Laser scanners

Thanks for your reply Simon.

As for an introduction, my name is Anthony and I run a lab in Australia called CAD/CAM Orthotics. The reason I had not included this in my general info is because I didn’t want to come across as someone marketing my own product. I am simply wanting to ask questions to build on my lab knowledge, and provide any useful information if I am able.

I would like to address the statement…

“Digital scans on the other hand do not need to be repeated for repeat manufacture of successful foot orthoses because scans only take up virtual space on a computer. In theory they can be stored indefinitely and used time and again. Therefore the position the foot was originally captured in does not need to be repeatable since it only ever needs to be done once.”

I can see where you are coming from and to a certain extent agree. However, I think that it is important that the individual producing the orthoses and the individual scanning the patient’s foot have a strong agreement as to the alignment of the foot in 3D space. So I suppose repeatability isn’t all that important like you’re saying, however a strong consensus between lab and podiatrist with respect to the alignment of NWB scans in 3D space is. WB scans do not have this issue, however NWB scans definitely do contend with this.

We understand that using the STJ bisection to align the foot with a NWB scan is not a valid measurement as often the posterior aspect of the heel is distorted, making it very difficult. In order to be NWB and 3D, we use a device that we have manufactured in house to capture the forefoot alignment relative to STJ neutral. Basically, we ask a podiatrist to provide us with the forefoot varus/valgus measurement of the patient relative to a neutral STJ and we will then align the foot according to this - forefoot geometry is extremely accurate compared to the geometry of the posterior heel in a 3D scan. Conventional goniometers did not seem to be appropriate, so we decided to make a device in-house which seems to satisfy our podiatry clients.

We believe that the fundamentals (using a bisection to align a cast perpendicular before orthotic manufacture) are still correct with respect to computer aided design. At the lab end we do not see the patient, we cannot assume where the starting point should be. So we do not provide lab discretion. It would be like an optometrist not sending any measurements to his lens manufacturer and assuming that such a manufacturer knew from experience how to make the ideal product. My point is that without measurement how do you quantify your prescription? From the podiatrists point of view, if he can take measurements that are repeatable and consistent across his patient base then he can prescribe what he needs from a lab more consistently. Theses measurements can be different from somebody else’s measurements of the same measure, but he will be able to write his script accordingly. My job is to make a consistent pair based on a podiatrists measurements so there will be as much consistency as I can offer.

 

Thank you for your introduction and private message, it is always helpful to know with whom one is discussing a topic and to get a feel for their background and education.

Measuring forefoot to rearfoot alignment off a conventional cast is pretty easy, measuring it clinically from a patient is a different matter. I should be interested to see some photo's of your jig, perhaps you could attach some?

Firstly, I should highlight that I have not stated here that no quantification in the prescription was necessary, merely that the position that the foot is captured in does not need to be repeatable. This is not the same thing. However, it is wise to recognise that the "posting angles" do not translate simply to the kinetic influences that the foot orthosis may have. To a large extent prescription by angle is a hangover from the Rootian approach, which is mostly otherwise redundent now, including the Rootian ideas regarding STJ neutral.

I applaud your efforts to attempt to standardize the position of the scans you receive from practitioners. However, the problem with your approach as I see it Tony is that it does not allow the practitioner to manipulate the foots geometry to meet the prescription requirements. I don't always want the foot positioned in subtalar neutral with the "forefoot varus/valgus" observed in this position when I capture the foot. Which brings us back to Robert's earlier point:

And Ian's

I agree that "lab's discretion" is a ridiculous concept designed to allow practitioners who do not know what they are doing to still prescribe custom foot orthoses (who invented this concept; the practitioners or the labs? I wonder why?), but I don't think your system allows more sophisticated practitioners the freedom they require to design the foot orthoses that their patients require. Now, mine has been an academic interest in CAD/ CAM, I do not run a commercial lab, but I have found it possible to set up reference planes and points within the CAD to enable me to add "posting" to the geometry in the areas and direction that I choose and to quantify this without needing a scan of the foot taken in STJ neutral. Are you saying that if I sent a model of a foot to your lab, taken in any position I had choosen and asked you to add a 6 degree varus forefoot post to it, you would not be able to do that unless the scan had been taken in your prescribed position? Perhaps I'm missing something ?

I'm going to play Devil's advocate a little: why should the lab be deciding which position the foot needs to be scanned in without seeing the patient nor having the knowledge base of the practitioner?

 

It is nice to talk to someone that understands that lab discretion is a lazy way out (for podiatrists and orthotic labs) and a law suit waiting to happen. We appear to be on the same wavelength with most things we are saying – from my perspective.

I would be happy to show you a photo of the jig. I thought I was clever when I designed it, however, it has been pointed out that something quite similar was designed years earlier. Although, I haven’t been able to find it readily available today, hence I just make my own. The idea behind the device is to align the foot in STJ neutral and find the forefoot varus/valgus position while in STJ neutral. This in essence gives a rudimentary starting position for the alignment in CAD software. Forgive me if I am incorrect, but what from what I gather you capture a 3D scan of a patient’s foot and use a CAD program (i.e. – Solidworks, Powershape) to create an orthotic model around the 3D scan.

I can see why you would say this as I have been talking about using a standardised foot alignment (STJ neutral). In reality this standardisation is only a starting point for computer aided design. Geometry modifications in all three planes are possible; there are no limitations - only ones imagination. My company encourage all of our podiatrists to download the CAD software we have designed, so if one wishes to take complete control of the CAD side of things then one can (forgive the advertising). Alternatively as podiatrists understand that they are getting a standardised and well defined initial alignment of the foot in 3D space they are more confident in prescribing alterations and changes to this position – as you can understand. I simply feel as you do that it is important that all podiatrists have a solid understanding of how the product is being designed, so that they can get the best possible results given what technology we have available.

That’s fine if you have that opinion. I hope that I have illustrated above how this is not the case. The more sophisticated practitioners (as I perceive them to be) that use my lab are definitely the ones that ask questions and try to learn as much as they can about what goes on in the lab and within software.

No, not particularly. Let me highlight that I primarily manufacture full length EVA.

Perhaps a picture will illustrate this more clearly? If it does not I will attempt to answer it again.





I don’t believe they should  and I am sorry if this is what is being construed. What there should be is a consensus as to what position the orthotic should be aligned in 3D space between labs and podiatrists.

If the patient has a 5 degree forefoot varus in NWB at STJ and the podiatrist wants the orthotic to be constructed around a foot that is 15 degrees inverted from neutral then they could…

(1) Scan the foot at STJ neutral and tell the lab to invert the foot 15 degrees in CAD. The lab would then align the foot to STJ neutral (5 degree varus using forefoot geometry) and then invert the foot a further 15 degrees.

(2) A podiatrist could scan the patients foot at 15 degrees inverted and then indicate to the lab in their prescription that the patient’s forefoot position is a 20 forefoot varus – assuming that is now the position of the forefoot when the foot is inverted.

(3) Do the CAD themselves and use the CNC facilities of the lab.

I hope that it is clear that the relationship between the forefoot varus/valgus and the heel bisection that is provided to the lab should be the relationship of the foot in the position that it is scanned. This can be any position that the podiatrists desires. All I need in the lab is a well-defined reference point as a starting point for orthotic manufacture – just as you need reference points.

Hopefully what I have laid out is logical.

P.S – I wish I posted on here earlier, I am enjoying this! :good:

 

Hi Kevin, sorry that is not me.. My Name is Anthony Dwyer and I'm inclined to say that I'm better looking

 

So, what you are saying is the foot does not need to be scanned in subtalar neutral and can be scanned in any position the practitioner chooses so long as they specify the angular changes they want you to perform.

 

What I am saying is the following.

The foot can be scanned any way that the podiatrist sees fit, provided that there is an agreement between the podiatrist and the lab as to what this position is. If the podiatrist and lab do not have this consensus then we effectively have podiatrists sending NWB 3D scans to labs who in turn are simply guessing as to the correct alignment of the foot.

The foot can be scanned, for example with a plantar flexed 1st, or any corrected position he wishes to hold the foot. As long as the relationship between this forefoot position and the heel bisection are provided to me as reference, then the particular idiosyncrasies of each podiatrists scanning technique can be accommodated.

Then both the podiatrist and the lab feel far more comfortable with external orthotic prescription as the guess work is taken out of it. :drinks

 

Everyone is guessing as to the correct alignment of the foot!

Still not sure why you need the clinical measurements though. In the images above it looks like you have basically rotated the mesh around the points marked in green (I'm guessing you selected a point corresponding to the 5th metatarsal head) and red (the centre point of a line bisecting the width of the heel section of the scan) or some other artificial reference axis, to add a 15 degree forefoot varus post. So why did you need the clinician to put the STJ in neutral and measure the forefoot to rearfoot alignment? You could have done that without any knowledge of the subtalar joint neutral position or the clinicians measurement of the forefoot to rearfoot alignment or for that matter any knowledge of the position the foot was in when the scan was captured. Like I said, you can generate reference geometry within the CAD and manipulate the mesh from there, which ostensibly appears to be what you are doing.

No, it's still guess work.

 

One further point, Tony. How does the clinician use this device to measure forefoot to rearfoot alignment in-vivo? I may be missing something, but it looks like a fixed platform that sits under the plantar surface of the heel and forefoot with a protractor at right angles to it which measures the rearfoot position? Forgive me, but all of the forefoot to rearfoot measuring devices I have ever come across, included those designed by Mert have been hinged to allow a frontal plane angular measure to be obtained between the forefoot and rearfoot. So, with your device we align the acrylic sheet beneath the forefoot, while dorsiflexing the lateral column (but making sure the instruments platform is making contact with the entire forefoot metatarsal region with the same force to avoid variation in soft tissue distortion; then we manipulate the subtalar joint into neutral and ensure it is maintained in this position with our free hand, but since the rearfoot platform is fixed to the forefoot platform we have to allow the instrument to fall away from the heel; then we move the pointer with our third hand to align the rearfoot bisection (which has been shown to be unreliable)? And within subject repeatability trials of forefoot to rearfoot alignment measures using this jig demonstrate reliability indices of... Nevermind. I've never seen a good jig to measure forefoot to rearfoot alignment a la Mert Root, I don't think I ever will.

 

Simon, let us try and be constructive and achieve some sort of consensus. I believe that bringing validity and reliability considerations into the discussion is distracting from the point that I am trying to make. That point is that there should be an agreement between the lab (or individual who is creating the orthotic) and the podiatrist as to the ‘neutral’/starting alignment of a NWB scan in 3D space before the orthotic is manufactured.

The clinician can scan the foot in any position they like - as I have said this does not have to be STJ neutral. They can also use any tool they like to find forefoot alignment relative to rear foot - it does not have to be my jig.

(As a note relating to the image: the red, blue and green are XYZ axes. Also, if I turned the scan to a shaded view with a JPEG overlay you would see marks under the 1st and 5th MPJs corresponding to where the podiatrist has measured the forefoot alignment from - these are not artificial reference points they are real. Perhaps my example was poor and I apologise for that.)

In the above image I was providing the following example.

(1) A podiatrist takes a NWB scan and measures a patients foot to have a 5 degree varus in what they perceive to be STJ neutral.
(2) The podiatrist prescribes 15 degrees of inversion in CAD before CAM.
(3) Therefore I am showing that the forefoot varus is now 20 degrees after inverting according to the prescription.

If measurements are arbitrary, then my question is this.. How would I know the apparent ‘neutral’ starting position of this NWB scan as the podiatrist wished it to be if I did not have an initial measurement?

If a podiatrist takes a NWB scan and asks me to invert the foot 15 degrees - what will be my starting point for this inversion? If I was to give you a NWB scan and told you to put it in ‘neutral’, how in the world would you do this without measurements being provided to you? Do I just use the forefoot geometry to make the 1st and 5th contact the ground and assume every individual has a neutral forefoot to rear foot relationship in NWB and then invert the prescribed 10 degrees from here? Keep in mind that if I did that in the case above then there would be 10 degrees less control in the above end orthotic. From my view, measurements are definitely not arbitrary. They are extremely critical in manufacturing orthoses according to prescription when using NWB 3D scans.

If you do not provide measurements to the lab they are guessing when aligning NWB scans. Measurements are critical. I can create any reference geometry that I like in CAD and manipulate the model until my heart’s content, but what good is that if it has no correlation to the patient’s foot? I can appreciate if the podiatrist scans the foot and designs the orthotic model in CAD and knows exactly what he is getting, but this is very, very rarely the case - however even under such a circumstance I would be inclined to maintain the argument that measurements are important to the alignment of a NWB scan.

As for the jig. Yes, the forefoot to rear foot alignment is measured in vivo. How you have indicated is essentially how it works. This is a very simple and basic tool that podiatrists using my lab seem to appreciate, I am not defending it’s within subject repeatability. Essentially all I have to go by is the feedback of hundreds of podiatrists that have used my lab over the last several years. Fair enough if this is not enough for you - I do not sell the product and have never profited from it. As I have indicated they are able to use any device they wish as long as they provide me with measurements so that a NWB scan may be aligned in 3D space in a well defined way.

I would like to move the conversation away from my jig and back to the question of why measurements are important in properly setting up a NWB 3D scan in CAD.

 

Hi Tony

I thought it was time to add my opinion to this thread as it has been driving me mad - I have exactly the same concerns that you do and have been trying to come up with a solution for a while.
The one over riding concern that us labs have is getting a consensus between what the clinician sees in the foot, the 'cast' and what the lab is required to do.
Laser scanning etc does not solve these issues but I believe it has the potential to do this if we think a little more laterally.
One of the key benefits of digital media is that it can be far more interactive so why does a lab need to bother interpreting the scan/cast etc. Why not provide a user interface (Cloud based?) with the scanner that facilitates the clinicians ability get the scan to where they want it to be.
For example the clinicians takes a a few different scans of the foot - STjt neutral, suspension, forefoot loaded, semi weight bearing or even of a POP or Foam box etc. (Should still take considerably less time time than traditional method).
The clinician chooses the scan that they believe best represents surface alignment of the foot and then they have the tools to correct the image e.g. get rid of FF Equinus, add/subtract ff varus/valgus etc.
The before and after scans are then saved and sent to the lab for comments and support - most practitioners will want support initially or when they have difficult patients.
The lab then designs the orthotics and loads onto the cloud based viewer so the clinician can compare the finished design against the scan.
From my perspective this would take no more time and would allow me to have a far better technical relationship with the practitioner - we can teach each other how we work and what our expectations are.

The scan would probably need to overlay the photo of the foot over the digital image so some laser based scanners would not be suitable - it is very difficult to assess a scan without the aid of the a real image of the foot (gets easier with experience). Also photo based images are great as they show any reference points you have drawn on the foot - e.g. a plantar heel bisection really helps with forefoot to rearfoot assessment.

The 1st scanner company to get this user interface sorted will answer most of the issues we have as both manufacturers and clinicians - BTW I don't make scanners so this is not a sales pitch.

Phil

 

Hi Phil,

I am glad that you have weighed in. For a moment I thought I was reading back my own thoughts... music to my ears :drinks This topic has been worrying me for several years now also, as I see this as a perfectly simple concept that to my perplexity is overlooked by a large majority of practitioners and labs.

Exactly, there must be a consensus between this position. Otherwise labs are doing a lot of guess work as to the prescribed alignment of the foot in 3D space. Some sort of measurement must be agreed upon if sending NWB 3D scans to a lab. This is why I have proposed my current solution (to use rear foot to forefoot alignment as a reference and align 3D scans according to this reference, which has been provided by the podiatrist). I see this as eliminating lab discretion and giving more control and confidence to the podiatrist. Your idea of a cloud based system is definitely an intelligent idea. Why not give podiatrists the ability to completely design their orthoses in CAD and use the CNC facilities and hand finishing abilities of orthotic labs? In my view the exposure of podiatrists to CAD software can only benefit the podiatry and orthotic industries.

If sending 3D scans to the lab I see it as nothing but a benefit for the scanner to be able to output geometry with photo overlay. It provides additional flexibility to practitioner and lab.

 

Looks like 3D scans with your smartphone is very close.

http://youtu.be/Qe10ExwzCqk

 

I'm late on this one i know but i think all podiatrist should be using scanners in their clinic. I understand they are expensive but it is a tool that can make your life a million times easier and your patients a million times happier ( as well as a great marketing tool )

Scanners are quick and easy as well as having the ability to scan in a semi weight bearing position whilst still allowing you to adjust the foot into the position you want the orthotic to hold it in. It is not always STJ neutral! you can pronate the foot, supinate it, full weight bearing, partial weight bearing what ever you want the orthotic to do to the foot.

Using a scanner removes alot of lab error for me and now with 3d printing you can essentially scan a foot in its ideal position and print an orthotic for that position. Without a lab tech guessing what you meant by minimal arch fill.

The materials are there for 3d printing and I use these orthotics in my clinic with great success. The benefit that this process has over milling is the accuracy. Milled orthotics still came back to me smooth and perfect even when they had a deformed foot. With 3D scanning and printing the orthotics come back to the shape of the foot and are super comfortable because of this. I may be a bit biased but it has solved all my issues with adjusting orthotics.

So my long winded answer is Definitely a 3d scanner is a must!

 

Tell us who you are, 3D Orthotics, and maybe we will consider your opinion valid.

 

A quick google reveals orthoses that look like they were manufactured from unmodified scans, nothing new and a distinct lack of imagination when it comes to using what this technology can potentially offer. Just like all the other labs currently using 3D printing, they seem to have missed the point: it's not the labs that need the printers, it's the clinicians. Anyway, to reiterate what I said at BSS 2014: "yep, they look like foot orthoses to me, beautifully reflecting the technological limitations in manufacture that Mert and John et al. had at their disposal in the late 1950's through early 1960's"- in this case, poorly designed ones at that. It's now 2014 BTW, tick-tock. Please try harder. Some original thought perhaps...

 

It is a funny one isn't it Simon. I think about orthosis design a lot and seem to come to the same shape and conclusions. We have all seen patients attend with foot orthoses they have whittled themselves from a block of wood and, bizarrely, with no clinical input whatsoever, they look just like a foot orthosis!

With 3D printing, surely we can make better use of structural mechanics to create orthoses that have apertures and "I" beam like fins in order to create a device that is rigid where required, non existant where required, super lightweight and non bulky.

Not everyone needs the total contact that traditional orthoses offer. Moreover, we need to be much smarter about how friction affects kinetics and our ability to apply forces to the foot. Like I said, I think about it a bit and I have come to the conclusion that I am not dedicated or smart enough to be the innovator and I applaud you for moving this on as per your lectures at BSS 2014

 

Hi Robin,
Do we yet have away to measure friction, so that we can improve our knowledge and its affects on kinetics?

I am applying the theory of "If we cant measure it, we cant improve it".

 

Although I'm somewhat skeptical about 3d printing of orthotics, mostly because of the time per unit and choice of materials. I should have 3d printing compatibility with OreTek in the very near future. I'm not confident in material choices and will need to long term test the protype devices before I'll be satisfied that they'll have similar characteristics to polypropylene or acetal (delrin). The CNCs will continue to do the brunt of manufacturing, simply because a single router can easily produce 1200 pairs per month, whereas a single 3D printer, let me guess, perhaps 4 pair a day? A new agreement with a network of practitioners is going to come with a 3D printer for software development, but it is doubtful that it will be mainlined into production any time soon. For devices such as a UCBL, or even an AFO, it makes sense, provided the printing medium is chosen correctly.

Assuming you can find a material that wont collapse over time, then comes the time it takes to make a pair of orthotics, along with finishing time, such as top covers. As far as the type of printer, it makes sense that it should have a work space equal to a single pair of devices, at minimum. I'm not satisfied that there is a 3d printer media that offers a product that wont collapse over time. While ABS has similar properties to polypropylene, instinct tells me that over time, since it has good thermo-forming characteristics, it will eventually collapse, but possibly not as quickly as HDPE (High density polyethylene). Important to consider about plastics, they are generally neither solid nor liquid, and vary in state with temperature and force. Recycling/reforming it into blocks is really just a matter of some heat well below its decomposition threshold and a lot of compression.

Okay, so through whatever means, you have made a shell, now what? Well, for starters, grinding and finishing. No matter how pristine the surface quality is, to get the top cover to stick, you have to rough it up a bit. Add a wire wheel, drill press, belt sander, gluing station, and you're back where you started, an albeit smaller, humbler lab, and not the kind you push buttons and watch money come out. The cost of an automated shell is less than 1/3rd of the total cost of manufacturing. Keeping a lab technician busy is going to take a lot more than a single 3D printer, and even, a lot more than a single doctor can supply in castings.

 

I spoke briefly with Prof. David Pratt about this following our lectures at Summer School. I reminded him of a design he had come up with in the early '90's which at the time would have been a pain to produce, but using 3D printing would be a doddle. I've attached a snap of the page from the book in which this was described.

While it is difficult to measure friction at the foot-orthosis interface we can make some indirect inferences. If we know the co-efficient of friction between two materials we can calculate the angle of friction. If we know the angle of friction we can measure surface angulation on the superior surface of the foot orthoses and make inferences as to the points upon the surface which will and will not exceed the angle of friction.

 

They are not. Technology prices are falling down. Some examples:

If you have an iPad you can add a Structure 3D Scanner



Or you can buy a 3D Systems Sense Scanner



Or you can hack an Asus Xtion Pro Live

 

No. 2 pair a day at most. See screen shot from CURA

For desktop (affordable) 3Dprinters

SOFT/ELASTIC/FLEXIBLE
Nylon http://taulman3d.com/index.html
Filaflex http://www.recreus.com/
Rubber-like http://www.3d2print.net/shop/3d-printer-filament/elastic-filament/

RIGID/SEMIRIGID

PLA reinforced with selective thickening areas using Autodesk MeshMixer
ABS reinforced with selective thickening areas using Autodesk MeshMixer

Expensive (FOR NOW) Polyjet 3D printers

Simulated Polypropylene http://www.stratasys.com/materials/polyjet/simulated-polypropylene

Expensive (FOR NOW) SLS 3D printers

SLS nylon http://www.solidconcepts.com/materials/sls-materials/

It is true. But, how many orthotics are done in-office by an average podiatrist? That is the point. Now you can manufacture using CAD and automated process for a fraction of few years ago price.

You can build an in-office CNC router KIT for 1000 EURO. For example:

http://www.instructables.com/id/DIY-CNC-Router/?lang=es

 

Not with a FDM 3D printer. You will need to add supports to the model or use a FDM 3d printer with cooling fan attached to the nozzle.

It would be easier with a SLS or SLA 3D printer.

 

Use a two head printer with dissolvable filament in one nozzle.

 

Simon,

I do not own a 3D printer with dual extrusion, but I have seen them printing dual density materials at different exhibitions. It will have the same problem when you try to print bridges, in this case dorsum of the foot part; inner surface will be irregular because of plastic drops. For avoiding this, there is an upgrade for most of FDM printers: layer cooling fan. You can print it with your own 3D printer and connect the fan wire to the ramps. Cura and Slic3r have the option to control a layer cooling fan.

See this experiment PLA frogs with and without cooling fan http://www.thingiverse.com/thing:202798

 

I may be wrong, but appears Tony and Simon's discussion may have a terminology problem. I think Tony is using the term neutral when he means heel bisection. (From knowing where the clinician thinks the heel bisection should be the forefoot to rearfoot relationship in the cast can be agreed upon.) I have often felt I have needed to put a heel bisection on the cast so that the lab will put the correct amount of intrinsic post in the orthotic. I've progressed to saying that I want x degrees of intrinsic forefoot valgus post and that I want a heel cup that appears like it has x mm of medial heel skive relative to a vertical heel. I will also ask for x mm of medial arch height at the navicular tuberosity. If the lab doesn't give me these parameters I feel that the device be remade free of charge. If I allow "lab discretion" I should not have that right. I do agree that it can be hard for lab and the clinician to be on the same page as to what the prescription means.

Eric

 

I think the key here Eric is that if the prescribing clinician specifies that he wants an X degree forefoot post, it's pretty simple to set up a reference plane across the metatarsal heads and add that X degrees of forefoot post. If the prescribing clinician says "post to neutral" it's impossibe for the lab unless they know the starting position of the scan. The same is true for the rearfoot. Personally, I prescribe in degrees, not in terms of neutral, nor "labs discretion", hence it is easy for me to add a reference plane X degrees from the reference plane at the metatarsal heads and extrude an intrinsic post to the postive model, I can then manipulate the splines to bring the model up to this, emulating a medial arch fill in the process. It's old fashioned, but I treat the positive model as if it were a cast. So, first I add my forefoot balance, the I add my arch fill, lateral and heel addition, insert a heel skive if required, then I create a new surface on the model as if it were a corrected cast. I then extrude my virtual orthosis onto this and add any extrinsic posting. In this way, I don't need to know where "neutral" is, so long as "neutral" isn't my reference- which it isn't.

 

Given an average weight of about 3 ounces per pair, raw materials 3D printed are roughly $12.00/pair, assuming $65.00/lb for printing media. Machined, raw materials are about $4~$8 per pair, depending on thickness. Ignoring the time is money part, it's more expensive to 3D print most devices. It will take a considerable amount of competition to bring the prices down, or, an alternative process that recycles machined waste into a spool. There is a place for 3D printers, but it's only a minor role for a very small percentage of the product line. Then the question becomes, do I 3D print, or make a positive and thermoform it? 2x12's are about $3.00 for enough to cut 3 pairs of positives typically, and thermoforming is both quicker and more cost effective.

As far as the CNC you referenced, that's not a unit I would sell to a client. I've seen references to cheap routers and scanners, and to some degree, you get what you pay for, especially for those systems that use page scanners and pressure plates. First, it's stepper based lacking positional feedback, and even if it had a usable range for mass production, the choice of spindle is grossly insufficient, suggesting much slower operation and as a result, shorter tool life. On the positive, it looks as though my own systems will be dropping in price from about $16.2K down to about $12K (USD), mainly because I'll be building the bottom axis, and ultimately, the entire machine. The realtime savings to a practitioner is in the scanner.

 

You should calculate financial costs also: ROI and opportunity cost.

What is the opportunity cost and ROI from a 12K USD machinery investment?

What software do you need? How much does it cost?

You can use Open Source Software (0 USD of investment) for design 3D printing objects:

FreeCAD http://freecadweb.org/
OpenSCAD http://www.openscad.org/
SketchUp http://www.sketchup.com/

And GCode generators also Open Source:

CURA http://software.ultimaker.com/
Slic3r http://slic3r.org/

Everybody can 3D printing their own designs at Fablabs for an affordable price.

Anyone can be innovative and creative everywhere, without the huge barriers to entry from few years ago.

We are talking different economic models, not just business. You are focused on mass production, it means cost per unit production. No innovation.

I am advocating for real manufacturing customatization allowing anyone to unleash their creativity without huge financial burdens.

 

Hi Kevin it's nice to meet you. My name Is Justin Hogg And I'm a Brisbane (Australia) based podiatrist that works in private practice. I've worked across all areas of podiatry and come from a distance running background.

To answer your question who 3D Orthotics is well there are three of us, 2 engineers and myself. One who is a senior engineer for an Oil company and the other is a software/mechatronics engineer. Both friends of mine that when i asked them how i could improve my orthotics 3 years ago and a few beers later this is what we have come up with.

We have trialed almost every scanner on the market and examined every printer, whilst i'm definitely not the technical part of the team the other 2 guys are pretty smart ( you will have to take my word on that ). We are about 1000 pairs in and it is all refined pretty well.

It's easy to take quotes out of context but i do stand by what i had previously said about scanners.

As for the design of the orthotics to Answer Mr Spooners questions i have full control over the design process with the software we have developed. Both to the foot scan and the orthotic, our aim is to however keep the control in the hands of the podiatrist as much as possible and a good way of doing this is through the scanning process.

We have printed honeycombe structured orthotics, printed 'batman' print on kids orthotics, changed the thickness in different parts of the orthotic to allow more flex, printed the orthotics to the in shoe measurements so that it fits the patients shoe correctly, I even printed a friends wedding anniversary date and his wife's birthday on the underside of his orthotics so he would never forget! Of course along with the usual cutouts, skives, domes, etc etc. Design is unlimited but unfortunately time isn't so if you want a Christmas tree on your orthotic I'ts easily done but will cost you.

I'll Come and introduce myself personally at the next conference i see you at Kevin or if your in Oz look me up and come say hello.

Have a good day/night everyone but i'm off to bed.

 

I wrote my own, actually. It doesn't use antiquated G-codes. The interface for machining foot orthotics is directly connected to the format of the stored plates, requiring no actual g-code interface. My system manufactures much more than orthotics, See playlist.

As for return on investment, a client system pays for itself in a matter of months, dependent on volume. One lab, doing about 50 pair/month broke even within 3 months. A client/server site is a bit higher, and I don't even recommend a lab go to that level until they're producing 100+ pair per month.

No innovation? I'd have to say that anyone using OreTek would be able to cite many innovations I've made in orthotics manufacturing, many of which making it considerably more cost effective for repairs, and entry costs. Mass production does not, in any way, have a negative impact on the attention paid to each individual prescription. Individual technicians might take shortcuts, but the system I've designed is meant to produce a prescription device, pure and simple.

Beyond technology is how we treat people. Personally, I prefer a cooperative business model, simply because there are no CEOs to bleed the profit out of the product. For one project I'm about to start, I'm paid for the machining, and the finishers for their work, separately. The end result is a revenue stream of well over $30.00/hour per finisher and with a final product price that is 60% of the norm. There wont be any employees, but rather, a symbiosis between the work I do, and the finishers. That same project will also include an asset swap, 2 client systems, for a 2X 3D printer to integrate into OreTek. Maintaining objectivity on the subject of 3D printers, even when implemented, I expect that it will rarely be used to manufacture orthotics.

 

So nothing new in terms of foot orthoses design then.

 

Hi All

I am going to add my 2 'penneth as I think we need to possibly re-think how we design orthotics based on how accessible technology is becoming.
In the 3D/2.5D shape that makes up an orthotic shell, there is a hierarchy of function/ORF that a shell needs to apply e.g. if we are trying to apply a supinatory moment, then anything that produces a opposing pronatory moment is not wanted.
So with this in mind why do we need our PP/EVA insole to to be full width/length?
The alternative is to take a flexible pre-fab shell e.g. made of soft EVA (Slimflex etc) and then machine/print the rigid/stiff skeleton/frame only in the areas required. This would be like making a cobra insole of Poly and then adding a 3mm EVA top cover to reduce lateral slipping. The majority of the ORF would could be applied to the appropriate side of the axis to get the force we want.
With 3D printing this would reduce cost, increase parts/hour etc.
The upper part could be made relatively low cost - £2.50/pair - and would have variable properties and aesthetics.
The actual cad design would be significantly easier as you could access 'pre-shaped' components (Freeware or as part of a web hosted library supplied by a scanner company that is charged for per use) that could be morphed etc to your scan of the foot. Doing the design this way is much easier as you don't have to worry about constraining the parts of the model you don't want to effect. It would be much easier to produce very complex designs e.g. struts, honeycombs, cross beams etc as the bulk of the design would only need to be designed once.

The hardware for the machining could then be far 'lighter' as the parts are smaller, less complex etc.
The original idea of Freeware designs came from Simon Spooner so I will credit him and I have just embellished it.

Phil

 

Considering how 3D printers operate, there isn't a single machine capable of doing that, Phil. It would need to be a hybrid 3D scanner/printer combo, and capable of printing in 3 axis of motion, instead of just 2. It's one thing to use additive manufacturing to create a part from scratch, but the machine has to understand what's already there before it can add to it.

 

Now you talking, Phil. Except I'd have it all for free, for everyone, for the good of mankind. Crazy, I know. Capitalism gets in the way though. We really got to start thinking differently about foot orthoses... I can download angry birds for free... or 45p. Now apps like that didn't just magically appear.... someone gave their time... for.... 45p

 

Simon

Now I am free from the restraints of commercial orthotic manufacture, I can't think of anything else I would rather do than make it all for free!!!!(Power to the People ''''fist pump''' etc'''''

Lets gets Javier, you, me and anyone else talking to make it happen.
Do you reckon we could start hosting things here on the Arena?

Phil

 

Joe

That's the point, we don't need to constrain ourselves to printing as a low cost CNC would suffice. Things such as roughing, plunge depths, step over are not really that important when you only need 4 components/day.
The actual components would not be very big in the z axis so you will be able to minimise machining time by using Polyprop material thickness of 15mm - you don't need the extra thickness to allow for flanges, heel pitch etc.

You could potentially then become the milling hub for anyone not wanting the hassle of buying a machine - BTW I would recommend to anyone to NOT buy a machine as they are a pain in the bum - out source the machining and concentrate on the design! Take it from someone who really knows having set up 6 orthotic companies around the world, it is always the machine that creates the biggest headache unless you can afford a Patriot Orthorut machine - used it twice and really impressed (No commercial interest in this company just really impressed by them and the machines)

Phil

 

Wow. FODDER (foot orthoses design depository and educational resource) comes to life . Which is really weird because I just had contact tonight with an old school chum that I haven't seen for about 9 years, who is also called "Fodder"- long story. I don't know about hosting- you'd need to talk to Craig or some people who know about such things, but lets make it happen.:drinks

 

3D Printing hubs are rising- For example 3D Hubs

Other options, as I said, Fablabs and Makers Spaces.

In Barcelona, we have also 2 public fablabs from the city council with SLS, 3D printing, CNC and laser-cutting machines.

Tech University offers industry-level prototyping machines for everybody for very affordable price.

Like, early 90's PC revolution, innovation is not on hardware (prices like then are dropping) it is on knowledge.

 

Sign me up :drinks

 

I must say, I like the idea of "orthotic nets" that coud be adhered to a simple insole or placed beneath a sock liner which Phil suggested.:drinks