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Milling machine options for foot orthotic fabrication

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Brandon Maggen, Apr 20, 2012.

  1. Brandon Maggen

    Brandon Maggen Active Member

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    Hi All

    Was wondering what the general consensus is in various parts of the world regarding 3d scanning and CNC designed orthotics.

    From what I have seen so far the quality of the EVA designed orthtics made for me (as a trial) are far inferior to the old-faithful polyprop designed off POP shells that I know and love.

    What concerns me is the loss of control, the increased thickness (EVA vs polyprop), and for me at least, the weakness of the lateral heel counter - to keep my foot from slipping off due to my Kirby skive.

    Is there a decent, suitable cnc solution that will allow me the use of EVA and polyprop?

    What is everyone else using? And how do the various companies charge, i.e. annual license fee/ fee per block/ once-off purchase etc?



    Go Stormers!!!
  2. Re: Milling machine oprtions

    Hi Brandon

    A very viable means of superb orthoses design, toolpath calculation and producing/milling orthoses is through the DELCAM Orthomodel+Orthomill range. They can further advise you on machining.

    There are others. ORETEK (Jojared) on this forum may be very helpful to you.

    All have advantages and disadvantages. But Delcam is a large and renowned company with the ability to provide excellent support and back up.
  3. Brandon Maggen

    Brandon Maggen Active Member

    Re: Milling machine oprtions

    Thanks Steven

    I will look into all you have suggested and filter what I'm told/ read.

    I have always rated Delcam and backup and aftersales support is just as important!


  4. drdebrule

    drdebrule Active Member

    I haven't used these systems, but recently researched this topic here in the USA. Here is what I think:

    Delcam- terrible customer service- I called them, left messages 3 times, sent an email, and no one got back to me. Just crickets chirping... I am done with them and you should be too.

    Amfit- If you have a small practice (just one doctor) and are looking for a user friendly cookie-cutter approach then this might be the company for you. However, they charge significantly more than Delcam and Oretek (2-3 times more) for the same thing. Customer service and support are excellent. Marketing materials are beautiful. Bruce Williams uses Amfit and says nice things about them.

    Oretek- This is the system I am leaning towards buying if given a green light by the COO. Joe does a great job of answering all your questions and lists orthotic labs on his website that are using the system. I called a couple of labs with excellent 5 star feedback. Also, if your milling machine doesn't make the orthotic quite right (not enough lateral heel reinforcement with a Kirby Scive), Joe can reprogram the machine. The price is about 1/2 or 1/3 of Amfit.

    Hope that information helps. I am hoping others will post their experiences.
  5. Phil Wells

    Phil Wells Active Member

    Hi Brandon

    There is another option to answers the technical issues such as deep heels cups, hemi posts, Blake inverted, MOSI etc.

    Get CopyCad and PowerShape (Delcam) and learn to use them. (They cost approx £8000)
    I did this over 10 years ago and I don't have any technical issues as a podiatrist and as a lab manager.

    The milling component is somewhat a bigger issue as this has a steep learning curve. It may be worth out sourcing the milling for the first 12 months and then making the decision to mill yourself at a later stage.

  6. Chris Lawrie

    Chris Lawrie Member

    Dear drdebrule.

    I am horrified and concerned that the service you received was not to your satisfaction as we pride ourselves on creating and maintaining good technical links with our customers. Can you please send me your details and I will contact you seperately to discuss this or at the very least to appologise for trouble this has caused you.
    We offer support in 85 countries WW through a network of direct offices and sales partners. In our experience this - as Mr Dowdeswell says - is one of the reasons why Labs, Podiatrists, Orthotists and Pedorthists chose Delcam.

    Your Sincerely
    Chris Lawrie
    Delcam Healthcare Division

    [email protected]
  7. Maida Koller

    Maida Koller Welcome New Poster

  8. BEN-HUR

    BEN-HUR Well-Known Member

    Thanks for the thread starter & responses so far. Coincidently, I have been thinking of this topic quite a bit of late. I know this type of topic has been discussed somewhat before but it is always good to get new discussions (due to improvement in technology) on the area as I feel the technology has so much potential as well as being the future for Podiatrist - orthotic fabrication - even if it means the Podiatrist doing the modelling/designing of the orthotic & having this digital file sent to an appropriate/compatible orthotic lab so they can fabricate for you.

    Been interested in 3D printers for a while now as well & their possible involvement/potential with in-clinic orthotic fabrication. More importantly at this stage, been thinking of appropriate means to get a digital scan of the foot as well as using a digital modelling system so I can then design my own orthotics to the way I specifically want them... then send the file to a compatible lab.

    Do others do something similar? ... or have a system of designing the orthotic themselves & outsourcing to a compatible lab? Pros & cons experienced along the way?
  9. Chris Lawrie

    Chris Lawrie Member

    Reference 3D Printers, Hewlett Packard (HP) will present their new desktop 3D printer at the Orthotics Technology Forum at SalfordUni on 12th & 13th of July (www.orthotics-technology-forum.com)
  10. Maida Koller

    Maida Koller Welcome New Poster

    The Delcam software is 2 modules, one part is for design or correction and the other part for the milling. So it is possible if a podiatrist wants to scan or cast the patient and purchase OrthoModel to design their own orthotic. Then they can send that to any lab using Delcam software for machining.

    You can see this more at the upcoming show in Leipzig.
  11. Lab Guy

    Lab Guy Well-Known Member

    I have been using Oretek.com since September of 2010. I discovered Joe/Oretek from reading the posts on Podiatry Arena. I also called other labs that use Oretek.

    Joe is very good to deal with and will give you as much time as you need. If you have a question as well as help you design your own specific orthotics using his software. He also read the books by Kevin Kirby and has a very good understanding of biomechanics for not being a Podiatrist.I love his intrinsic rearfoot posts and his software allows for a terrific medial or lateral rearfoot skive. It makes very good positive casts and fabricates EVA inserts.

    I was looking at Delcam but I was quoted around $60,000 for everything. In addition, you you have to pay for software updates. Their scanner is also $4,000 plus.
    For around $17,000, you get the CNC mill, software, two computers, scanner and complete training. I also pay royalties of $2.00 a pair for milled devices and $1.00 for positive casts but free support and software updates. His 3D scanner is very reliable and uses line plane intersection from the data points to accurately delineate the height. The scanner is only $1,200.

    The prices are low as Joe is not money oriented and has minimal overhead. He wrote the software, builds the scanners from scratch in his garage and gets his business mainly through word of mouth. He has never exhibited.

    The main disadvantage is that Joe is a one man operation and likes to be in complete control of all facets of his operation. If anything happens to Joe, then my Oretek system would not function and I would have purchase a different system although I would still have my CNC milling machine. I decided to take the risk as I have a small lab and it did not make sense to spend that much with Delcam. If I was big time, I would still use Oretek but have a back up system in place for insurance.

    Last edited: Apr 28, 2012
  12. BEN-HUR

    BEN-HUR Well-Known Member

    Thanks Lab Guy, that was helpful information.

    Just to double check I understand correctly; in regard to the 3rd paragraph, I take it the first part is in reference to Delcam & the second part is in reference to your (Oretek) situation... of which you pay royalties of $2 for each milled device & $1 for a scanned pair (i.e. positive cast) of feet?

    I assume after you can scan the foot, it then can be viewed on your computer... then there is an associated software program that allows you to shape the orthotic & subsequently allows you to modify the digital orthotic shape to the desired contours/correction required? Then this digital file can be sent to a compatible system for milling?

    I suppose I should get in contact with Joe (Oretek) as I'm in Australia (he in the USA?) & subsequent logistics.
  13. joejared

    joejared Active Member

    The royalties are $2/pair for polypropylene, and $1.00/pair for positives, accommodatives, and prefabs which have not risen in more than 10 years. Given that the fiat based non-sovereign monetary system, which is due for a complete collapse in the immediate future, has lost substantial value over this past decade, now more than ever, my own success is dependent on the success of my customers. It's been nearly 10 years since I've charged for the software itself, and all updates are free as well, other than the income stream from royalties. The only real profit margin is based on a simple philosophy of mutual success.

    For the diabetic plans, each additional pair in the set is 50%. There are no royalties associated with scanning, only finished products. As for the price of the systems, the router and all associated jigs has actually gone down a full $2K due to cost saving changes. I changed spindles and created an adapter for a standard shopvac for EVA devices, each of which shaved machine expenses dramatically. The current prices are: $1300 to $1340 for a client system (Scanner and OreTek only WIFI option is $40.00), and for the router, $14950.00 . Unlike any other system out there, the milling software treats each foot on a plate as an individual order, rather than a series of machine codes.

    It also isn't limited to orthotic manufacturing and has its own language of machining, which is based on my own experience in teaching myself how to machine. (videos) Locally, I'm trying to create a cooperative of businesses using my technology and am also developing an injection molding machine not just for prefab devices but for other products as well. Experiences have taught me that conventional employer/employee relationships have, in many cases, effectively degraded into slavery and at least for the local area, I'm hoping to inspire a new type of industrial revolution that makes each individual a company of their own.

    OreTek natively handles all of the above in one package, whether it's a client (scanner only) or client/server site. In fact, the routing of data from client to client/server is seamless, whether it is a simple scan from a podiatrist or a completed plate for machining.
  14. joejared

    joejared Active Member

    My experiences with EVA of varying durometer values pretty much supports your opinion. First, a Kirby skive will become almost non-existant on an EVA device in a very short period of time due to compression. I only have 1 customer who exclusively manufactures EVA devices. From my own perspective, I am not a fan of EVA but support them only because some labs want them. For the newer systems, the cost of the EVA hardware is about $155.00, not counting the shopvac, which is usually in the $100.00 range. It's a messy substance and almost immediately dulls even carbide.

    As to heel cup height, it should be at least 2 1/2 times the height of the Kirby skive, due to similar triangles and trisecting of the heel. For this same reason, it is impractical to make a heel height less than 2 times the skive, simply because there would be no heel cupping on the skive side. In the past decade, I've created 3 different versions of the kirby skive, the last of which was based Dr. Kirby's writings.

    On a similar note, I've also created a Blake Inverted design code, which seems more popular overseas. Simply twisting the heel doesn't make it a blake design. The arch peak needs to be moved proximally as well, as would normally happen to the mid-tarsal joints when a foot is supinated.

    As for strength of the device, there are several options in OreTek that can change thicknesses at various regions of the device.
  15. BEN-HUR

    BEN-HUR Well-Known Member

    Thanks for the information Joe. I'll probably get in contact with you in the near future for more info.
  16. joejared

    joejared Active Member

    Great to know! By the numbers, I don't recommend buying a router until you have at least 60 pairs/month of production, and that number will change soon due to a lab function I'm working on. In the coming month, I should have plastics recycling up and running, which should drop manufacturing expenses in terms of plastics by about 80%, and immediately after that, will also add injection molding capabilities to my network as well. As for the prototype router I've been using since 2009, there are plans to replace the entire mechanical structure with my own design. That will likely enable me to bring the cost down even more, likely in the $10K range for a router.

    There is the possibility of 1 or more used machines coming my way. Techno hardware doesn't depreciate much and all machines here leave in new condition only and maintain a contract lifetime new machine warranty.
  17. Footoomsh

    Footoomsh Active Member

    Hello all,
    Does anyone in Australia use or know someone who uses the Oretek system? It sounds very attractive but I need to know if it is viable to use in Australia when the guy who runs the show lives in the States.
  18. joejared

    joejared Active Member

    Sam and Peter Towers of Cadence Orthotics would be a good place to start. As for shipping to Australia, the carriers are sometimes very brutal. On the positive, recent enhancements to the software eliminated the need for the shroud for normal lighting conditions and improved the parallel port interface for laptop based units. The unit shown on the RadScan section is the AIO unit, which has the computer integrated into the base of the scanner.
  19. joejared

    joejared Active Member

    At Cadence Orthotics' request, I did appear at the Australasian conference in Sydney first week of this month. I am glad to have found and cleared up one minor binary error in filtering of noise in months prior to the show. A part of me was home watching my family, which could have been observed in the booth, which prompted another development idea. Some of the newer things I'm working on will allow me to have a presence at any show should the client request it.

    The exhibition went well, although our prices were significantly lower than the competition. Between theft and embezzlement (Tax and duties) and shipping expenses, the OreTek Client system is more than double what it is state-side, at $3000 AUD, as compared to DelCam ($11,000K AUD) and Paromed ($13,000 AUD). The Pegasus variant (foot scanner only version), will likely be only $2500.00 because of the design of the enclosures. On the first day, I suggested that they list the price on their simple sign, faintly written in blue, which prompted a shocked reaction from one competitor. (Hands on head "We can't compete with that!). The next day we got a nice wide point black marker and well, it's in the album. By the end of year, I expect to be able to produce a complete cad cam solution for $11,250.00, which is down from the current price of $16,250.00.

    As to how I can easily compete with the larger companies, it's really simple. Instead of outsourcing, I IN-SOURCE, teaching myself what's necessary to not have to depend on anyone else for anything other than raw materials. As for the understanding of debt misrepresented as wealth, aka money, If one were to truly understand it for what it is, it becomes only a secondary motivation, if that. Real wealth, at least from my perspective, is my capacity to help others to empower themselves and well, yea, the ability to look in the mirror and respect who I see.
  20. Boots n all

    Boots n all Well-Known Member

    Here is your first problem in trying something new, you cant have another lover whilst the first one is possibly clouding your judgment?

    The heel cup in an EVA device will not, should not be a problem as the shoe heel stiffener is supporting it, l can make as many as 50 of these EVA devices a month, not many but enough to know they work and work well.

    We are not milling, they are hand made, for the moment:D

    When the workshop warms up, currently -1 degree, l will make and cut a cross section of an EVA device at the middle of the heel cup, may help in the discussion
  21. Bruce Williams

    Bruce Williams Well-Known Member

    do you have a scanner for plaster casts or foam boxes as well for your system?
    Also, how does your software interface for modifying the orthotic compare to AMFIT's, which is drag and drop?
    just curious. keep up the good work!
    Bruce Williams
  22. joejared

    joejared Active Member

    It's the same scanner (AIO=All In One). That's what the door is for. A type 0 scan is for plaster and tall biofoam boxes, type 1 is for short biofoam, and type 2 is for feet. The interface to shape changes is the prescription form, with each design code being 1 or more pages of design code variables. As far as what the design codes interface to, I've been trying to make a practice of documenting a couple variables per day, but lately well, I'm backlogged with routers and scanning workstations. As these variables are documented, they are accessible as context sensitive help.

    One thing I did like seeing was their biofoam scanner, which could easily be built as a separate station from the AIO unit, although not using biofoams at all is one goal.

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