achieving compliance with your patients. Having open communication between allied health team members is extremely important in providing quality care, as you must be able to go to your physician and ask for clarification and discuss the options for your patients. At the end of the day, it is usually a lack of communications that ends up burning bridges in our business.
Learning Objectives:
1. Learn the Do’s and Don’ts’s of interacting with physicians and patients.
2. Discover how to achieve compliance with patients.
3. Explore methods to convince the geriatric patient to change their lifestyle to achieve healthier and more active mobility, and how this can impact the success or failure of a treatment plan.
4. Discuss specific types of orthotics and shoes that benefit patients over 40, highlighting the high-risk diabetic patient.
GS8: General Session
Title: Advanced Composite Insoles for the Reduction of Stress Fractures
Dr. Steven King, DPM, C. Ped.
This session will review the results of the initial phase of a research project conducted for the U.S. Army Medical Research and Materiel Command to develop an advanced orthotic for use by the military. The orthotic design incorporates the modern technology of composite materials, including carbon fiber and Kevlar TM, with simple and well-known technology (lever, fulcrum and spring). The orthotic is an innovative solution that decreases the risk of stress fracture injuries by reducing loading rates while increasing energy storage and return. The orthotic is lightweight, puncture resistant, and provides protection from injuries due to stress fractures and strains. Phase I efforts addressed the orthotic’s biomechanical and physical properties and the incorporation of the orthotic into a synergistic military boot housing to produce a fully tested, integrated, and developed orthotic that will reduce injuries from stress fractures, punctures, and fatigue in Army soldiers. This prototype orthotic reduces weight while increasing protection against stress fracture and strain injuries, fatigue, and puncture injuries. This orthotic has been incorporated into synergistic military boot housings, protects from injury due to ground impact shock, fatigue, and injuries due to punctures, and may save the Army millions of health care dollars and months of lost training time by protecting Army soldiers from injury.
GS9: General Session
Keep Your Eye on the Foot
Dane LaFontsee, C. Ped.
This session will explore the concept that utilizing systems such as “foot typing” and computer technology can “only” be used as assistance in a pedorthic practice. Pedorthists must not “solely” depend on such systems and techniques but to use them in conjunction with your own “hand-on” and “eye” skills that have been developed through years of experience. The presenter will discuss how pedorthists must use all of their knowledge and tools to properly create foot devices, footwear and other solutions to very difficult foot problems, because no two feet are alike!
Learning Objectives:
1. Discover how to fully utilize your intuitive and experiential knowledge developed over the years practicing pedorthics.
2. Learn how to use “all” of the tools in our toolbox.
3. Realize the importance of never replacing hand-on knowledge.
GS10: Closing General Session
Clinical Relevance of Pedorthic Foundation-Funded Foot Biomechanics Research (Ultrasound Analysis)
Dr. Geza Kogler, Ph. D., CO
Pedorthics has limited evidence-based knowledge to support the use of prescription footwear and orthoses as part of a treatment plan. The Pedorthic Foundation is funding several lines of research aimed at advancing the science associated with clinical practice. The preliminary findings of a study investigating the use of ultrasound to evaluate tissue properties of the plantar surface of the foot during terminal stance (i.e. 3rd rocker) of walking will also be discussed as it relates to the design of the rocker profiles in shoes.
Learning Objectives:
1. Restate the importance that knowledge of the mechanical properties of plantar soft tissue may have on orthotic and pedorthic management.
2. Describe the stiffness properties of the foot’s plantar soft tissues in non-weight bearing compared to weight bearing.
3. Restate the influence foot orthoses can potentially have on stiffness properties of the foot’s plantar soft tissue.
Sunday, November 3, 2013
OPS1: Optional Post-Symposium Workshop
CPR for Healthcare Providers
Robert Sobel, C. Ped., EMT-P
As part of the facility accreditation process, every pedorthic facility should have a person on staff who knows how to perform cardiopulmonary resuscitation (CPR). Every participant will learn CPR, clear an obstructed airway, and operate an automatic external defibrillator (AED). Attendees who successfully complete this workshop will receive CPR and AED course completion cards to meet regulatory requirements.
Learning Objectives:
1. Learn how to perform cardiopulmonary resuscitation.
2. Learn how to respond to a choking victim.
3. Learn how to effectively use an automatic external defibrillator.
Wednesday, October 30, 2013
OFT1: Optional Pre-Symposium Fieldtrip
Educational Fieldtrip to the Vibram/Quabaug Laboratory and Factory in North Brookfield, MA
Enjoy lunch at Quabaug before learning more about the Quabaug factory and laboratory and taking a tour of the facility. The program will conclude with a Q & A period and wrap-up. Participants on this educational fieldtrip will learn about the various types and physical characteristics of EVA and the effects of lighter weight material; explore different slip resisting materials and learn about slip resistance standards in the US as set by the SATA; discover Gumlite compounds, see the material being manufactured, and view the final result at the end of the manufacturing process; and, learn about the differences between EVA, Gumlite and Newflex compounds.
This program is open to practitioners, product retailers and non-rubber manufacturers.
Optional Happy Hour with the Board
Join the PFA Board of Directors for a networking happy hour at Boston’s historic Union Oyster House. Spend time with your friends and colleagues and those fellow practitioners who volunteer their time to make PFA and the pedorthic profession the best that it can be.
Fee for this event includes round trip transportation, one complimentary drink ticket and hors d’oeuvres.
Thursday, October 31, 2013
OGS1: Opening General Session (S)
Speaker and topic to be announced soon!
GS2: General Session (B)
Title: Medicare DMEPOS Documentation and RAC Audits: An Overview of Recent Findings and an Update on What to Expect Next
Zita Upchurch
This session will provide attendees with a high-level overview of recent findings of RAC audits of Medicare DMEPOS claims, including those related to the Therapeutic Shoes for Diabetes benefit. Also to be discussed is what pedorthists and other DMEPOS suppliers/providers and anticipate in the future.
GS3: General Session (S)
Pedorthic Assessment and Treatment of Sagittal Plane Deformities
Dr. James B. McGuire, DPM, PT, C. Ped.
This session will examine sagittal plane osseous deformities and their affect on the biomechanical function of the foot. Traditional “Rootarian” biomechanics will be challenged and a new “lens” introduced for foot evaluation and treatment.
Learning objectives:
1. Know the various regional sagittal plane foot deformities.
2. Understand how these deformities affect foot function and compensation.
3. Formulate a treatment plan using shoes and orthoses to address pathological complications.
GS4: General Session (S)
Title: Speaker and topic to be announced soon!
A1: An Indepth Review of Medicare Documentation Issues, Findings of RAC Audits, and Best Practices Using Actual Case Studies (B)
Zita Upchurch
This breakout session will build upon the earlier general session, exploring in more detail Medicare's documentation requirements for certain DME, exploring the findings of RAC audits across the country, and learning how to keep as compliant as possible through reviews of actual case studies of claims and audits. This program contains an interactive analytical component where attendees will review claims from the perspective of a RAC auditor and determine whether the claims should be paid or not. The session will wrap up with a review of the actual outcomes of the claims attendees "audited".
A2: Essentials of Business Anatomy: An Introduction to Core Structural Aspects – Legal and Tax – of the Principal Life Stages of a Privately Held Business (B)
Allan J. Weiner, Esq.
With real life case studies, you will examine how you might decide whether your family or a trusted manager should own and run the business or whether it is time for an outsider to come in. Then, with more everyday examples, you will gain an appreciation of how broad and varied are the ways that these transition events can occur and how the differences will affect the business and tax planning issues you will face. It is never too early to think about the future of your private business. This session will give you the framework to begin your plans.
Learning Objectives:
1. Become familiar with general legal and tax considerations regarding the acquisition or sales transaction. This portion of the presentation will review several case studies involving succession planning.
2. Become familiar with the various forms of transactions, processes, agreements, etc.
3. Become familiar with the important legal and tax considerations regarding the start-up of a new business
A3: Marketing Your Pedorthics Facility (B)
Karen Henry, Doug Chartier
Marketing today isn’t what it used to be. Regardless of whether your business is well-established, just getting started, or struggling in the current economy, marketing is no longer optional for pedorthic facilities. This presentation will provide an overview of some of the factors that make marketing essential for today’s pedorthic businesses, outline the basic tenets of an effective marketing program, review some of the primary materials your business needs in its marketing arsenal, and discuss some new and effective ways to use newsletters and other marketing materials to cut through the clutter and market your facility to referral sources and patients.
Learning Objectives:
1. Identify the factors that make marketing essential in today’s pedorthic field.
2. Discuss the pros and cons of various marketing media in terms of investment and effectiveness.
3. Determine ideal uses of marketing media for different pedorthic businesses and facilities.
B1: Physician/Supplier Requirements to Accurately Submit Therapeutic Shoe Claims to the Jurisdictional DMEMAC (B)
John Shero, COF, C. Ped.
This session reviews the physician/supplier requirements needed to accurately submit Therapeutic Shoes for Diabetes benefit claims to the Jurisdictional DME MAC. Attendees will review the coverage criteria for the certifying physician and an in-person evaluation of the patient requirement; coding examples; utilization limitations of coverage; required modifiers; documentation requirements of a typical beneficiary file, orders, Statement of Certifying Physician, and medical records; Comprehensive Error Rate Testing (CERT), which includes the audit process and responding to a request from the CERT contractor; and, Jurisdictional DME MAC resources and events.
Learning Objectives:
1. Requirements, coverage requirements and coding for therapeutic shoes.
2. Limitations and modifiers of claims to the Jurisdictional DME MAC.
3. Complete and appropriate documentation and CERT requirements.
B2: Retail Pedorthics: Pedorthic Referrals Outside of the Diabetic, Medicare and Private Insurance World (B)
Robert S. Schwartz, C. Ped.
There is a large universe that pedorthists can take advantage of that doesn’t involve the diabetic patient, Medicare, private insurance or crushing regulations. The fact is, many people would happily pay out of pocket for custom orthotics, shoe modifications and other pedorthic modalities to treat an uncommon or minor pathology to enhance comfort or performance. Add to this a retail footwear component – whether it is athletic, comfort, Euro, etc. – and you have the opportunity to utilize your pedorthic scope of practice in many, more profitable ways while minimizing your exposure to regulations and escaping the trap of public and private insurance.
Learning Objectives:
1. Increase physician referrals and customer loyalty for a wider range of pedorthic products and services at little to no cost.
2. Utilize your existing customer base and “cash and carry” retail model to achieve a double digit increase in revenue.
3. Understand the benefits of a hybrid pedorthic business model which doesn’t include an insurance component.
B3: Do Private Insurance Contracts Have a Place in Pedorthics? (B)
Aaron Sorensen, CPO
Has your practice shied away from pursuing private payer insurance contracts? This presentation will take the “mystery” out of private contracting and will demonstrate how your company can benefit financially through having these payers as a revenue stream. Being in-network with private payers also helps improve your customer service by offering privately insured patients the option of conveniently using their health insurance benefits to cover portions of their treatment.
Learning Objectives:
1. Provide an understanding of the financial and patient service opportunities of being on contracts with private payers.
2. Overview of the steps to take to secure private contracts; how to find the information, information to understand about the process ahead of reaching out, how to negotiate reimbursements and, once the contract is secured, how to ensure that the terms – particularly the reimbursement terms – are followed by the payer.
3. Identification of key areas/language to be aware of in private contracts and how to address them for the best benefit of your practice.
C1: Alternative Management for Foot and Ankle Conditions (S)
Frank Caruso, CO, LO
This presentation offers treatment choices for dysfunctions in Achilles, PTTD, pronation/supination, arthritis and other conditions involving the foot and ankle. New innovative treatment options will be introduced for achieving foals of reduced pain, gait improvement and better patient outcomes utilizing dynamic suspension adjustable AFOs or other devices. Review patient trials with different clinical indications. Attendees will leave with a new perspective on managing soft tissue injuries, foot deformities and pain with effective techniques to use with patients in their practice.
Learning Objectives:
1. Gain a better understanding of medical conditions resulting in foot and ankle pain, deficits and deformities. Realization of progression with and without treatment.
2. Have a better understanding of muscle function and anatomy relating to the biomechanics of gait involving the foot and ankle. Can achieve goals of pain reduction, improved posture, balance and functional movement with dynamic suspension system AFOs and other types of orthoses and shoes.
3. Learn how to perform an appropriate evaluation and assessment on patients with different clinical indications and have the knowledge of proper devices to fit for management.
C2: A Tale of Two Pathologies: CTEV Fifty Years Apart (S)
Dean Mason, C. Ped., CO
This session reviews the cases of two male patients, born about fifty years apart, both with the same resistive CTEV, with spectacularly different outcomes. Both patients had great difficulties with management issues of their condition, and both were greatly aided by pedorthic modalities. Trace the progression from how the condition was treated in the 1950’s to today’s modern management, including surgical and non-surgical modalities. Learn evaluation techniques and methods to effectively manage this condition. Club foot, once a curse, now is highly manageable with the right medical and pedorthic interventions that bring life back to these two patients. Video interviews with both patients give an individual perspective on how real people live with this once debilitating disease.
Learning Objectives:
1. Trace the history of CTEV and its various modes of management over the years.
2. Discover how two patients, fifty years apart, have similar and strikingly different results.
3. Learn about surgical and non-surgical management along with long-term pedorthic management.
C3: The Foot Bone’s Connected to the Hip Bone (S)
William Smith, MSPT, C. Ped.
One of the key components to proper posture and functional mobility is the ability of our feet – which are the “foundation” of our bodies – to communicate and work properly with our hips and pelvis, which are the “core” of our bodies. Pathology, poor alignment and weakness can adversely affect how these two components work together and be the cause of pain and impairment. It is imperative that, as clinicians, we have a clear and consistent understanding of how these two systems work together when evaluating our patients.
This presentation will provide an overview of the complex relationship between foot and hip biomechanics and to give practical evaluative tools and insight that clinicians can utilize immediately with their patients. Topics covered will include the effect of hip weakness and/or joint restriction on proper foot function; the effect of pathological foot function on knee and hip arthrokinematics; differential evaluation and pedorthic treatment of leg length discrepancy vs. pelvic obliquity; a discussion of orthotic design and shoe modification that takes both foot and pelvic function into consideration; and, the use of foot orthotics as a proprioceptive tool to improve posture and gait quality.
Learning Objectives:
1. Discuss and review the direct relationship between foot and hip functional biomechanics.
2. Provide a comprehensive checklist for clinicians to utilize when assessing their patients.
3. Provide specific case study examples of pedorthic interventions that clinicians may utilize with their patients in conjunction with a functional hip strengthening and flexibility program.
4. Review orthotic design that takes hip function and/or limitation into account when assessing postural alignment and gait.
D1: Modern Athletic Shoe Construction and How Pedorthists Can Reduce Increasing Injury Rates (S)
Jeremy Long, BOC Pedorthist
Changes in footwear design and construction have not kept up with the physical changes of today’s team sports. Modern athletes are bigger and faster than ever, often sustaining injuries previously unheard of in these activities. In addition to uncovering the differences in performance footwear now compared to in years past, this session will review how to overcome the challenges presented to team sports participants in their communities, as well as how to help reduce injury rates and keep athletes actively engaged in competition.
Learning Objectives:
1. Present paradigms in footwear distributed and worn in team sports.
2. Review the numbers and types of injuries occurring now, and how they differ from years past.
3. Look at how pedorthists can manage modern footwear deficiencies in order to reduce injuries.
D2: Core Casting Management of the Pro-Athlete (S)
William Meanwell, C. Ped.
Dealing with the pro-athlete is no different than working with everyday people’s needs. The pro-athlete may be larger and faster than other patients, but feet are still feet. Finding out those needs and focusing on what the athlete wants versus what you may think you want is the key to success.
Discover that normal casting processes need to be reexamined when casting the pro-athlete. Casting in normal fashion puts pressure on different parts of the body. Casting should be looked upon in a more functional position or core cast for the pro-athlete. These concepts can help your practice move into the athletic community, building a new customer base and revenue stream.
Learning Objectives:
1. Learn observation and analysis of player position, movement and evaluation (same feet, different needs).
2. Review materials selections, shoe fitting, casting and lab techniques.
3. Meeting the expectations of the pro-athlete and the importance of follow-up.
D3: The Vertical Foot Alignment System (S)
Neil Smith, C. Ped.
The Vertical Foot Alignment System – or VFAS – is a device which allows a practitioner to apply vertical, translational and rotational forces to the plantar surface of the foot to redirect load, change the foot’s posture, and alleviate stress from forces which can stress and damage tissue. The mold, cast or direct mold that is produced, is an exact replica of the foot’s corrected position. This means there are no modifications to be done to the positive model and, in the case of a direct mold orthotic, material can be added to the medial or lateral sides to increase resistance forces.
Learning Objectives:
1. Gain a greater understanding of supination and pronation resistance and the forces required, on the plantar foot, to obtain better foot posture.
2. Review news assessment protocols to gain a better understanding in real time what happens to the body’s posture when the feet are held in weight bearing neutral.
3. Gain a more practical understanding of kinetic force and kinetic movement and its relationship with the amount of force required on the foot to relieve stress on damaged tissue.
Friday, November 1, 2013
GS5: General Session (S)
Energetic Consequences of Forefoot and Rearfoot Running
Dr. Allison Gruber, Ph. D.
The forefoot (FF) running pattern, typically observed with barefoot running, has been advocated to improve running economy compared to the rearfoot (RF) pattern as a result of increased elastic energy utilization of the plantar flexor muscletendon complex. However, these claims have not been supported by empirical evidence. We investigated the advantages of RF and FF patterns to improve running economy in 20 habitual RF and 20 habitual FF runners. We also used a muscle model to determine the difference in elastic energy utilization and gastrocnemius and soleus muscle metabolic energy expenditure between footfall patterns. No differences in steady state oxygen consumption (VO2 ) or the relative contribution of carbohydrate to total energy expenditure (%CHO) were detected between groups when running with their habitual footfall pattern at 3.0, 3.5, and 4.0 m•s-1. However, when both groups performed the RF pattern at 4.0 m•s-1, this pattern resulted in significantly lower VO2 and %CHO compared to FF running. Although FF running resulted in greater elastic energy utilization in both the gastrocnemius and the soleus, FF running did not result in lower muscle metabolic cost of either muscle because this pattern required greater muscle force production, negating any benefit of elastic recoil. These findings indicate that the FF pattern does not result in greater running economy or lower muscle metabolic energy expenditure despite increased elastic energy utilization compared to the RF pattern. Contrary to previous speculation, these results suggest that RF running might confer benefits in endurance events in both habitual RF and FF runners.
GS6: General Session
It Really IS All About Quality…The Government’s Pursuit of Medical Necessity and Quality of Care Cases (B)
George Breen, Esq.
As you assess your risk exposure for government enforcement, there is increasing concern with the government’s pursuit of quality of care and medical necessity cases. Clearly, the pursuit of healthcare providers is at an all-time high – just in February of this year, the Department of Health and Human Services (HHS) and Department of Justice (DOJ) reported recoveries of $4.2 billion for FY 2012 in False Claims Act settlements and judgments, as well as healthcare fraud administrative actions.
Recently, HHS and DOJ announced that they were teaming up with private insurance organizations in pursuit of healthcare fraud. Reportedly, this will include a sharing of information for the purposes of detecting and preventing payments for allegedly unlawful or fraudulent healthcare billings – putting a spotlight on medical necessity issues. MAC and ZPIC auditors are already focusing their sights in this arena.
Moreover, certain federal healthcare programs require adherence to standards of quality, including the measurement and reporting of quality indicators making quality of care a likely target of increased enforcement efforts.
Learning Objectives:
1. Review the government’s theory of liability in “quality of care”, “worthless services” and “medical necessity” cases against providers.
2. Learn how to challenge and defend against the government’s enforcement efforts.
3. Learn what providers can do proactively, and how compliance programs should be adapted to address these heightened risk areas.
GS7: General Session
Minimalist Shoes and Barefoot Running: A Final Verdict? (S)
Dr. Roy Lidtke, DPM
This session is sponsored by Dr. Comfort
Barefoot running and minimalist shoes have been around for several years now, but do we know any more now about the results and success versus failure rate of minimalist shoes? Our research group has completed many years of research on various shoes and running styles to show this may not always be the best approach. This, coupled with evidence from elite runners, clubs and shoe stores, is producing compelling evidence on who should try this and how to go about getting into this style of running – and who should stay clear of it.
This presentation will review research data from several studies on the mechanics of barefoot and shoes. Additional evidence will be presented from leading runners and running clubs as well as running shoe stores on the current methods for those who wish to start barefoot running.
You will see that there was a statistical difference in the mechanics of those who could potentially benefit from minimalist shoes and those who may react negatively to such styles. Simple clinical techniques can be utilized to evaluate patients for variations in lower extremity biomechanics. Methods to gradually transition into barefoot or minimalist shoe use demonstrate greater success.
Knowledge of barefoot running and minimalist shoes is needed by today’s practicing pedorthist. Considerable data and knowledge is available to assist patients who may be considering this style, are using this style, or have tried it and failed.
Learning Objectives:
1. Understand the pros and cons of the various running techniques and how to evaluate and consult patients who may be interested in this style.
2. Understand how minimalist footwear influences lower extremity biomechanics and what is needed for a successful conversion to minimalist or barefoot style of running.
3. Become familiar with the latest research on barefoot running and minimalist shoes.
E1: Biomechanics of the Foot and Knee: Treating Knee Osteoarthritis (OA) as a Pedorthist (S)
Dr. Roy Lidtke, DPM
This session is sponsored by Dr. Comfort
There are over 30 million people in the United States with knee osteoarthritis. There is mounting evidence that the biomechanics of the foot is integral in the pathomechanics of knee OA. Current mechanistic research is shining new light on the effects of the foot and knee.
This session will review the latest research from Rush University Medical Center showing how the medial column of the forefoot may play a key role in medial knee OA. Attendees will discover how pressure and gait data show how mobility of the medial column of the foot increased knee adduction movements, knee angular impulse and subchondral bone density
Knowledge of foot mechanics and how to manipulate lower extremity biomechanics at the foot ground interface may be critical in treating patients with medial knee OA. This opens up a new area of therapeutics for pedorthists.
Learning Objectives:
1. Understand the biomechanics of the foot on the knee.
2. Become familiar with how gait analysis data is used to determine the foot-knee relationship.
3. Understand how manipulation of the foot ground interface can influence the mechanics of the knee and how, as a pedorthist, you may be called on to do this.
E2: Triple Arthrodesis: When Patients Consider It (S)
Nancy Naftalin, C. Ped., Surgical Assistant
Using before and after x-rays of the feet pre- and post-triple arthrodesis surgery, this session will review the procedure and explore why surgeons offer it to patients with severe deformity. We will also review which deformities respond best to triple arthrodesis, including severe flatfoot and cavus with deformity to the mid-foot.
Learning Objectives:
1. Review the need for triple arthrodesis surgery and why this fusion will give patients better movement without pain.
2. Determine when orthotics or bracing is not working to the patient’s satisfaction and when surgical intervention may be considered.
3. Review the surgical procedure, learning precisely what the surgeon fuses, and what is expected post-surgery in terms of movement and footwear.
E3: Functional Gait Analysis & Foot Typing Methodology (S)
Dr. Louis J. DeCaro, DPM
This program will provide the student/attendee with an over-view of normal and pathological foot biomechanics, an introduction to a simple, inexpensive method of video gait analysis and a common sense approach to foot orthotic selection and design. Six major foot types will be presented with their typical clinical conditions and how each foot-type may correlate specific rehabilitation goals.
Learning Objectives:
1. Identify the basic biomechanical principles of the foot and lower extremity as a function of gait, and recognize the affect pathological foot conditions have upon normal gait.
2. Be able to differentiate between a compensated and uncompensated rearfoot varus deformity and their affect on gait.
3. Recognize the affect forefoot varus and valgus deformities have upon gait.
4. Be able to differentiate between common pathological foot-types.
5. Be able to recognize the relationship between pathomechanical foot-types and various differentially diagnosed foot conditions.
6. Demonstrate the ability to recognize key weight-bearing compensations specific to rearfoot and forefoot deformities.
7. Demonstrate the ability to select the appropriate orthotic design and selection based on pathological foot-type, as well as fit pre-fabricated devices specific to foot-type in a lab setting.
F1: Effects of Specialized Footwear on Joint Loads in Osteoarthritis of the Knee (S)
Dr. Roy Lidtke, DPM
This session is sponsored by Dr. Comfort
Dynamic joint loads are important in the pathophysiology of knee osteoarthritis and biomechanical interventions aim to reduce these loads in the hopes of improving symptoms and delaying disease progression. Recent evidence suggests that footwear can influence dynamic knee loading. This session will review a study of the longitudinal effects of mobility footwear compared to a control shoe on a knee over a six month period.
In the study, subjects with radiographic and symptomatic knee OA were randomized to a mobility shoe or identical appearing stiffer “control” shoe. Investigators and participants were blinded to shoe assignment. Baseline gait analyses were performed in subjects’ “own shoes”, study shoes, and barefoot.
Attendees will discover how this double-blind randomized controlled trial suggests that the use of mobility shoes over six months results in significant reductions in medial knee loading compared to a control. Thus, attendees may conclude that they use of flexible footwear may be an effective biomechanical intervention for the management of knee OA.
Learning Objectives:
1. Understand the pathophysiology of knee osteoarthritis.
2. Become familiar with gait parameters that influence knee osteoarthritis.
3. Understand how mobility shoes can be utilized in the continuum of treatment for knee osteoarthritis.
F2: Age Specific Orthotic Protocols for the Podopediatric Patient: From the Time They Walk Until High School Graduation! (S)
Dr. Louis J. DeCaro, DPM
This session will review age specific protocols in the treatment of flat feet, in-toeing, low tone, neuromuscular child-specific diagnoses and more. It will include a general overview of the most common foot and ankle pathologies associated with podopediatrics involving orthotic treatment. Attendees will learn the normal ranges of forefoot and rearfoot varus and valgus from infancy to the teen years and uncover the mysteries and misperceptions of when it is appropriate to treat both. This presentation is ideal for those who see patients from ages 1 to 17 as it draws the practitioner’s attention to focusing on the essentials of how to treat each age easily and effectively; and, even if you don’t treat this age group, it will open your mind to each and every encounter of “every day adult foot pathologies” that you treat and how those conditions may be linked genetically to your patient’s offspring.
Learning Objectives:
1. Understand age specific protocols of orthotic treatment for various podopediatric pathologies.
2. Understand the normal ranges of forefoot and rearfoot varus and valgus from infancy to the teen years.
3. Discover how common adult foot pathologies may be linked genetically to your patient’s offspring.
F3: Total Contact Casting for Charcot Management (S)
Dr. Louis N. Iannuzzi, PT, DPT, C. Ped.; Adam Dreyfus
This session will discuss the indications, applications and expected outcomes of incorporating total contact casting into the pedorthic clinical practice.
Learning Objectives:
1. Review the principles of total contact casting, including indications and contraindications, history and application.
2. Understand the pathomechanics of ulceration and neuropathy, and the biomechanics of total contact casting.
3. Discuss the clinical integration of total contact casting into the clinical environment of a pedorthic practice.
G1: Medicare Policy Overview-Practical Applications (B)
Aaron Sorensen, CPO
Keeping current with Medicare guidelines can be a job in itself. In this presentation, attendees will learn the finer points of compliance with Medicare regulations. Attendees will also be exposed to ways and means of working in compliance with these rules that are proving effective for a wide spectrum of type and sizes of companies. Geographic nuances that may affect your practice will also be discussed.
While audits may be inevitable, being prepared ahead of the game is your best defense. Tips regarding how to best handle RAC and CERT audits will be an integral part of this presentation, starting with best practices on the front end. Information and statistics will help spotlight current trends in the various regions on what items and areas are being scrutinized the most by the Centers for Medicare and Medicaid Services (CMS)
Learning Objectives:
1. Learn the most current CMS guidelines and regulations for pedorthic practices and how to best manage compliance with these policies.
2. Discover the geographic nuances of how CMS and their contractors interpret guidelines and regulations, and how you can be affected by them.
3. Prepare for facing a RAC and CERT audit, and learn how to manage these types of audits when they occur.
G2: Weird Diagnoses: You Have What??? (S)
Erick Janisse, CO, C. Ped.
This session will familiarize credentialed pedorthists with some highly unusual diagnoses that they may come across over the course of their career treating patients with foot disorders. It will explore the pathophysiology of a number of rare disorders, such as Ehlers-Danlos (also known as cutis hyperelastica), Marfan Syndrome, and Osteogenesis Imperfecta, to name a few. The presenter will also offer guidance for the conservative treatment of a number of these conditions.
Learning Objectives:
1. Gain a better understanding of the etiology of several rare disorders.
2. Understand the terminology used by physicians to describe these diseases and syndromes.
3. Learn how to provide appropriate care for many conditions which lie outside a traditional pedorthists’ comfort zone.
G3: Current Healthcare Economics and Market with Positive Response from the VA Perspective (B)
Dr. Anthony Lazzarino, DPM
This session will provide an overview of the gait restoration process from the perspective of a high volume provider – the Veterans Administration Healthcare System. The presenter will provide a description of the type of pathology dealt with on an ongoing basis, focus on the expected positive outcomes from the treatment regimen provided, and discuss the negative outcomes that also occur. The session will also focus on resolution strategies, including the co-creation of pedorthic solutions with private (i.e. outside of the VA system) vendors and how the VA develops their technical standard of care to achieve the maximum value per tax dollar spent on patient care. Finally, the presenter will review first-hand experiences in the co-creation arena, contrasting outcomes that have utilized this model, and those outcomes that have not utilized the co-creation model.
Learning Objectives:
1. Review biomechanical and metabolic issues limiting normal gait from the perspective of a Veterans Administration healthcare system podiatrist.
2. Examine the technical resources available to enhance positive outcomes through joint research and development projects with private suppliers and the co-creation of restoration services.
3. Learn about reimbursement issues from the perspective of the VA, with an emphasis on reliability and service from the products that are procured from outside partners, all with the goal of accountability and most value for the tax dollar spent.
Saturday, November 2, 2013
H1: Using Social Media to Develop Relationships with Baby Boomers (B)
Dr. Melodie Phillips, Ph. D.; Aaron Sorensen, CPO
Competing in an ever-changing marketplace has become more and more difficult for independent P & O firms. Not only has Obamacare and changes in Medicare and Medicaid policies made competing more difficult, but increasing problems with cash flow management have made budgeting an effective promotions plan virtually impossible. Fortunately, changes in technology, patient behavior and relationship marketing have made social media an affordable and effective method of promoting your company, new technologies in prosthetics and orthotics, and maintaining relationships with patients and doctors. Come and seize this affordable tool!
H2: The Modern Financial Challenges in Working with the Therapeutic Shoe Benefit (B)
Jeremy Long, BOC Pedorthist
Pedorthists now face several challenges when fulfilling prescriptions under Medicare’s Therapeutic Shoes for Persons with Diabetes (TSD) benefit. Shoe material costs are higher and construction is curtailed compared to previous times, contributing to both reduction in cost for service and quality or service to patients. Attendees will discover how to differentiate among Medicare Pricing, Data Analysis and Coding contractor (PDAC) approved products in order to maximize treatment efficacy, and how to realize sustainable profitability.
Learning Objectives:
1. Review the challenges involved in Medicare’s reimbursement for benefits provided under the TSD.
2. Discover how materials costs have altered footwear construction in recent years.
3. Find out how pedorthists can be profitable, while still providing quality made therapeutic footwear.
H3: Taking Steps in the Right Direction: Building Your Pedorthic Practice (B)
Dr. John Mina, DPM; Tara Evans, C. Ped., L. Ped.
Focusing on good business strategies, this session will review the importance of developing relationships of professional trust in the podiatric/pedorthic field and achieving compliance with your patients. Having open communication between allied health team members is extremely important in providing quality care, as you must be able to go to your physician and ask for clarification and discuss the options for your patients. At the end of the day, it is usually a lack of communications that ends up burning bridges in our business.
Learning Objectives:
1. Learn the Do’s and Don’ts’s of interacting with physicians and patients.
2. Discover how to achieve compliance with patients.
3. Explore methods to convince the geriatric patient to change their lifestyle to achieve healthier and more active mobility, and how this can impact the success or failure of a treatment plan.
4. Discuss specific types of orthotics and shoes that benefit patients over 40, highlighting the high-risk diabetic patient.
GS8: General Session
Title: Advanced Composite Insoles for the Reduction of Stress Fractures
Dr. Steven King, DPM, C. Ped.
This session will review the results of the initial phase of a research project conducted for the U.S. Army Medical Research and Materiel Command to develop an advanced orthotic for use by the military. The orthotic design incorporates the modern technology of composite materials, including carbon fiber and Kevlar TM, with simple and well-known technology (lever, fulcrum and spring). The orthotic is an innovative solution that decreases the risk of stress fracture injuries by reducing loading rates while increasing energy storage and return. The orthotic is lightweight, puncture resistant, and provides protection from injuries due to stress fractures and strains. Phase I efforts addressed the orthotic’s biomechanical and physical properties and the incorporation of the orthotic into a synergistic military boot housing to produce a fully tested, integrated, and developed orthotic that will reduce injuries from stress fractures, punctures, and fatigue in Army soldiers. This prototype orthotic reduces weight while increasing protection against stress fracture and strain injuries, fatigue, and puncture injuries. This orthotic has been incorporated into synergistic military boot housings, protects from injury due to ground impact shock, fatigue, and injuries due to punctures, and may save the Army millions of health care dollars and months of lost training time by protecting Army soldiers from injury.
GS9: General Session
Keep Your Eye on the Foot
Dane LaFontsee, C. Ped.
This session will explore the concept that utilizing systems such as “foot typing” and computer technology can “only” be used as assistance in a pedorthic practice. Pedorthists must not “solely” depend on such systems and techniques but to use them in conjunction with your own “hand-on” and “eye” skills that have been developed through years of experience. The presenter will discuss how pedorthists must use all of their knowledge and tools to properly create foot devices, footwear and other solutions to very difficult foot problems, because no two feet are alike!
Learning Objectives:
1. Discover how to fully utilize your intuitive and experiential knowledge developed over the years practicing pedorthics.
2. Learn how to use “all” of the tools in our toolbox.
3. Realize the importance of never replacing hand-on knowledge.
GS10: Closing General Session
Clinical Relevance of Pedorthic Foundation-Funded Foot Biomechanics Research (Ultrasound Analysis)
Dr. Geza Kogler, Ph. D., CO
Pedorthics has limited evidence-based knowledge to support the use of prescription footwear and orthoses as part of a treatment plan. The Pedorthic Foundation is funding several lines of research aimed at advancing the science associated with clinical practice. The preliminary findings of a study investigating the use of ultrasound to evaluate tissue properties of the plantar surface of the foot during terminal stance (i.e. 3rd rocker) of walking will also be discussed as it relates to the design of the rocker profiles in shoes.
Learning Objectives:
1. Restate the importance that knowledge of the mechanical properties of plantar soft tissue may have on orthotic and pedorthic management.
2. Describe the stiffness properties of the foot’s plantar soft tissues in non-weight bearing compared to weight bearing.
3. Restate the influence foot orthoses can potentially have on stiffness properties of the foot’s plantar soft tissue.
Sunday, November 3, 2013
OPS1: Optional Post-Symposium Workshop
CPR for Healthcare Providers
Robert Sobel, C. Ped., EMT-P
As part of the facility accreditation process, every pedorthic facility should have a person on staff who knows how to perform cardiopulmonary resuscitation (CPR). Every participant will learn CPR, clear an obstructed airway, and operate an automatic external defibrillator (AED). Attendees who successfully complete this workshop will receive CPR and AED course completion cards to meet regulatory requirements.
Learning Objectives:
1. Learn how to perform cardiopulmonary resuscitation.
2. Learn how to respond to a choking victim.
3. Learn how to effectively use an automatic external defibrillator.
