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Orthotic producers/Ipad scanner

Discussion in 'Practice Management' started by TPCMAN, May 18, 2017.

  1. TPCMAN

    TPCMAN Member


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    Hi Folks

    I am now at the stage of looking into an orthotic company for my practice in Melbourne. I am really liking the new technology around infared cameras on the ipad.

    At the moment I know footwork are flogging those cameras for $750 and I've actually had them steer me away from their $10K scanner due to the fact that "everyone will be using the ipad." I gave it a try and found it to be simple to use and accurate. I was wondering what sort of experiences you guys have had with other companies as Footwork will charge around $150 for a 3/4 poly with top covers and cambrelle.

    I am wanting to know what are the alternatives and what has worked well in your practices.
     
  2. Boots n all

    Boots n all Well-Known Member

  3. TPCMAN

    TPCMAN Member

    Yea I've seen this website before however you will find that other orthotic labs will say that no matter how accurate the iPad scanner is, there is no way of providing forefoot correction during the scanning process without having the podiatrists hands interfere with the scan. Furthermore scanning in STJ neutral is questionable as the foot is just dangling from the chair.

    I would love to hear the thoughts of the forum and what has worked when a podiatrist needs to be mobile
     
  4. Apart from the whole casting in STJ neutral issue, you can always scan a cast, sure it one step extra, but depending on the needs of the patient ....
     
  5. mr t

    mr t Member

    Hello everyone,

    I would just like to add my two cents here with regards to not only the structure sensor, but all handheld scanners.

    I think the podiatry community need to ask themselves whether holding the foot at the point of capture is a critical component of the scanning/physical casting process. The suspension casting technique appears well understood and allows a podiatrist to manipulate various foot segments at the point of capture. A handheld scanning device appears to not allow this level of control.

    None of the podiatrists using my lab over my twenty-year tenure have ever proclaimed to simply allow the foot to hang in free space while the plaster was setting. It seems to defy logic? I would very much like some experienced podiatrists that use this forum to comment here as it seems to me that handheld scanning has come into prominence due to convenience, price and a widespread acceptance that this methodology is OK. What am I missing?

    It seems to me the only way to develop proper standards with orthotic manufacture is to start with a consistent foot capture that has repeatable reference. Already the wide inconsistencies between various non-weight and weight bearing systems makes it difficult to provide consistency in manufacture for many labs. Handheld scanning appears to be a sub-standard methodology. At the present time, our lab will not accept scans from these scanners unless they are captured by an assistant.

    I have purchased jigs and trialled various ways to stabilise the foot in a repeatable position using these scanners, but it seems to me that there is often significant scan artefact created by these jigs – especially at the forefoot. I am in touch with quite a few other labs. In four cases where they have advocated the use of handheld scanners, they are all telling me that they have to now phase them out because of inconsistencies.

    The software I use at my lab does not lock me into using any type of scanning hardware, I simply want to make orthotics that have effective clinical outcomes for my client’s patient’s. I have trialled many scanners over the years and have even built my own laser scanners. We will continue to advocate that podiatrists purchase scanners allowing hands free operation until I am convinced that holding the foot is not an important part of the scanning/casting process.

    I ask everybody two questions for my own interest… The first is would you plaster cast a foot and then get the patient to stand and put on weight while it’s drying? I haven’t had a single yes as of yet to this question. Everybody looks at me perplexed with a look of disgust. So that seems to dismiss all of the WB scanners. When people proclaim that these scanners are fantastic I am yet to meet someone without optimism bias. The second question I ask… Would you plaster cast a foot and then go have a cup of coffee while it’s drying? I get the same response. Everybody says that they wouldn’t do it as it would have bad outcomes. I guess everybody knows the answer, but asks because they want justification.

    I had a close friend visit a podiatrist a few weeks back and this friend asked if the pod could use my lab. They accepted and captured a scan of the foot. We received the scan and I had a look because I cared very much about my friend. The scan was captured hands free with a structure sensor. So, I called the podiatrist and asked the above two questions. Surprise… I got the same answers. I asked him what was different about this scan and where were his hands? He agreed with me that it wasn’t right, but when I asked for his justification - his answer?

    “Everyone else is doing it.”

    Just because everyone else is doing it, doesn’t make it right. People used to think the earth was flat while they ran around the globe burning witches, it didn’t mean that was right.

    Many labs have paid for software development so that they can sell these scanners at a low cost and provide pods with an iOS app that integrates with their lab. I am unsure if such software creates proprietary files that lock in podiatrists to a lab after they purchase the structure sensor. It may not be a significant purchase, but $750 is still enough to create an optimism bias within the purchaser preventing them to think critically about their new toy, or change labs (if they are lab-locked).

    I am concerned whether this technology is good for improving the podiatry profession, or if it will damage the profession and increase the existing cynicism that the general public and other allied health/medical professionals have towards orthotic therapy. If we continue down this path where we don’t hold the foot, let it hang loose and stick to our guns that measurements don’t matter and are not repeatable then what’s the point in having a podiatrist? I ask you, without measurement how do you quantify your prescription? When something goes wrong and you get sued are you prepared to say to the judge ‘I just guessed’.

    We run a very high-end lab with detailed scripting that requires measurement. We advocate the best scanners (within a reasonable price range) that we have found despite them not being the cheapest. We have gone to great lengths to create brackets and stands to allow many of the scanners our pods use to be able to mimic a suspension cast technique. My advice at the moment is to spend the money and get a scanner that allows you to capture a consistent scan with photographic reference.

    I encourage people to buy scanners that are non-proprietary and will never sell proprietary hardware to my customers as a fundamental principle. If my lab is not good enough to keep them I don’t want them to stay and I deserve to lose them until I improve my product. Too many people are accepting scanners that are lab-locked because they are free. I often attend universities and I am seeing more and more free scanners popping up also, which to me is worrying.

    Am I the one heading down the wrong path? I would very much like to hear other people’s experiences with handheld scanners. As I said I can accept any type of scan at my lab and it would be easier for me to put wool in my ears and simply accept this as OK.

    I can’t help but get the feeling that it’s a little bit like the Grenfell disaster… having an approach that near enough is close enough is not acceptable because it all ends up in smoke.
     
  6. ErinaPod

    ErinaPod Welcome New Poster

    Well said Tony,

    I have an $11,000 Delcam branded iCube scanner sitting in my office that I now only use for scanning casts that have been pre measured.

    I agree that unless we all take some kind of repeatable cast/scan with bisections and measurements then we may as well use a pre-form.

    I think this a case where technology (which often happens) has leaped ahead in front of research and clinical experience. The current crop of high res scanners are amazing. It's how we use them that's lacking.
     
  7. Anthony Robinson

    Anthony Robinson Welcome New Poster

    I agree Tony,

    IMHO I think the position of the foot during the modelling process (read scan or cast, which ever takes your fancy) is a super important part of the design process for prescription foot orthoses. For example, in a foot with a supinatus contracture, don't we try to eliminate the "deformity" while modelling the foot otherwise the final model will not be a true representation of the foot. If we accept that any foot position will be 'OK because its easier and everyone else is doing it" we are only really selling expensive library devices/ prefabs and we may as well stop 'prescribing' foot orthoses.

    I am not aware (yet am very happy to be corrected) of a lot of evidence supporting the use of the STJ neutral suspension modelling technique; the foot only passes through this point for a very small period of time during gait and it certainly doesn't function in this position. However, if we think of the neutral foot position as the anatomical skeletal alignment where the surrounding soft tissues/ ligaments have as little tensile, compression/ torsion/ bending load applied as possible rather then as the "normal foot position", I think we can make more sense of this and better understand its importance as an appropriate modelling position.

    If we approach orthosis prescription from a truly mechanistic position (what I see as managing internal and externally generated loads/moments about joint axes to reduce damaging forces on human tissues) starting out with the joint structures etc in a 'neutral position' means less force will need to be generated by the orthosis to develop a state of equilibrium about joint axes.

    I pay to use Mr T's lab and the software it freely provides as I was rather disillusioned with the quality of devices returned from the many plaster labs I have used. When every device comes back looking the same despite the prescription sent, something is not right there. The benefits of using a digital model and then designing the orthosis myself through the software, gives me an almost infinite number of potential prescription elements without an unqualified technician (who has never see the foot or seen it function) touching the device until it needs a top cover.

    There is no denying the future of prescription foot orthoses lays in the digital sphere. Down the track we will all be modelling the foot electronically, using CAD to design and virtually testing the device before milling or using a 3d printer. I suppose the question we need to ask ourselves as a profession is: are we as a profession driving the best practice to model/ prescribe/ manufacture custom foot orthoses, or are the labs that sell the hardware driving the process?

    Best regards,

    Anthony
     
  8. Phil Wells

    Phil Wells Active Member

    Hi both

    I do agree with what you are saying but feel that we aren't really going far enough with the idea of the clinician taking responsibility for getting an impression of the foot that is relevant to the aim of the end product.
    A foot impression needs to provide a starting surface shape which is then complemented by the 'cast' modifications (arch lowering, Skives, 1st ray additions etc) and then the external modifications - heel raises, posting etc. (These I would loosely classify as Orthotic reaction Forces ORF) Additionally, we need to look at the orthotics interface with the inner of the shoe - shank dependency, pitch (offset, forefoot drop) the ability of the upper to 'hold' the foot onto the orthotic. Then we add in the outer of the shoe (Shoe reaction Forces SRF) such as toe spring, heel height.

    I am getting on my soap box but really hope that as software develops to point that the clinician can use it easily, then the impression method becomes much less important. For example, if I do take a fully weight bearing impression using a laser scanner, then using the same scanner do a non weight bearing version. I then import both into the software so that I can compare the 2 extremes of the foot and do my own very subjective 'Finite Element Analysis' (Yes I know it is nothing like the real thing) with all the clinical information gained from the assessment, I reckon we would start getting close to the perfect solution.
    Additionally this software would have pre designed prescriptions that based on consensus (We will never get a conclusive body of evidence) would be best practice for applying specific ORF's.

    Phil
     
  9. Boots n all

    Boots n all Well-Known Member

    Your all wasting your time, these guys have just cornered the market with their 99.9% accuracy! And just for $35.00, well for the scan anyway.

    l wonder how they got the 99.9% accuracy statement, love to read the supporting research?

    http://footscan.soaringhealth.com.au/
     
  10. Boots n all

    Boots n all Well-Known Member

    l asked if they had research to support their statement of 99.9% accuracy, they replied "four different papers to spport..", l then asked for the papers.
    They then deleted my comments and replies ...
     
  11. davidh

    davidh Podiatry Arena Veteran

    Any system which can measure all three arches accurately gets my vote :D .
     
  12. TPCMAN

    TPCMAN Member

    Yea it seems he is a Chiropractor dabbling in podiatry with some wiz bang piece of tech because chiros are tired of annoying physio's :p

    If you look at his website further he does a 40min biomech consult charging $35, now if thats not trying to undercut the podiatry profession then I dont know what is... its just annoying in my opinion :mad:
     
  13. footsteps2

    footsteps2 Active Member

    I think it also comes down to the Orthotist making them. My Orthotist is a Podiatrist and he can see what needs to be altered with the i pad scans. He also has a way of securing the foot so it doesn't move during the scan and is as close to STJ Neutral as possible. He still believes that casts are the gold standard but the i pad scanners can do the job if the person making the Orthotics can see and adjust what he needs to, comes down to their experience and skill. It unfortunately seems to be moving this way forward. I still do casts as I don't do that many at the moment but if my volumes increase I will have to look at this again.
     
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