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Casted Orthotic production, the 10 minute trick

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Robertisaacs, Dec 21, 2010.

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    From rough casts to finished insoles in under 10 minutes. This was for a child so its a no arch fill, high medial flange job.

    Over to you Spooner (and any other lab guys). Can you do better? 8 minute trick?
    Last edited by a moderator: Sep 22, 2016
  2. I used to be able to grind and post an EVA from rough vac formed to finished in about a minute, occasionally I'd leave my fingers on the grinder...:butcher: Several of the students from that time can vouch for this. I used to give the students one get out of jail free card, so when their patients turned up and they hadn't made the devices they were supposed to have made for them, I'd try and get them done before the patient came in, sometimes it gave me an hour, sometimes it gave me 10 minutes. Happy days.
    Last edited by a moderator: Sep 22, 2016
  3. RobinP

    RobinP Well-Known Member

    We used to line the foam box with cling film before pouring the plaster to reduce the removal of the pink debris. You also then had the cast box that could be used for a completely different type of rectification if required. It was also lighter to transport the foam impressions if giving them to the patient. Casts also have a tendency to dry out and break up.

    Impressed by 10mins. Another thing though, I have seen labs using a layer of stockinette over the cast pre vac forming, to wick away the air better and give a closer mould. Is this a bit of a fallacy? Judging by your video, the only benefit would be to keep the EVA clean.

  4. You can use a thin "bull sh!t" sheet, usually a thin layer of poron or neoprene or silicone which sits over the cast for when you're vac forming polyprops, just hides some of the little imperfections in the cast and gives a nicer finish.
  5. Phil Wells

    Phil Wells Active Member


    Cheating a bit but we have managed to do a bespoke insole from scan, design, mill and polish in 10 minutes.

  6. dougpotter

    dougpotter Active Member

    As a consumer, it repulses me that any podiatrist would use a lab that works this fast. It's no wonder most insurance plans won't cover the cost of orthotics.
  7. Dear Ned ;)

    How odd! Is it the end product which repulses you or the fact that I can make them that fast? I could slow down and eat more biscuits I guess. Wearing thick gloves would slow me down. Platinum plating them or something would add value.

    Never fear however. This is an NHS lab, producing vast quantities of devices for the impoverished suffering public. So no podiatrists DO use a lab which works this fast. Also, its not the lab which works this fast, its me. Most people take rather longer.

    And as Phil said, with the advent of cad cam, devices CAN be puched out just that fast! Its the future, as much as I hate to admit it.
  8. Really can´t wait to get me all CAD/CAM-ed up. going to be fun.....
  9. dougpotter

    dougpotter Active Member

  10. Sorry to hear that, AGAIN, Doug. Did you go visit Erin as I suggested?
    :deadhorse::deadhorse::deadhorse:And you have complained previously. Why not come see me over in the UK? Especially for you, I'll charge you by the minute, just so that you know you're getting exactly what you paid for. Alternatively, try a different profession if you are so disgruntled by your local podiatrists. Jeezus:bang:- Happy Birthday.
  11. Sorry you've had a bad time Doug. Sometimes a diagnosis takes time. Other times it doesn't. Some orthoses take me a few hours. Others don't.

  12. Man, I've spent over an hour just on a topcover / forefoot extension combo. If it wasn't Christmas... :butcher: Ultimately though what has construction time got to do with anything?.... This thread was a bit of fun, it's been hijacked by a disgruntled patient= Doug. Doug I feel for you :empathy:, I really do, but what do you want us to do about it? You've told us how you didn't think you'd had enough time spent on your assessments, you've told us how things weren't like they were back in the day. We've answered you, and offered advice as to people local to you who might help you. What more do you want? Go back and see the people who you felt weren't up to par and tell them! Get to the point of you continued presence here, please... what is it that you are hoping to achieve? Are you lonely? Do you feel the need for companionship within this community? What is it, Doug? You can tell us...
  13. efuller

    efuller MVP

    If the ortotic works, why would care how long it took to make it? The video also skips the time to prepare the cast, which is longer than the pressing and grinding.

  14. RobinP

    RobinP Well-Known Member

    Is this not a tad extreme Doug?

    It has been said before Doug, this is a site for professionals. If you don't understand the principles of orthotic treatment, don't post until you do and perhaps use a little less inflammatory language

  15. Boots n all

    Boots n all Well-Known Member

    Okay l see a simple error in your method that could reduce your time and effort by 50%, thats right 50% and you havent used the most important item on your bench that will help you achieve this.

    Its called a coffey mug, you simply sip on it whilst one of your minions preps the cast and does the vaccum forming, then you only need 5 min of your time and effort to produce the same orthosis, giving you more time for some Christmas cheer and answering Doug's questions:drinks

    P.S. Doug some of the cost of your orthotics are in the reimbursement for Roberts new Jacket
  16. CraigT

    CraigT Well-Known Member

    We will be Delcam-ed up early next year!:D
  17. Actually no!

    Anything which would be a plaster addition in the traditional method would be done by pressing out the foam. This can be done during the assessment appointment, giving the advantage that you have the patient in front of you when you do it. Takes seconds or minutes depending on how much expansion you want. I generally favour materials like therrox and EVA which allow a high medial flange so I generally don't need to do much medial expansion in the arch. If I'm using a more traditional polypropylene device I'll expand it more. The soft tissue expansion around the heel is generally not needful because of the semi WB nature of the cast. The distil corners are the work of a second to flatten.

    Anything would would be a plaster reduction (like a Kirby skive) is done as part of the process I showed. Perhaps it was not clear but that was a rough cast, straight out of the box.

    Hmmm. Minions you say. You may be on to something there!:D

    Thing is, the cast prep is probably the most important bit (as it defines the surface geometry). Whenever I try to get my minions to do that bit it never seems to be to my satisfaction. Call me a perfectionist, call me a control freak, but I like to be the alpha and omega of my orthoses. :eek:

    Not a chance!:mad:

    That Lab fleece has been in the department longer than any member of staff and has worked twice as hard as most. It has never been washed (so much plaster in it it would probably break the machine). It comes when I call. It has sufficient plastic, glue and plaster ground into that it offers significant physical protection. I'm pretty sure it has magic powers. I have sweated, cried and bled in that jacket.

    There will NEVER be a new jacket. When I retire I will pass it on to some worthy successor in the manner of an heirloom.
  18. markjohconley

    markjohconley Well-Known Member

    That's about how much of your post is worth reading Doug Potter...most podiatrists will have stories but you remind me of the time I had debrided the callus/ corns from the sole of a patient's feet, and before she even looked/felt her soles she complained that i "hadn't taken enough off" ... I informed her I had and told her to get shod and go! As one of the previous posters pointed out the amount of time is irrelevant! If the clinician "knows his stuff" many pathologies can be diagnosed very quickly (obviously applies to more than the podiatry profession). And as the gorgeous RobinP said "Begone"
  19. CraigT

    CraigT Well-Known Member

    ...who will try and burn it but probably fail

    But it did skip mixing the plaster and waiting for it to set.
    Do you know the trick of never cleaning your plaster mixing bucket to egt the plaster to cure faster?

    The process is not dissimilar to what we are currently doing using an Amfit to mill the positive (about 30 minutes per pair), doing some modifications to the model post milling, then pressing polypro or XT carbon. The most time consuming part is waiting for the thermoplastic to cool. Grinding Poly is faster than EVA, but then we also usually have to add the heel post.
    The Amfit would work well with your technique, but it is expensive for what it is.
    As I mentioned we are getting the Delcam system because we should have the control over the final product and the work that David's minions would be doing will be automated...
  20. Lawrence Bevan

    Lawrence Bevan Active Member


    Your logic is perverse. Presumably the patient that will receive these orthotics is in pain, the faster they can be made, the quicker the end to their suffering.

    The fact that they can be made so quickly and so well is a high skill level particularly when in this case that skill is matched with diagnostic ability. These skils should be well reimbursed by insurances, governments or direct-paying customers. I think this is your point - "its so fast, therefore it so easy, therefore it should be very cheap". Not so, acquiring skill costs money, Im afraid.
  21. Hard to know. It does weigh about 3 stone so its pretty dense, on the other hand it has been around a lot of solvents...

    Nuke it from orbit. Only way to be sure.

    Ok, I'll give you that. I do have to fill the cast. Takes a couple of minutes.

    Not heard of that one. I use water as hot as I can get it and a power drill and a lid on the bucket. Generally fill about 20 at a time. The heat means you can dissolve a lot more plaster in the water which gives a nice dense mix and a set time of about 30 minutes. Thats quick enough for me ;).

    I wonder if its possible to go from negative model to finished insoles inside 30 minutes...

    As I say, I think Cad Cam is the future. Although I don't have to like it. Some of those systems can do what I do in the same time and create a similar or better orthotic. And unlike me they don't get tired, or have a bad day, or stop for tea and cake. Or indeed to post on pod arena. Its sad but I fear I will one day be obselete. But meantime, having trained me, the department gets its moneys worth.
  22. Boots n all

    Boots n all Well-Known Member

    Maybe there is a new photo thread in there "Physical status of my jacket".

    Mine usually stands in the corner until l call it, l am a little suspicious that does a little finishing of some product at night when l am behind;)

    An heirloom you say, hmmm l dont think any of my minions would want to wear it, it also weighs more than it should.

    Craig, if l go automated, what do l do with my minions?
  23. David Wedemeyer

    David Wedemeyer Well-Known Member

    Robert has some serious grinding skills. Well done.

    On another note Doug I want to address your comments in a respectful manner. I am obviously not a podiatrist but I do provide orthotic services for their patients so I see a number of them. I appreciate that you enjoy this forum and that you are attempting to be proactive in your care. At the same time, I feel that at times it may not be productive that the public have access to professional forums for good reason.

    While not belonging to any secret club, health care professionals enjoy a level of training that just cannot be conveyed to the lay public in a forum. I am often tasked to provide foot orthoses or a brace for a patient referred to me and typically it is helpful and we never hear from them again (although they do follow-up with their primary). At other times, even the best effort does not produce results and we hear complaints about the referring physician and at times their frustration is directed at us. This often precedes a doctor shopping mindset where the patients seek numerous opinions and often they are precisely the same opinion but offer a different treatment option which also fails.

    I don't feel that this is the fault of the doctor but the body, your doctor merely guides the healing process; the body ultimately does all of the healing and there are a lot of variables to be considered. At some point the notion that after several failed attempts you have not achieved progress is a sign that orthoses may not be your best treatment option.

    What I have learned is that no two patients respond precisely the same way, in the same time frame or with the same results for many common conditions. There are a percentage of patients who will become chronic despite our best efforts and often those efforts are heroic. With regard to foot orthoses what may seem a simple process to you based on Robert's video, you also have to realize that he has practiced his craft for many years. Despite the relatively brief time that it took him to craft the pair of orthoses in the video, he is accomplished at it and makes it appear much more simple than it really is.

    Foot orthoses are very valuable tools at addressing various pedal complaints but they are just tools in a process which includes a great degree of training, clinical experience and skill. That is what you pay for when you purchase orthoses; the potential outcome and an educated provider. No two are completely alike but the doctors here are trying to bridge that gap through the application of knowledge and science.

    I do hope that you find that provider.


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