My thoughts on digital orthotics?

Members do not see these Ads. Sign Up.

Greetings everyone, a long time lurker, making a first post in a long time. Over the last few years, I’ve spent a lot of time centered around scanners, printers, and fabrication speed. But honestly, after years in playing with tech, I’m starting to think manufacturing may actually be the easier part to standardize.

The larger variability often seems to come from:

• assessment,
• prescription logic,
• modification choices,
• and how labs interpret those prescriptions.

Two clinicians can prescribe very different devices for the same pathology, and two labs can interpret the same prescription differently depending on the technician involved.

That raises an interesting question:
If digital manufacturing improves reproducibility, but the clinical workflow itself remains inconsistent, are we simply scaling variability faster?

I’ve also become increasingly interested in whether orthotics should become more iterative rather than “one-shot” devices. Once modifications become inexpensive and reproducible digitally, it potentially changes the entire workflow model. We can correct conditions in stages, increasing correction with each device.

Over the past year, I’ve actually been building a browser-based orthotic workflow platform called ArchSpline around some of these ideas. I recently opened a small free founding beta specifically because I’m trying to gather feedback from clinicians regarding what a genuinely useful digital workflow should look like long term.

Not really posting this as a sales pitch; I’m honestly more interested in hearing where others think the profession is heading.

A few things I’m curious about:

• Are current CAD workflows actually clinician friendly?
• Is assessment the true bottleneck?
• How much variability do you see between prescription intent and final device outcome?
• Do you think iterative orthotic workflows become more common over time?

Would genuinely appreciate thoughts and criticism from others working in this space. If this is not acceptable post, please let me know.

 

Bumping my own thread with a few updates, as I’ve spent the last few months looking closely at how clinics are adapting to digital manufacturing. The lack of initial chatter here actually highlights the exact bottleneck: most clinicians are too buried in back-office clinic workflows and lab backlogs to look at the underlying data loop.
I wanted to share two specific observations regarding the "scaling variability" problem and the reality of moving to an iterative model:
1. The Lab Interpretation Gap is Real

We ran a small internal test tracking how different technicians modify a standard prescription for acquired flatfoot deformity. Even with identical scan data, the manual variance in heel-cup design and arch-fill execution between traditional labs was staggering.
This confirmed my suspicion: manufacturing isn't the problem; it's the lack of protocol-driven automation in standard orthotic CAD software. To fix this, we have to bake the clinical logic directly into the cloud environment so the software removes the technician's guesswork entirely.
2. The True Economics of Iterative Orthotic Therapy

The main pushback against "staged or iterative orthotics" has always been cost. No clinic can afford to bill a patient for three sequential pairs of poly or EVA devices just to phase in a correction.
However, looking at the physics of modern in-house 3D printed orthotics, the material utilization of additive manufacturing completely changes the financial model. Because design-for-additive-manufacturing (DfAM) minimizes support structures and reduces material waste to near zero, the marginal cost to print a secondary, slightly modified shell is trivial compared to traditional milling. Staged orthotic modification is no longer a cost issue; it’s purely a software workflow issue.
For those interested in seeing how a browser-first environment handles this without the steep learning curve of legacy engineering software, I've formalized the open beta layout. You can play with the clinical interface and run the workflow metrics directly via ArchSpline Systems website. Nothing to install as it runs from your browser.
I’m still deeply curious—for those who have moved their orthotic production completely in-house, did you find that standardizing your prescription logic was harder than calibrating your 3D printers?

 

My contention with Rx orthotics, these days, is that they are used indiscriminately, frequently for abnormal pronation, which is Not a diagnosis, only an observation.

Parallelism: GP prescribing an antibiotic for a sore throat, not bothering to order a throat culture to determine the specific antibiotic to prescribe. Malfeasance if not malpractice.

Using an orthotic to control pronation is similar to the above parallelism, not bothering to determine the cause of the abnormal pronation. (Plethora of causes for abnormal pronation, all using different types of orthotics.)

Are we that stupid, or just lazy?

 

I agree, and honestly, this line of thinking is a large part of what pushed me toward building workflow software in the first place.

Historically, I think part of the issue came from manufacturing limitations. When orthotics were slower, more expensive, and heavily dependent on centralized fabrication workflows, there was strong pressure toward “safe,” generalized prescriptions that could work reasonably well across broad patient groups.

In many ways, the profession adapted around the constraints of manufacturing and communication rather than around truly iterative biomechanical management.

The result is exactly what you’re describing:
pronation itself often becomes treated as the diagnosis rather than an observable compensation pattern with multiple possible underlying drivers.

Digital workflows potentially change that dynamic.
If modifications become:

• inexpensive,
• reproducible,
• quickly adjustable,
• and easy to redesign,

then orthotics no longer need to function as static, one-shot devices where everyone feels pressured to “get it perfect” on day one.

That’s really where my own thinking has shifted over the last few years.

Rather than asking:
“What orthotic do I prescribe that most patients tolerate?”
the better question may become:
“What mechanical contributor am I attempting to influence, what is my therapeutic goal, and how does the patient actually respond over time?”

That’s also why I’ve added a guided protocol systems and iterative modification workflow to archspline.com. Not because I think software replaces clinical reasoning, but because most clinicians realistically cannot stay maximally fluent in every nuance of biomechanics, material science, gait compensation, and orthotic modification theory simultaneously while running busy practices.

Ideally, digital systems should help structure thinking around:

1. pathology,
2. contributing mechanics,
3. treatment goals,
4. patient response,
5. iterative adjustment.

To me, that’s probably where digital orthotic workflows become genuinely useful, its not simply just faster/cheaper orthotics.

 

What a refreshing contribution on this forum. I commend what you are doing and totally support your efforts!

The core of my research is two-fold:

• Think in terms of the foot neurophysiological postural model, the Biomechanical is fatally flawed, e.g., posture is controlled via the brain stem and cerebellum, not by propping up the foot with arch supports and other sundry devices.
• There are many different types of proprioceptive insoles. Depending on the pathology being addressed, determines the type of proprioceptive insole to prescribe. Digital orthotics might be the answer to this issue.

You are one of the few contributors on this forum that has stated that abnormal pronation is a symptom, not a diagnosis. Bravo!!

Tell me something about yourself. Are you a private researcher or do you work within a group of investigators?

You can access my research and publications at the following Researchgate site:

https://www.researchgate.net/profile/Brian-Rothbart-2

Hopefully you will find my publications on the Neurophysiological Postural Model and Foot Embryology useful in your research.

 

Thank you for the kind words and for taking the time to respond.

My background is perhaps less academic than many contributors here. I was a practicing podiatrist who became increasingly frustrated by the disconnect between our biomechanical theories, the realities of orthotic manufacturing, and the practical outcomes we see in clinic. That ultimately led me down the path of digital orthotic design and manufacturing.

One of the things that has become apparent to me is that we often spend considerable effort debating the "correct" orthotic design while overlooking the fact that patient response is influenced by numerous variables beyond the device itself. Footwear, activity level, adaptation, compliance, pathology, and likely neurophysiological factors all contribute to the final outcome.

My particular interest has become less about finding a universally correct orthotic and more about creating workflows that allow clinicians to systematically evaluate response and make structured modifications when needed. Digital manufacturing makes that iterative approach far more practical than it was historically.

I appreciate you sharing your work. I will spend some time reviewing your publications.

I look forward to reading more.

Bryan