CAD employment in orthopedic last designin

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OST magazine 6/2012, page 44: "Der erste Schritt zum Massschuh" (the first step to the made-to-measure shoe"
An association called "Praeparatio" supports prospectiv technicians-masters to get know-how in shoe-technique. The article tell us about a cours in Landshut, Germany, for lasts designin and fitting.
Conclusion: It's crucial to have knowledge about the foot functionality, its shape, settings and spots. It's needed to evaluate a shape-feeling, a last isn't just a spacekeeper for an orthopedic shoe.
Indeed, in the editorial the autor writes: "... can we develope [with CAD tools] a shape-feeling for a functional an esthetique last? After my first practical experiences this is douptful. ... anyway I wouldn't miss the experience, the the piece of wood in my hands is forming to a last."

Does anybody have experiences in last making with CAD tools? Is it so bad?
In my own expeience, there is a part of handcraft work with CAD-tool as well. Is it suitable to act against CAD with arguments of handcraft?

 

Not sure exactly what it is that you are asking, but I worked in last design about 20 years ago.

 

Thank's for reply. Please tell us: What exactly did you work in last design? What tools did you use? What kind of lasts? Orthopedic, single shoes or standard industrial? What is in your eyes crucial to get good results?

 

I used a proprietary CAD system for orthopaedic last manufacture. Depends what you mean by "good" results. Good results from a cosmetic perspective might not be the same as good results from an health-care perspective. The key is that with a CAD system you can make the last any shape you want, but if you are going to use machines to last (pull) the upper, the machines need to be able to deal with the last that you've designed. If you are hand lasting (pulling) the uppers it matters less, but if you've still got to make it match the perceptions of what a shoe should look like.

 

We use hand lasting method and we don't work in industrial way, only orthopedic single suplies. Even the uppers are made by hand modeling. I don't know from what part of the world you come from. Indeed, in Germany/Switzerland we have some discusion about employment of CAD in the field of orthopedic shoe design. Most care providers reject the method by arguing the results of last-fitting may be bad. And sometime they make peer group against CAD users. I'm looking for authors with experiences in last design in orthopedic footwear, who might write an article in the magazine OST. Do you know somebody?

 

Not really, as I said, I was working in this field 20 years ago. Why not contact one of the commercial CAD system manufacturers and ask if they can recommend someone who uses their system?

 

There are plenty of orthopaedic shoe manufacturers in the UK using CAD last design

Kenward Orthopedic
County Footwear
Reed Medical
Blatchfords
to name but a few. Majority of MTM footwear made there is CAD designed on shoemaster(?)

 

Yep, that'll be the one.



I don't know who is doing their lasts for them these days, but Springline lasts in Northampton might be worth a call.
http://www.springline.net/ I think they might be the last of the last makers in the UK, Mobbs Miller bit the bullet many years ago.

Ken Tipping was the guy who used to run the show at Springline, I don't know if he still does. Lovely chap and highly skilled in the art. There were a number of artisans, working specifically in orthopaedic shoes, still around in Northampton back then- we used to take the CAD problems to these guys who'd solve it for us by hand... taught me to hand last uppers. They may all have gone now, sadly. Don't even have my lasting pliers anymore, but I can still sharpen a piece of hacksaw blade to put in my clicking knife handle. Happy days. You know the film "kinky boots"? Yep, exactly like that, only County Footwear were attempting to survive at the time by specialising in orthopaedic footwear rather than "kinky boots". And one chap, not the foreman or even the union rep, decided whether "the factory" wanted to do something or not... just like in the film.

 

We work closely with a traditional last maker "Shoe Lasts Australia" who in the last two years has bought in and is now using a CAD system for last making.

As to the quality of the fit, its like hand making the last, its only as good as the image/shape/data you have collected to work with.

The end product should have no difference in the final fit of the shoe at all, as you always do a last fitting test before you make the shoe.

The one thing we have found with utilizing the service, the toe boxes are always a perfect match.

As for your peers not approving, they need to get out into the new world and see what is happening and be part of it or get left behind

The system was on display at IVO 2012

 

I've been making orthopaedic lasts for 35 years now. I carve them by hand from planks of beech wood and have developed my own practice for the last 25 years. The shape of the last is only part of the solution, the prescription of the footwear is just as important. Every element of the footwear has to be thought about and well designed. The shape also has to be given a fitting whether Cad or hand made. A little about me if you want to judge whether I know anything about this.

I was apprenticed at John Lobb, the Royal Appointment Boots makers in the West End of London for 11 years by men who were themselves apprenticed in the 1920's in London. I have worked with biomechanics since 1979 when I did a couple of weekends with Ray Antony a the London post graduate study group, mostly Root Mechanics and have made the design and development of fully prescribed made to measure footwear a lifelong study. I did the Smae course in the 1990's but never practiced as a chiropodist as I just wanted a solid basis in foot anatomy and physiology. Bio-mechanics I have studied with a deep interest since 1979. My business focusses on both the aesthetic as well as the form and fit of the shoes. I am currently putting together a history of the shape in footwear from 1790 until the present day, and seeing three competing elements in the development of last shape. The first is fashion of course, the second is ease of manufacture and the third is the development of understanding of foot anatomy and physiology. I have run the bespoke footwear design course at De Montfort University as part of their footwear design degree course for 5 years.
I currently make about 2 pairs of fully bespoke lasts a week from first principles. From the ball joint backwards I copy a rectified cast so that the insole of the shoe behaves as an orthotic. From the ball joint forwards I give room for the toes and create an elegant shape and the body of the last is carves to the measures and given as much elegance as the shape of the foot will allow.

I know a number of makers are going down the Cad Cam route and are having some degree of success. I was lecturing at the Orthopedtecknic conference in Gothenberg last year where I met and talked with 2 companies that are working on Cad Cam. I thought what they were doing had a lot of potential. They both said the same thing. The computer will get you about 95% accurate and then you need to do a fitting to fine tune for the client's preference. This they said was because each individual is a human being and not a machine and there is a hugely complex range of factors that go into making a person comfortable in a pair of shoes. Estimating the shape based on the scan of the foot can only ever be a starting point. I agree with this point of view.

The CAD CAM process will never be a replacement for a skilled craftsman/technician but in the hands of such a person, a really great tool.

Why don't I use one. Because I can make a pair of lasts from a plank of beech wood in a couple of hours and 70% of my clients come back for more shoes. I don't need to spend the £30,000.
I suspect that a lot of firms tell their clients that they use CAD CAM because it makes a more accurate last. The reality is that they use it because they don't have the people who can do it by hand. I have an apprentice and she is getting really good but it has taken years!!

 

I think the interesting thing is that the same question of CADCAM vs traditional measure was levelled at foot orthoses some years back when CADdesign started to become more common.

I know plenty of CAD technicians who do very mediocre work with the designs of foot orthoses due to lack of knowledge or lack of desire to investigate the limits of the technology. Equally, I know a couple of people(Phil Wells to name one) who can do amazing things with creating custom foot orthoses on CAD.

You can have the best last making tools in the world but if you are a poor last maker, it will make no difference. The same is true of CAD. Some people are good, some people are poor. Some clinicians will always deem traditional manufacture to be better, others will prefer CAD. Others will not be able to tell, not will they care.

One thing I would say is, rightly or wrongly, never underestimate the power of technology in increasing patient compliance/concordance.

Just my 2p

 

Bill Bird: I agree 100 percent with your statement: CAD CAM is a tool, not replacement for a skilled craftsman! That's the point.

I know a company, making some marketing with CAD-CAM, computerized shoes and so on, but in fact they work by hand. They use the technology as a marketing decoration. Why they do? They don't unterstand the program tools and waste too much time on the screen. Finaly they say: On the srewingmachine it's faster.

We do lasts with CAD-CAM, but we only set the basic alignements and markers. Design is done by specialist from www.orthobaltic.lt. Fitting and finish we do eventualy by hand and near to the patient. We are able to care complex cases.

 

Agree. As I aswered to Bill Bird: The knowledge and experience is the crucial point. Not the tool. my problem is: Insurances in Switzerland pay less money if there is use of CAD technology because the gild says: "It's not possible to care complexe cases with CAD, it's only possible by hand..." and so on. I try getting some information from all over the world about the state of the art in matter of CAD-CAM technology in the orthopedic last design sector.
I'm sure, there is a big potential in the CAD technology. However, it's not the only point. Customs and insurances can limit all oportunities. Poornes sometimes is ordered by regulaiton.

 

The one thing about carving a last from first principles on a band saw is that it carries a danger element. Attached is a picture of my assistant Emily learning to carve on a bandsaw. I have devised a clamp device that holds the cone at the back to keep the hands well away from the blade (not Shown) that makes the process much safer.

 

Thats not true, ask them how they came to that conclusion, what evidence do they have to support that statement? l would suggest none

Here is a pic of a foot that we had scanned and turned on the cadcam system to make a complex tight fitting sandal on, the straps had to run close to the retracted toes and not rub them, not a whole lot of foot to hold a sandal on with ankle and forefoot straps, complex/detail, you can see the toe nail.

Go to your local Cad/cam last maker guy with your worst OA client and ask them to scan and turn a foot only if you want to see detail.

 

Thanks.

 

'elf and safety would have a field day. Chain-mail gloves?

 

No Simon, the blade would rip the chain mail and the hand even worse. I learned to do this is the days before guards and dust extraction. The answer, other than Cad Cam is to use the clamp device which keeps the hands right out of the field. In the picture, Emily is skimming the wood which is perfect safe. From this stage she goes onto a course sanding machine especially made for the purpose by Standard Engineering of Kettering. She roughed out the last with the clamp and so was in no danger then either. It wasn't till I started to teach her that I thought to design the clamping system

David that's a really nice piece of Cad Carving and ideal for a sandal. The client is lucky to have you and I bet you did something really nice for them. Having something with that level of detail means you can place the straps just where they hold but also draw attention away from the deformities. Wood is so much better than plaster or plastic.

For a shoe where appearance is important, there is also an element of toe shape and line that can be set out on the computer by using and modifying an existing last program. The thing is a foot has soft places and hard places and with arthritis etc, these cannot be scanned by a computer as yet. The fine tuning, just as with a prosthetic cup for a leg stump, is knowing here to modify from the scanned shape. Obtaining elegance is a true art form, it need not compromise the fit or function and usually has to be worked in after the cad/cam product has been turned.

If a client doesn't like a pair of shoes, in my experience, many would rather turn into a couch potato than be seen wearing them. It's a quirk of our species that I haven't quite figured out or indeed even agree with. Just my observation over the years.

 

That's right: Appearence is crucial for success of an orthopedic shoe. Many collegues don't belive.
About influence of esthetic, see also van Nettens study: http://www.google.ch/url?sa=t&rct=j...pulqLs63oIxf7kE3g&sig2=18VXn16iK_G8ecsVO4ZuIQ

 

Thanks very much Jack. I glanced over the thesis and I can see it's gold dust. I will peruse much more deeply.
It reminds me of a study done in the UK circa 1994 that said something to the effect that of the £12 million spent on orthopaedic footwear in one year by the NHS, £8 million worth of footwear ended up in the bottom of the wardrobe because it was unsightly. There are two responses to that. Improve the appearance by spending more or say it doesn't work and reduce spending overall.
Soon after that, modular footwear came of age and reasonable looking footwear came along which was a compromise fit but a good compromise for a struggling economy.

 

Its all about you listening to the input of the client if you want them to wear them.

We recently made a black pair for a client, 4 weeks later she wanted another but this time in "Cherry red", a small input, but l know everyone at that Podiatry clinic knew about it, she was just so excited she was getting a cherry red pair of boots- her input.

l said it in another thread, if you want people to wear the shoes made for them, consult with them, listen to their concerns, all the way through the 4 different stages and make them pay a portion, dont just give them away and dont just turn up with a finished shoe after taking measurements.

By being part of the process and having input to the creation of the footwear and a financial interest, they will wear them...nothing like wearing a pair you had a hand in designing, whether its just colour or more.

l believe her sister is now getting her a handbag made to match.

Ps By the client paying a portion of say $200 it also means the NHS can now help more people get more shoes

 

Hey David. I could have said every word that you have. It must be right because we have both evolved the same relationship process with the client. Stage payments, consulting and involving them in every stage, finding out their dreams and understanding their frustrations. It all costs money but in the long run it's more economical because everybody is happy.

My daughter just sent me an article written by the editor of the Architects Journal, in London this week. It was how architects could describe what they do to their future clients. The primary thing she said was that good architects listen to their clients first and then measure the property second. My daughter sent it to me because the editor made an analogy between having a good pair of bespoke shoes made where your dreams are met and having an architect design your house. A builder builds a house, and architect a home.
I think that's what you are getting at in what you say.

This bit David has been suggested by many people but goes against the founding principle of the NHS which is 'free at the point of delivery.'