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3D Orthotic Printing: Fad Or Game Changer?

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Kevin Kirby, Dec 1, 2016.

  1. Admin2

    Admin2 Administrator Staff Member

  2. Thanks, Kevin.
     
  3. For the record, the pictures accompanying the article have nothing to do with me. If that's a Root orthosis you can call me Simon Van Spooner.
     
  4. Dieter Fellner

    Dieter Fellner Well-Known Member

  5. Yet strangely foot orthotic design and manufacture is one area where this technology could and should potentially bring about significant and positive changes to the status quo. However, this requires that the people who run the industry change their minds; Kuhn told us all about the barriers to that:

    http://projektintegracija.pravo.hr/_download/repository/Kuhn_Structure_of_Scientific_Revolutions.pdf

    And on a personal note, myself and others have been fighting that battle for the best part of two decades with regard to podiatric biomechanics... and are still banging into those defending the status quo with all their might (though less frequently now). Give it a couple of decades...

    One of the other issues is that quite often the technology is in the wrong hands, i.e., those trying to make a quick buck, rather than with the deep thinkers and the knowledgeable with regard to foot orthoses in the clinical sense. Viz. a product comes to market that has no advantage over the existing technology, just manufactured in a different way.

    For example, I got into a "discussion" on twitter last week when the article was published with someone promoting their business that is selling 3D printed foot orthoses. He claimed 3D printing was "a game changer" for the industry, I asked "in what way?". This is the response I got: "Durability, accuracy, mass customization, intrinsically change flexibility/torsion with one single material using geom. structures". Hmmm, questionable marketing response- I'm sure you'll all agree. Moreover these are the first things on your patient's mind when discussing their treatment options- not.

    But when pressed, he admitted that at present 3D printing of foot orthoses was slower, more expensive and no more efficacious than existing manufacturing processes- I'm guessing that at least two of these factors are important to your patients.

    So... I got bored of the marketing speak at that point and asked how they'd design a foot orthoses for an 18 stone professional rugby play with a mid-portion plantar fascial tear. Strangely enough, I got no response...

    Craig, nevermind a boot camp, we need a "think camp" on this...
     
    Last edited: Dec 6, 2016
  6. Dieter Fellner

    Dieter Fellner Well-Known Member

    Simon,

    Appreciate the insight and review of the technology, as this stands. Given the current limitations, where should technology be going, now? How can the technology best address design and manufacture issues to improve on the 3-D technology of today? Is there a future for integrating technologies e.g. F-scan analysis / Video Kinematic Studies etc. I am trying to figure out, I guess: what's your ideal vision & set up?
     
  7. Something that integrates kinematics, kinetics and foot orthoses with pathology. That's the key: models that predict pathology.

    I read an edition of JAPMA from 1960 today, in which there was an article where the author stated something like: "if you ask people what causes foot problems, people will answer "fallen arches" but anyone will tell of any number of individuals with the flatest of feet, yet who suffer from no problems"- something like that. Technology in terms of measuring things is great- we can measure 3D kinematics, 3D kinetics, but if we don't know what the significance of those measurements are to the patient in front of us... we might as well be talking in terms of "fallen arches" and using a Harris-Beath mat.
     
    Last edited: Dec 6, 2016
  8. Dieter Fellner

    Dieter Fellner Well-Known Member

    Models that predict pathology ... I just had a flash-back to Shavelson's foot typing .... :D
     
  9. In a scientific sense, as oppose to "some shit I just ripped off from someone else that didn't make a great deal of sense the first time around" sense. BTW, you know when you did your top-up degree and you used that pointer on the tibia, can you remember the paper that came from? I thought it was G.K. Rose, but can't find it. I was looking for the original source the other day.
     

    Attached Files:

  10. Dieter Fellner

    Dieter Fellner Well-Known Member

    Yup.... The Rose Pronatometer ... I want to say it was published in the British Journal of Orthopedic Medicine

    btw ... Kevin endorsed the concept of 'foot typing' a la Drs Scherer et al ( that's what Dennis stole first)
     
  11. Couldn't give a monkey's what Kevin did or did not allegedly "endorse", the great thing about Kevin and mine's relationship is that it has always been based upon questioning our belief systems in order to push the boundaries of our understanding. He will disagree with me and me with him, but we both walk away thinking about it... You got the reference for the Rose paper?
     
  12. Dieter Fellner

    Dieter Fellner Well-Known Member

    Well, ok - lol it's a written record of fact that he did. Since Kevin carries a lot of gravitas in the field I don't dismiss this as lightly as you. I was always curious to know why Dr. Scherer abandoned the idea in favor of pathology specific orthosis. I will call him one day, to get the low down.

    As for the reference, sorry no can do. All that material was trashed when I jumped across the Atlantic.
     
  13. Dieter Fellner

    Dieter Fellner Well-Known Member

    And 30 seconds on the Google machine and you can find what you need ;-)
     

    Attached Files:

  14. I appear to be missing your point: Yeah? And? So? What?
     
  15. Dieter Fellner

    Dieter Fellner Well-Known Member

    'And' ... perhaps there is some merit to the project. It was never fully explored. 'So', that could be important or interesting, or useless. We don't really know, for sure, right? I have no answer to your 'what'. You can fill in the gap.
     
  16. Add to that: "whatever"...
     
  17. Dieter Fellner

    Dieter Fellner Well-Known Member

    lol ... ok, grumpy pants. I can tell you're not interested. I was always curious to know if a similar foot-type might behave in a predictable pattern. Perhaps to know, for sure, we'd need the assessment tools we don't yet have. So: whatever, dude.
     
  18. a) I'm not your "dude" b) you'll always be that funny little man, with ideas above his station trying to gain his degree in podiatry to me. :) Wind your neck in fella, and we might get somewhere.
     
  19. Dieter Fellner

    Dieter Fellner Well-Known Member

    lol ...too funny, dude. I got several Podiatry degrees 'above my station' but thanks for caring.
     
  20. And that response, tells it all. Still the cock you always were. Btw none of them trump mine, but that's just a pissing contest..
     
    Last edited: Dec 6, 2016
  21. Dieter:

    I don't know where you got the idea that I ever endorsed "foot typing" as per Paul Scherer and Jack Morris chapter in Ron Valmassy's book (Scherer PR, Morris JL. The Classification of Human Foot Types, Abnormal Foot Function, and Pathology. In: Valmassy RL. Clinical Biomechanics of the Lower Extremities. St. Louis: Mosby; 1996. p. 85-93).

    Yes, both Dr. Scherer and Dr. Morris were professors of mine during my Biomechanics Fellowship, and yes, I also wrote a chapter, titled "Troubleshooting Orthoses", in Valmassy's book. However, Scherer and Morris's chapter and foot classification, which I was not aware of until it was first published 20 years ago, was in the exact opposite direction to what I was working toward at the time.

    I have never endorsed Scherer and Morris's foot classification scheme either 20 years ago or at any time over the past two decades. I read it, I understood it, but don't like any concept that "pidgeon-holes" foot biomechanics for simplicity. I believe this type of "foot typing" approach leads to crude generalizations that aren't always true and relies on only externally measurable variables that are often not functionally significant.

    In addition, I don't endorse Dr. Shavelson's foot classification scheme either, and never had.

    Please, Dieter, or anyone else, before you claim I have endorsed or not endorsed a concept, check with me first.
     
  22. Dieter Fellner

    Dieter Fellner Well-Known Member

    Kevin,

    Sorry, but you did. I believe it was for the book review published in a magazine. If you really need it I can probably dig ot out sometime. Right now I don't have access to my library.
     
  23. Dieter Fellner

    Dieter Fellner Well-Known Member

    Ya,
    funny - that's exactly my sentiment about you too, buddy. Don't take yourself too seriously (or try to sniff less glue from your orthotics). It was fun, dude, but I have to run. No need to thank me for finding you the article. That might suggest some manners. Which you never did have.
     
  24. Good luck Dieter love. For the record: neither your "buddy" nor your "dude". Funny thing is, you'll always be "Dieter love" because the league of gentlemen said so... and that baseball cap just makes it more so. Bless your cotton gusset. You are not American, don't try to pretend to be.
     
    Last edited: Dec 6, 2016
  25. Eric Fuller was working as a Biomechanics Professor at CCPM with Drs. Scherer and Morris at the time Scherer and Morris's chapter was published. Eric had been a biomechanics student of mine when I was the CCPM Biomechanics Fellow. Once Eric did the Biomechanics Fellowship a few years after me, we started closely working with each other toward a new way of treating patients with foot orthoses. I was in private practice, and he went the other direction of teaching biomechanics at CCPM for a number of years.

    Eric Fuller and I were, and still are, as they say, kindred spirits. Our collaboration over the years resulted, ultimately, in our chapter on Tissue Stress Theory that was published 3 years ago but was completely written 10 years ago (Fuller EA, Kirby KA: Subtalar joint equilibrium and tissue stress approach to biomechanical therapy of the foot and lower extremity. In Albert SF, Curran SA (eds): Biomechanics of the Lower Extremity: Theory and Practice, Volume 1. Bipedmed, LLC, Denver, 2013, pp. 205-264). I don't believe either of us like the idea of "foot classification" as proposed by Scherer and Morris or by Shavelson.

    I believe you may want to speak to Eric Fuller about the origins of the term "pathology specific orthoses". He has an interesting story to tell about that one also.
     
  26. I really need it. That'd be fun if you could provide it Dieter Love. By the way, in which English NHS region do you hold a salaried "consultants post" as a surgeon? Let me guess: you "consult" in England... Now you and I both know that them two, they are very different things, but the lay public... never an attempt to deceive, that's the main thing- right? So, which NHS area are you currently salaried as a "consultant podiatric surgeon" for? This country has changed a little bit since you left, fella.
     
    Last edited: Dec 7, 2016
  27. Sorry, Dieter. I don't think I ever said that and I don't ever remember doing a "book review" in a magazine. In fact, I don't think I have ever had a "book review" published....anywhere. You must be thinking of someone else.
     
  28. My rugby coach once said to me "don't apologise for something you haven't done"- think there is a message there, boss.
     
  29. The problem here, Simon, is that I have authored or coauthored 78 publications (book chapters, published papers, and podiatry articles) and over 350 monthly newsletters over the past 33 years and can't be 100% sure that I ever mentioned the book chapter by Scherer and Morris. However, I am completely sure I never did a "book review" of their chapter and since I never did really like their foot classification system. In addition, I am also completely sure I never said anything about "endorsing" foot typing.

    However, I might have said in one of my thousands of online comments over the past two decades on the various podiatry websites that I thought that my biomechanics professors' foot classification system may be helpful for some podiatrists. I really wouldn't call that an endorsement but rather an acknowledgement that some clinicians, those with a relatively poor knowledge of foot biomechanics and a relatively poor potential for further improvement in their knowledge, may be helped by anything that makes the complex topic of foot and lower extremity biomechanics more simple for them.
     
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