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Foot orthotic design software

Discussion in 'Biomechanics, Sports and Foot orthoses' started by lorcanjack, Feb 18, 2016.

  1. lorcanjack

    lorcanjack Welcome New Poster

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    HI ALL
    having tried numerous softwares for orthotic design i still find a lack of functionabilty
    any suggestions on new software out there for direct and indirect milling

    regards and thank you all
  2. Craig Payne

    Craig Payne Moderator

  3. Petcu Daniel

    Petcu Daniel Active Member

  4. Craig Payne

    Craig Payne Moderator

    number of reasons:
    * just found it easier to use and quick to use compared to others I have played with
    * does not use a template system
    * the output can be used with a 3d printer (other systems apparently will not be able to do that without re-writing from scratch)
  5. Craig Payne

    Craig Payne Moderator

    BTW, its also free to download and use to design orthotics - only pay when actually want to use it to make orthotics
  6. lorcanjack

    lorcanjack Welcome New Poster

    thank you all for your replies
    much appreciated
  7. Hi to all interested in designing orthotics (Milling) and making it from scratch using POP and Polypropylene and EVA

    I would like to put a number of questions out there, but I must admit to the possibility of being biased: I cannot afford a milling machine, gait plate, or 3D scanner, and that might contribute to bias without the intend to.

    I make mu own polypropylene orthosis - thermoplastics from scratch: POP NIC method

    After 8 years of experience in making both EVA and polyprop orthoses, I want to raise a few conserns regarding direct milled devices (in other words, EVA orthoses - albeit hard 50/55 shore, 55/60 to 65/70 shore EVA)

    1. I understand and accept that the milled EVA orthotic can have a MLA area similar to the the thermoplastic, but is it as durable as compared to a thermoplastic that is made from a 3mm or 5mm thick plastic with forefoot and rearfoot stabilizing posts?

    2. I understand and accept that it can be comfortable, but is there any statistics out there to compare the comfort of the devices - it does make a difference in patient complience

    3. Is it cheaper compared to making it yourself? I am of opinion that you can make your own thermoplastic devices at a very good price - save money, and avoid having to work at retirement home (I find working at retirement homes very tiring).

    4. For South Africa: Won't it lead to job creation if we assist 2nd year drop outs in becoming skilled in making orthotics, seeing that the existing labs are too busy - literally - already, because very few people seem to be encouraged to make their own devices while being students. They can still be useful with their basic understanding of foot structure.

    5. STJ control: Is the soft EVA heel cup capable of limiting STJ motion in the way your patient need it (either invertion or evertion moment being generated at the STJ)? Does thermoplastic devices provide it? I assume so, but thinking logically about EVA - is it possible?

    6. Is it profittable if you take into consideration that you cut away what seems to be 50%, 60% - 70 % of the EVA bulk in a country where examination and orthotics cost below $200 (R1800, SOuth Africa). The reason I'm asking - if you are a start up podiatrist from an average family, you will likely not qualify for financing fro the banks, left allone afford any lab fees. Why not start making it yourself while you have time to do so?

    7. Is it possible to limit navicular drift and drop sufficiently using an EVA device? Can Eva provide a flange in an orthotic and still allow your patient to wear his or her formal work shoes? We can't always wear running shoes.

    8. I found that when a patient wears her orthoses inside sandles that have a closed heel, and 1cm broad straps around the ankle and across the foot (or multiple thinner straps), they remain functional enough to provide pain relief for plantar fasciitis. Is it possible to accomplish similar results using an EVA orthoses in sandles? I also found that in our country where people can't afford expensive running shoes, that orthotics made from thermoplastic works well in softer cheap canvas shoes from the local affordable shops. Is that possible with more flexible EVA? I don't know - I generally use polyprop, answers from those who have used EVA devices in their practice a lot?

    I would like to hear from people who understand biomechanics and get their input also. I am of opinion that the sales reps who sell these systems focus a lot on time vs money vs quantity, but focus little on research and quality, and lack, often, knowledge on biomechanics and STJ stability (yes in my limited understanding of biomechanics, STJ control is a huge factor in making my orthotics - I focus on where do I place the highest point of the arch (I hope under the navicula) and do I want to and allow the subtalar joint to evert or evert).

    Another question: of how much importance is bringing the ground to the foot in forefoot varus and forefoot valgus. I need good recent articles that explain that to me. Where and when do you add or don't add forefoot medial wedging. Lateral wedging is when the patient needs to be inverted in the STJ or forefoot, if invertion during midstance is causing his tenoditis or HD, or knee OA (in short, and typed very rushed).

    Hope to hear from some people who know what they do when it comes to orthotics - people who can't make an orthotic must not reply.
  8. I understand that my reply doesn't relate directly to types of software, but I hope that it relates by getting you thinking about the question - is it going to do what it promises to do, and will your patient benefit from the software + milling + fancy pressure plate as much as from good old manual biomechanical and physical examination. Research has proven (I read it before but don't posess it therefore can't place any referance) that doing a physical examination wins a patients trust. Kevin Kirby has written about the value of manual examination (and computirized gait analysis) before. Both has it's benefits. Patients are disppointed if you don't do a physical examination, although they are impressed by your fancy equipment.

    Just another thought. I'm a bit negative due to sales reps who thrust technology down your throat, while you are getting along and solving your patients complaints without it.
  9. Phil Wells

    Phil Wells Active Member

    Hi Pierre

    You have put out a fairly exhaustive list of questions which I think would be best answered on mass.
    CAD and CAM are just tools. Some aspects are better than traditional methods e.g. varying the PP thickness through out the device, multi layer EVA to give different shore densities at the heel, mid and forefoot, the ability to 3D print. Negatives include a initial costs, steep learning curve.
    I have been using CAD for 15 years but instead of buying an orthotic package (The ones around at the time were too limited) I learned how to use a generic CAD package and continue to this day to tweak it to make the desired orthotic design.
    A pair of CAD orthotics can be designed and milled from start to finish in under 30 mins (excluding finishing time) with material cost ranging from ?3.50 to ?8.50 for the raw material.
    The biggest headache has always been the CNC machine but if a group of pods joined forces they could have a centralised CNC set up without too much overheads per orthotic.

    Don't let the sales men spoil it for you - it is another avenue to go down once you are too busy clinically to make your own.

  10. Phil

    I understand fully the time aspect. I've been doing it for 8 years. All those cushionings sound great but over cushioning might slow dow propulsion if applied incorrectly. So does a less rigid device when a more rigid device is needed.

    The questions that concern me most are not answered:

    1. The STJ moments that one aim to generate - is it possible to achieve this using orthoses with soft heel cups.

    2. Do EVA orthoses limit a patient's options in terms of shoewear further than does more rigid thermoplastic orthoses? My suspicion is it might - but I only have 8 years experience in the lab and 6 years clinical.

    It seems as though the only benefit is the better return time.

    Anyone who thinks like an engineer has an inout on this (... referring to an article: should podiatrists think more like engineers... ). If we think like engineers then time is not the most important factor. Think what happens if you dont allow concrete to set for the required number of weeks to save time: the second story of the building collapse. :deadhorse:
  11. footdoctor

    footdoctor Active Member

    Hi Pierre.

    Answer to question 1......

    Probably not as soft foam will compress on load and therefore the external force generated will be minimal.

    Answer to question 2

    Invariably an Eva device ( shank dependant) will occupy more space within a shoe than a poly shell.

    As for the digital vs traditional manufacture debate, this is where I stand.

    1) Negative formation is quicker and cleaner using scan technology, though indeed the initial outlay is costly. Saying that there are plenty bolt on 3d scanner for iPad now that will do a very nice job of capturing a 3d foot image for under ?300.

    2 Through the creation of a corrected positive mold pretty much any device can be created or material utilised. It is quicker to create a digital corrected negative and machine it than it is to plaster pour and manually correct, imo.

    3 re patient compliance to direct milled poly devices, it's all in the geometry. It doesn't matter if it's pressed over a plaster positive, direct milled or vacuum pressed over a mdf corrected positive. It's down to shell geometry and stiffness. Generally, however, a 3mm direct milled poly device will be stiffer than a 3mm poly pressed device as the thermoforming of the plastic changes the molecular structure.

    The only limitation of direct milled devices is wall height as most cnc machines will not mill greater than 40mm blocks and even if they could it would be too costly to use in excess of 40mm.

    Pro's for digital - faster, more repeatable

    Cons - costs a pretty penny to set up and will take a lot of time to learn the design side and machining side of the operation, believe me. There is no plug and play systems out there despite what the salesman will tell you. Each system has potential flaws and limitations but most of these can be over come with experience.
  12. qldpod

    qldpod Member

    I made the change early last year and not only changed the in clinic methods but also the in house lab and how they made our devices. We went from traditional plaster cast devices of either EVA or SUBO. To now 3D scanners and CNC milling machines and EVA devices ONLY.

    Yes there was a little learning curve to begin with and yes there has been computer issues to deal with but 2016 was a great year for 98% of our clients that is the success rate we had with our orthotics. In terms of comfort, fit and function and pain relief.

    We use LASERCAM and they are amazing and very forth coming with their knowledge and we could not have done it without them. We are so glad we made the change.
    Yes cost needs to be considered but this way for us is saving us time and money.
    Thank you so much Anthony Dwyer and Konrad Jobst for you encouragement and help.
  13. Trent Baker

    Trent Baker Active Member


    This is an interesting post and the chain has been fun to read. I have to say Pierre that your original proposition of bias seems to be the case here. It's time to move on... The days of taking a cast, filling it with plaster, then peeling off the outside shell, nailing nails into the cast, hand adding plaster, heat moulding the poly, Gluing EVA and then grinding the shell to shape are over and inferior in my opinion. It seems you are cutting a copy of a key off a copy of a key...

    3D scanning followed by cad cam milling is a great leap forward in orthotic manufacture. It's more accurate, time effective, and in my opinion produces a superior device than the old school methods. We have been using 3D scanning and cad cam milling for many years now and finally set up our own lab about three years ago. The EVA devices in particular that we design and mill using LaserCam software are amazing and results driven. We have never looked at orthoses with the bottom line in mind, our group which includes upwards of 20 podiatrists have and always will strive to produce the best device for the best patient outcomes possible, and as such will continue to push forward with technology.

    Lasercam designed devices fit foot wear very well, will create an excellent "STJ moment" and again, in my opinion are more comfortable than poly devices. EVA is not soft, it comes in many different densities as you would be aware, and if you design and finish the orthoses well they will create an effective correction base in most situations. Since switching to Lasercam most of our Podiatrists are moving to EVA devices for many reasons, however the overwhelming reason is that we get better results. In particular our athlete patient base love these devices and find injury prevention levels superior to our experience with athletes using poly devices.

    In short, EVA is great, you need a change. Go and check out LaserCam, if you can't afford the mill and software you can have Konrad and Tony make your devices for you. Once you make that change I'm sure you will be in line at the bak looking for finance to assist you setting up your new lab.

  14. Phil Wells

    Phil Wells Active Member

    Hi Pierre
    If you start to think like an engineer it will allow you to make material decisions for your orthotics that use physics and clinical intuition combined.
    I am not convinced about the heel cup being as important as you think. They do have the potential to create moments of force but due to the movement of the COM through the foot, this force may be so transitory to be negligible. If the rearfoot complex has 'pathological' movement then a combination of proximal control exercises, shoes with good heel counters and orthotics is probably needed. An orthotic on its own may not be up to the job!
    EVA is easily up to the job of applying the required forces as long as geometry and material density are defined correctly.
    I think both Trent and qldpod have answered things well enough to hopefully put your mind at rest!

  15. ALL_FEET

    ALL_FEET Welcome New Poster

    Hi All,

    Great posting, this is progress talking it out

    1. Pierre you're questions are so vaild, and I believe our colleagues Phil, Trent, QldPod & FootDoctor have answered in spades

    * Disclaimer - I've nearly finished a step-by-step course for Podiatrists who want to build their own personal orthotics lab using lasercam software - it covers EVERYTHING. I build my own lab with CADCAM and lasercam software in 2014 and could only imagine getting the experience and information out to other Podiatrists

    I'd like everyone possible on Podiatry Arena to complete a very simple 9 question survey posted here https://www.surveymonkey.com/r/ZZ7G5BD because you're all so passionate on continuing progress in orthotic manufacturing and the professional standard

    - P.s as a side note, it's possible to have an entire orthotic lab package, scanner and all tools for ~$20K with extremely high quality, industrial grade machinery. This course is being developed to educate Podiatrists on the future of orthotic devices, materials, technology and to give to power & confidence BACK to the practitioners

    It would be a HUGE help to answer a few short questions because you're all so experienced https://www.surveymonkey.com/r/ZZ7G5BD

    And keep an eye out for this course to be released this year - Build Your Own Labs

    - P.p.s Craig would you be kind enough to complete this survey specifically since you endorse the software? Could be so important to have someone with your experience and would love your view on our course structure

    Cheers all :D
  16. Craig Payne

    Craig Payne Moderator

    I not sure if you will get much of a response to this as people tend to not want to hand over this sort information unless its clear who is conducting the survey and why and to what purpose the information being provided is going to be used for.
  17. efuller

    efuller MVP

    Hi Pierre, I used to teach how to make orthotics at the California College of Podiatric Medicine. So, I'm very familiar with plaster of paris production of orthotics.

    I've seen EVA devices last multiple years. When a device is dependent upon the shank of the shoe for support it will probably be quite durable. The posting can be incorporated into the EVA (assuming the operator knows how to do this) and it should still be quite durable. What matters is the shape of the top of the device and how it deforms in response to load from the foot.

    I know of no statistics that would show that one method is better than the other.

    You do have to take into account time costs. It would take me around an hour of time (while doing something else while the plaster dried) to make a finished pair of orthoses. I do enjoy the control over the finished product, but that is a lot of time. If I had as much control over the finished product with CAD CAM and it was faster I would do it.

    Train those drop outs to service CAD CAM machines and learn computer support.

    If you have a soft device made in a manner that after it deforms it is the same shape as the loaded plastic device it should work quite similarly. There is a learning curve with any material. The amount of change in STJ moment from the device is still guess work what ever material that you are using. We don't know if a 2 mm medial heel skive is better than a 2.5mm medial heel skive for a given patient with a given material. We make the clinical decision that a patient needs more supination moment and then we make our best guess on what cast modification will produce that change. Different materials may give us a different change, but we could change our prescription after learning a new material, if needed.

    The initial investment is a lot lower with the traditional method. However, when you get busy enough that you can earn more in your office than you can in your orthotic lab, then you should be in your office.

    I don't have experience trying to grind a flange with CAD CAM.

    You can make polypro orthotics with cad cam.

    John Weed used to describe a test where he would try and put his fingers under various parts of the patient's foot when they were standing. If you can run your finger under the first met head in relaxed stance you should add a varus wedge under the metatarsal heads. You would also expect things like sinus tarsi symptoms and lateral column pain in these individuals. Putting, your fingers under the lateral forefoot is a little more complicated for valgus wedging.

  18. Pierre:

    It would be better in the future if you asked just a few questions at a time.

    Polypropylene is more durable than EVA. Polypropylene is a shank independent material and EVA is a shank dependent material. However, both of these materials can be used to make quite effective custom foot orthoses.

    There are no studies on these materials to my knowledge. Patient compliance and comfort with orthoses is multifactorial and certainly not limited only to the material used for the orthosis shell.

    Making your own orthoses can be cheaper than using a lab, however it also takes quite a bit of time to make your own orthoses. I prefer to use a lab for all my orthoses so I can see more patients and ultimately have a better income with more free time.

    There is a big difference between being a good podiatric clinician and being a good orthosis lab technician. One doesn't need to have a precise understanding of foot structure in order to be a good orthosis lab technician.

    Foot orthoses, regardless of whether the shell is made of polypropylene or EVA, work by altering magnitudes, temporal patterns and the discrete locations of ground reaction forces acting on the plantar foot during weightbearing activities. Polypropylene, polyethylene, EVA, Plastazote, cork, stainless steel, wood, graphite laminate , acrylics and even bundled up tissue paper can function to alter the magnitudes, temporal patterns and the discrete locations of ground reaction forces acting on the plantar foot during weightbearing activities. The three-dimensional shape and the load-deformation characteristics of the orthosis inside the shoe is more important to orthosis function than is the material that makes up the orthosis shell.

    For the right person, making your own foot orthoses for your patients can be a very good way to practice. It is not, however, for everyone.

    An EVA orthosis can be just as effective as a polypropylene device in creating external subtalar joint supination moments and external forefoot plantarflexion and adduction moments. However, shank independent foot orthoses, such as polypropylene foot orthoses, are less bulky and will fit into wider variety of dress shoes more easily than will shank dependent orthosis such as EVA orthoses.

    Hope this helps, Pierre. Next time, if you want more people to answer your posts, limit your each post to no more than 2-3 questions.
  19. ALL_FEET

    ALL_FEET Welcome New Poster

    Point taken Craig, thanks - I'm an Australian, Victorian Podiatrist asking 9 simple Yes/ No/ Please explain questions regarding practitioners experience with their custom orthotic set ups (be it internal or external labs they're using). I'm searching to know more about how Podiatrists feel, are they happy, not happy, in between and/or do Podiatrists want to learn more about building their own labs.


    So the course is designed to educate Podiatrists on why the could use CAD design, they could use EVA by choice, and then it teaches step-by-step HOW to build a CNC orthotic lab to suit their needs and budget.

    At the moment the course design is mostly complete, and focuses on CAD design software - I have used LaserCam for a few years and haven't looked back, in no short part with help from Anthony and Konrad. I went down the path of designing and building a CNC orthotic lab before meeting Anthony and only with his help did I end up getting what I wanted.

    No names are shared or labs discussed, the purpose of it is to get a feel for where the community as a profession is at.

    The aim is to increase the confidence of Podiatrists by educating them and getting hands-on with their approach to prescription orthotics

    Cheers all :D

  20. ErinaPod

    ErinaPod Welcome New Poster

    Hi Guys... and Pierre,

    Great discussion and thrashed out now I believe.

    We have been making CAD CAM EVA style devices for many years. Footwear fit was always a bugbear as our devices tended to be much thicker and more cumbersome than Poly and hence we used to make poly devices by hand when footwear fit was a consideration. We have since started to employ some higher quality EVA material than can be milled out much thinner whilst retaining it's structure with reasonable wear rates. This has helped a lot with shoe fit, however you have to very careful with your finishing to ensure you leave enough bulk in the areas you would like to control.

    You do make a good point Pierre (I think it was you) about medial flanges. We still occasionally make poly devices from scratch to get around this. CNC milling not quite there yet with this one. Possibly to be solved by 3D printing but I'm not holding my breath. If anyone else has thoughts on flanges (or alternatives) with EVA I would be keen to hear about it.

    For the record we started off with Amfit but have recently started using Lasercam - played around with Delcam but it was too slow, too inconsistent and had a low repeatability factor as well as other issues.

    Nice to hear passionate talk about pods making orthotics. More please, before we become prescriber's not manufacturer's.
  21. markjohconley

    markjohconley Well-Known Member

    Goodaye Kevin,

    So unless the surface of the insole is considered (incorporated) in the milling process then wouldn't there likely be a change of the surface topography of the orthoses between a polypropylene and an EVA orthosis?

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