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Expert discussion “Orthopedic shoe production involves both craftsmanship and human intellect“

2017 marks the 100th anniversary of orthopedic shoe production in Germany. To honor the milestone, in January Bauerfeind invited sector representatives to its headquarters in Zeulenroda to discuss the developments made in recent years as well as the opportunities and challenges of the future. In a nutshell , the participants concluded that while their craft is becoming more technical , people are still at the heart of it.

Werner Dierolf, President of the German Federation for Orthopedic Shoe Production, is passionate about representing the trade’s interests.
Werner Dierolf, President of the German Federation for Orthopedic Shoe Production, is passionate about representing the trade’s interests.

Henning Quanz: This year marks the 100th anniversary of your trade but the celebrations come at a time filled with many challenges. Looking back on 100 years of orthopedic shoe production, is there anything your trade can reflect on with particular pride?
Werner Dierolf: We’ve made tremendous progress in recent years – transforming from traditional shoemaking to high-tech production. We no longer rely on our craftsmanship skills alone, but draw on the latest technology as well. The trade itself has also developed in terms of the knowledge we have at our fingertips. We spend much more time studying the human body and how it works. Today, our knowledge can be compared to that of builders, as we are aware, for instance, that the heel bone is the most important focal point in terms of the statics of the foot. In the past , our work solely consisted of making shoes with various volumes for injured war veterans, but today we produce foot orthoses that have a sensorimotor effect and are customized to the wearer’s foot. We have developed continuously over the past 100 years in terms of our knowledge and our use of technology – and of this we can be proud.

So your trade has become more technical. What do you focus on as a manufacturer?
Andreas Lauth: The industry and craftspeople are united by a common goal , namely the health and wellbeing of the people who need our products. This is why we are making increased efforts to look into comprehensive process chains that incorporate everything from materials to ordering and delivery. This encompasses material development and research as well as the investigation of new technologies and how to use them. The development of process chains also involves using measurement technology to collect data and taking this data to assess what needs to be done from a craftsmanship point of view.

Ms. Jordan, you work in Krefeld with your father in your own family-run business. What role does new technology play in your company?
Jana Jordan: We always use the latest technology – collaborating with the industry makes this easier, of course. For financial reasons, we don’t have our own orthosis milling unit , but thanks to Bodytronic ID:CAM we are able to access Bauerfeind’s milling technology. We use the latest measurement technology to stand out from competing orthotists. Our customers are aware of this and really appreciate it.

Albrecht Breymann, a retired orthotist , is an Honorary Federal Guild Master of the German medical trade profession of orthopedic shoe production.
Albrecht Breymann, a retired orthotist , is an Honorary Federal Guild Master of the German medical trade profession of orthopedic shoe production.

How does craftsmanship and technology fit together for you, Mr. Dierolf?
Werner Dierolf: They are a good match. We take scans and use 3D, CAD and milling technology. Combined with our knowledge of anatomy and how the body moves, this enables us to explain to our customers how they can use our products to stay fit and healthy for longer and enjoy life more. There are, however, some technical applications we can’t access on our own. Here we rely on the industry’s use of batch-production technology. For example, we can now use the Bodytronic system, which was initially designed to measure the legs and provide custom-fit compression stockings, to produce cleats and thereby create custom-made shoes. It awaits to be seen how open individual craftspeople will be to these changes. But I think they’re great!

Some people fear that technology might make craftspeople dispensable. As a long-standing master craftsman, what is your opinion on this matter, Mr. Breymann?
Albrecht Breymann: That won’t happen under any circumstances. Our in-depth background knowledge about the foot , the bones, how we move and the interrelationships within the body set us apart from technology. Every damaged foot is different! Technology might be capable of measuring everything, but it comes unstuck in terms of ascertaining whether and how these measurements will ultimately affect the human body. Even in the future, this will require skilled and knowledgeable craftspeople to rule out any doubt.

You have written a chronicle of the history of orthopedic shoe production from 1900 to 2004. In your closing words on the topic of technology, you wrote that your colleagues will need to majorly rethink their approach to this in the future. What did you mean by this?
Albrecht Breymann: Older businesses in particular are refusing to use modern technology because they feel it is unnecessary or find it too difficult to use. However, if companies are to survive, it is essential that they keep moving with the times and try to integrate the latest technology into their business to the best of their ability. After all , it is often said that if you are standing still you are moving backwards. We learn from technology and technology learns from us.

A young, female craftsperson. Jana Jordan is one of a growing number of women working in orthopedic shoe production.
A young, female craftsperson. Jana Jordan is one of a growing number of women working in orthopedic shoe production.

A lot of technological changes are happening in your company, Mr. Lauth. In terms of technology, how important will collaboration between craftspeople and industry be in the future?
Andreas Lauth: Collaboration is absolutely essential. The ability of craftspeople to tell with their naked eye how certain movements will affect the body never fails to amaze me. In my opinion, orthopedic shoe production involves both craftsmanship and human intellect. While we on the industrial side of things provide the necessary manufacturing technology, the creation of finished products still requires the input of experts who design the topology, select the materials, insert the wedges, etc. Once this is in place, a machine can do the rest. But then at the end, it is down to craftspeople to use their “human intellect” to refine the product.

So craftspeople use their knowledge and refinement skills. Ms. Jordan – what kind of person do you believe an orthotist needs to be in order to succeed today?
Jana Jordan: I think it’s crucial to be innovative and to move with the times. Specialist knowledge is vital to enable us to communicate with physicians, for example.
We must also be in a position to pass this knowledge on to customers in a way that they can understand. To remain successful in the future, we need to change with the times and stop working in isolation, beavering away making shoes behind closed doors. It’s simply a matter of presenting ourselves better.

What will be required of the orthotists of tomorrow in your opinion, Mr. Dierolf?
Werner Dierolf: Orthotists of the future need to be very outgoing and open-minded. Like anyone who works with people, they must also be able to impart their knowledge and build contacts with others. Like before, their most important trait will be honesty towards others – the honesty to say, “I have the required knowledge and my work will be of true value to you.” These are the essential characteristics of an orthotist – honesty and the ability to inspire enthusiasm in others, from senior citizens and local football players to elite athletes.

In which areas do you believe the orthopedic shoe production sector needs to take action, Mr. Breymann?
Albrecht Breymann: We need to step up communication between craftspeople and physicians so that customers are better prepared when they come to see us. Customers think they can wear their foot orthoses in their normal shoes and are surprised when they find out they need sensible shoes for their orthoses. Besides issuing a prescription, it would therefore be beneficial for physicians to provide additional clarification to patients about what the product entails. This requires us to keep physicians up to date with our work.

Communication with physicians is very important. Mr. Lauth, how do the industry and quality partners work together when it comes to the effectiveness of products? What role is played by physicians?
Andreas Lauth: It isn’t possible to say how effective a product is straightaway. Studies must be conducted to investigate such matters. We generally conduct such studies with physicians with experience in the respective product group, joint and indication. Without studies we wouldn’t have any evidence. We see ourselves as a supplier of products with medical benefits.

What role does effectiveness play in terms of selling products?
Jana Jordan: It plays a huge role. Customers frequently want to test products, accustom themselves to sample foot orthoses and discover what they feel like. They also like us to explain exactly how they work.

The companies covering the costs of dispensing these products are also interested in how effectively they work. What message would you like to send to health insurance providers?
Werner Dierolf: Firstly, health insurers must recognize that our aim is to help people. Secondly, I would like to see less red tape. At the end of the day, we’re dealing with people in pain. They are real people with names and faces, not just numbers. And it is vital to recognize this.

Bauerfeind’s Andreas Lauth calls for the health benefits of foot orthoses to be better communicated.
Bauerfeind’s Andreas Lauth calls for the health benefits of foot orthoses to be better communicated.

We are all familiar with the graph depicting age distribution in Germany.
It is much wider towards the top where the oldest age groups are than it is at the bottom. Will foot orthoses continue to be made available on prescription, Mr. Lauth?
Or indeed should this practice continue?

Andreas Lauth: The fact of the matter is that the fixed amounts that have been in place for years are what they are. We will definitely all see cost structures and rising costs being passed on to consumers. Orthopedic orthoses certainly cost health insurance companies considerable money and I expect that consumers will be required to pay more of a contribution in the future. This makes it all the more important to educate customers and to convince them of the health benefits and value of these products.

Training new orthotists is very important for the future of the trade. However, a lot of young people prefer to go to university. What can be done to convince this generation to turn their hand to your trade?
Werner Dierolf: We provide one of the best forms of vocational training. An orthotist not only provides services, but can feel justified in doing so. Our profession helps people. Then, of course, we can offer academic training as part of our apprenticeships. This is important because – and this is not only a problem being faced by our trade – members of today’s generation frequently want an opportunity to study. As part of the dual vocational training system, new entrants to our profession can learn our trade and study at the same time. In such cases, we don’t see academia as a competitor, but rather as being complementary to what we do. Craftsmanship skills will always be the most important requirement , however.

How does the industry help find eligible new entrants to the profession, Mr. Lauth?
Andreas Lauth: Our company’s greatest treasure is its people, not machines. However, we constantly have to work out how to find new treasure. Simple advertisements just aren’t enough. We run activity days for school classes, giving youngsters the opportunity to work on small projects simulating real life. These days are very well received. We also visit schools ourselves, give presentations, work with vocational colleges and attend career fairs. There is no ONE method of success.. Instead, we have to try a wide range of approaches.

Jana Jordan: You are a young, female craftsperson. How confident are you that your chosen profession has a future?
Jana Jordan: The healthcare sector will never disappear. In fact , with people living longer, demand will rise even further. We must stand out from the crowd by providing excellent advice to our customers and emphasizing the quality of our products. In other words, we can use our advisory skills to secure our profession’s future.

2017 marks the 100th anniversary of orthopedic shoe production. What wishes do you have for the future of your trade, Mr. Breymann and Mr. Dierolf?
Albrecht Breymann: There’s strength in unity. I want to see a unified orthopedic shoe production trade that preserves this unity across Germany.

Werner Dierolf: My wish is for us to keep developing so that we can play a leading role among the medical industry’s trade professionals. I also hope that we will have an excellent relationship with our partners in the healthcare sector, in other words, physicians, health insurance companies and industry players. Working together for the benefit of the people who need our care – that’s what it’s all about. And we want it to stay this way in the future as well. 

Images: Detlef Majer