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ESM 2014 once again brought together the crème de la crème of international research on dynamic load distribution. Four keynote speakers, almost 60 presentations in eight scientific podium sessions, two invited talks and the presenters of the thematic poster sessions discussed many important and timely topics, such as rehabilitation, diabetes, shoes and hands, normative biomechanics, pathology, and pressure assessment instrumentation.

DAY 1

The first conference day (Thursday, July 3rd) was started off by a brilliant keynote speech by Dava Newman (MIT, Boston MA) who took us on a voyage to the outer space. MIT researchers and astronauts, as she lucidly explained, have developed advanced spacesuit concepts for human exploration of Mars that enable astronaut locomotion. The first session focussed on rehabilitation, with papers about foot and gait deformities and the application of pedography for correcting respective diseases. Australian researchers Karen Mickle and her colleagues Caputi, Potter and Steele presented their art in science award finalist paper on toe muscle problems and the effectiveness of progressive resistance training in increasing strength of the toe flexor muscles in older adults. Session number two dealt with diabetes, a particular relevant issue in the light of its ever increasing numbers worldwide. The participants discussed alterations of plantar pressure, the development of diabetic ulcers, and methods of measurement and treatment adjusted to and designed for different focus groups including populations such as native Chinese. Among the papers presented was Dutch researcher Sicco Bus and his colleagues’ interesting contribution about the efficacy of removable devices to reduce pressure and heal plantar foot ulcers, which received the best presentation award. As compared to non-removable offloading, the team concluded that removable devices feature lower healing rates and a lack of association with pressure reduction. Moreover, US American researchers David Sinacore and colleagues talked about tarsal bone density, alignment and peak plantar stress in adult-acquired mid foot deformities showing that low tarsal bone mineral density coupled with tarsal joint mal-alignment contributes to excessive mid foot stress, ulceration and amputation. In the subsequent session three, the theme of shoes took centre stage with presentations on shoe-floor interface, the influence of boot and surface type on pressure distribution using the example of coal mining surfaces, and different forefoot relief shoes.

The second keynote speech on this first day of ESM was delivered by Marian Hannan from the Harvard Medical School and Institute for Aging Research at Hebrew SeniorLife. Hannan raised the important question of how a population-based perspective of foot type and function in community-dwelling adults can inform science and medicine, arguing that the intersection between epidemiology and foot pathologies helps bridge the distance between population needs and foot sciences. This most relevant keynote speech was followed by Session IV on normative biomechanics. Amongst others, it involved a talk by Ibadete Thaqi and her US colleagues, including our own Maria Pasquale from novel electronics inc (MN, USA), discussing the overall decrease in plantar loading among the army cadet population following an intensive athletic training upon entering the military academy. Sabata Gervasio, Uwe Kersting and their colleagues from Aalborg, DK, and Göttingen presented new insights about the functionality of a so-called short-latency crossed response contributing to the activity of muscles in the opposite limb showing that conditioning these reflexes increases dynamic stability in patients with impaired locomotion. The session was rounded off by a discussion of how different simulated gravity levels alter regional plantar loading patterns while running on a treadmill, presented by Kevin Ford and his colleagues from North Carolina.

Next on the agenda was the first poster session with eleven researchers and research teams presenting their projects. Among the many interesting posters featured Mandy Gibbons and her team’s poster about plantar pressure parameters and the effect of foot structure in a west point cade population, and AM Hampson’s ‘equine’ depiction of the influence of an intensive rider core fitness program on the horse’s back. This day’s meeting was rounded off a session on the theme of the hand, with some presentations based on research working with novel’s manugraphy^® technology. art in science award finalists Erin Marie Williams was the first presenter casting a glance into human history during the palaeolithic age and into the origin of the human thumb. In a vivid presentation she explained that the unique robust human thumb is a selective response to the use rather than the production of stone tools. Her talk was followed by one of the highlights of this year’s ESM meeting: The art in science award winners Henriette Gaertner, Trossingen, Germany, and Renzo Pozzo, Udine, Italy, presented their pioneering work about the force and impulse acting on the key by the fingers during piano playing. Using pressure sensors applied on the key surface, they have analysed the relationship between force-time characteristics and the performance of pianists. They showed that the application of respective feedback can directly improve the quality of sound among piano students.

DAY 3

While the second day of this meeting, the Networking Day, was integrated with various enjoyable activities in Cambridge MA and its environs, on Day 3, Saturday, July 5th, we met back at the conference venue to resume the scientific sessions. Georg Duda from the Julius Wolff Institute at Charité in Berlin started off with a keynote speech about the employment of physical clues to initiate tissue generation such as after a fracture. His stimulating lecture highlighted the importance of understanding mechano-biology, the link between biology and mechanics and their direct interactions, which as he argues is essential for a better comprehension of healing processes and conditions. The subsequent session followed up on the theme of diabetes which we already started to discuss on Day 1. art in science award finalists Metin Yavuz and colleagues from Ohio and Texas commenced the session with a paper about the clinical value of temperature in assessing foot loading in diabetic patients, a theme which as they argue should be further investigated. Sicco Bus from the Netherlands and his Dutch and British colleagues presented their interesting research about the factors that predict barefoot plantar peak pressures in diabetic patients with peripheral neuropathy and a recent history of foot ulceration. Their study revealed the presence of local deformity as the largest contributing factor to barefoot dynamic plantar pressure. Furthermore, Cristina Sartor, Claudia Giacomozzi and Isabel Sacco, from Brazil and Italy respectively, spoke about the effectiveness of ankle exercise intervention for diabetic polyneuropathy in both improving foot loading and preventing a worsening of patients’ conditions.

Session VI dealt with pressure assessment instrumentation, and was introduced by an illuminating and comprehensive invited talk by Claudia Giacomozzi (Rome, Italy) on technical standards for pressure measurement devices. Among the papers featured Yoon Hyuk Kim and his colleagues’ presentation about their evaluation of the feasibility of wearable motion capture systems with novel’s pedar^® system. The study showed that wearable inertial sensor based systems using the in-shoe pressure system reveals reliable joint force and moment in comparison to the conventional system, especially in lower extremities. Anne Crowell and Annette Gavin, from Virginia and Warfordsburg (PA, USA) respectively, introduced their work on the role of billets, i.e. long straps that are attached to the saddle tree, with regard to load distribution produced by the equine saddle. They found substantial differences in pressures distribution between two commonly used billet positions, centre billeting and the point and (Y) configuration.

The fourth keynote lecture of this ESM by Paolo Bonato from the Harvard Medical School dealt with a particularly timely issue: the crisis in current healthcare systems, both in the U.S. and worldwide, which leads to the development of enabling technologies “to keep people outside of the hospital”. Bonato discussed future potential developments in mobile health technologies, their technical challenges as well as potential roadblocks and impacts. This was followed by an invited talk by Mary Rodgers (NIH) about funding possibilities within the U.S. National Institutes of Health. The last thematic paper session of this ESM meeting focussed on pathology. art in science award finalists Marion Mühldorfer-Fodor and her colleagues from Bad Neustadt/Saale and Rostock spoke about the question whether partial or complete wrist fusion change the load distribution of the hand during gripping. They found that midcarpal arthrodesis and complete wrist fusion result in reduced grip force, but do not influence the load distribution while gripping. The session further included a talk by Claudia Giacomozzi and her team about kinematic and footprint-based parameters for the classification of functional flatfoot. Among others, they identified modified subarch angle and midfoot/forefoot ratio as the most appropriate dynamic-footprint indexes for classifying flatfeet.

A poster session marked the end of Day 3 presenting once again a wide range of insightful research findings. Among the posters featured the introduction of the 1000 Norm Project, a database of plantar pressure and musculoskeletal measures across the lifespan, presented by Marnee McKay and her Australian team. Woosang Sim and colleagues from South Korea spoke about their study about hemiplegic patients, which verified that using an elastic ankle-foot orthosis improves their balancing ability. Matthieu Trudeau and team showed that different running shoe heel designs influence force distribution at the heel, to name just some examples. The best poster award was conferred on Mark Arts, Sicco Bus and Dutch team for an outstanding poster on data-driven directions for effective footwear provision in diabetic patients with a history of foot ulceration. The subsequent most promising proposal (MPP) award presentations honoured Licia Pazzoto Cacciari from Sao Paolo’s innovative proposal about force generation in the female pelvic floor.

DAY 4

The fourth day of the ESM meeting, Sunday, July 6th, was allocated for novel workshops discussing how to measure load distribution correctly (Workshop I), the practical applications for load distribution measurements in complex environments (Workshop II), data evaluation in clinical routine and research (Workshop III), and novel support tools and applications with various hardware systems (Workshop IV). The introduction into the theoretical and practical details of novel’s load distribution measurement technology provided the possibility to try out novel software and hardware, and was followed by many inspiring discussions and talks.

We thank all the participants, friends and colleagues for making ESM 2014 a most productive meeting, with cutting-edge research and inspiring presentations, lectures, talks and posters in a great atmosphere. We look forward to seeing everyone again in two years’ time at ESM 2016!

Written by Sophie Elixhauser