The Pros and Cons of Computerized Foot Orthotic Technology

With the vertical system much of the variablity between casts is eliminated. My college and i if casting the same person get very similar cast (without presenting objective measures). The variabilty you get from the lab is also greatly reduced, because there is no forefoot platform, arch fill, lateral expansion, or for that matter no platster additions at all. In short when fitting the orthotics foot and orthotic are very well approximated, they fitt like gloves. It is also interesting to compare the vertically casted orthotic to those orthotics that have been made non weight bearing. I have noticed one area of significant difference, the lateral longitudinal arch. In the vertically cast device the lateral control appears more accentuated than in non weight bearing. The overall response from clients is that they feel well balanced when comparing to their weight bearing orthotics. much more research is need, a particular area that i would like to explore is Charcot foot ulceration . i would expect that a weight bearing correct foot position, may provide quicker healing times for ulceration. more time needed

 

Craig,

Is this research available? Could you point us to it?

Sean

 

Still not quite got around to finalise writing it up - so many other projects being worked on. I did mention more of the results here.

Several other projects are on going and more completed - just finished one RCT on patients with orthoses that had peviously failed -- I wll post some results on that one here soon.

Bascially all we are doing are asking the question - what is it that foot orthoses change in foot function that is associated with am improvement in clinical symtptoms? (and its not rearfoot motion)

 

So am I making a mistake by using the Footmaxx orthotics?, I do have the option to send in a slipper sock cast or using the data captured from the scan. I have less complaints with the orthotics used from the scans.

 

To All,

Just to add my two cents worth.

The FootMaxx system CAN NOT deternine a 3D image from a 2D scan. The math and physics needed to do thid Doe NOT exist!

This is the reason footMaxx was written out of the Non Insured Health Benefits package for Health Canada. FootMAxx did set up a conventional casting method for manufacture. I have visited the lab and seen their production. The FootMaxx scan devices are prefabricated library stock which are customised to the SCAN/Questionaire.

Lazer scanning seems to ne improving. I know PARIS orthotics have developed a Lazer scanner using 3 cameras which seems to capturr a true 3D image. The dificulty here in Ontario is wheather the insurance companies will accept this device as eqivalent to a POP cast.

Regards

 

The FootMaxx scan devices are prefabricated library stock which are customised to the SCAN/Questionaire.


you have been in the lab and seen the production??,

 

Kevinl,

Yes, I have.

Regards

 

To all,
Have you seen the 3D scanners that can accurately scan an object non weight and weight bearing.

Don

 

I've seen many types of scanners, some of which being well marketed glorified page scanners and others being extremely costly, and overkill in terms of input data, also being quite costly. Finding the balance between cost and quality has been a challenge. Obviously, if the input data is 2 dimensional, it's not going to be very effective in any system.

Beyond the scanner itself is the supporting software to produce a foot orthosis or positive cast. If it cannot emulate all of the features that a plaster based lab can, it should be considered insufficient. Key items to note in any automated system is longitudinal arch position, how closely an orthotic with no fill matches to the cast itself, and how flexible it is to suit a lab's and/or podiatrist's needs. At least one competing system uses their scanner for little more than perimeter definition, paying little attention to the topography of the input data, effectively templating out the device. In any automated system however, the most important tool is that tumor between the auditory receptors of the technician running the software.

 

been doing plaster splits castings for years and I always had to make changes to get the patients happy with fit and comfort. I started using the metascan system and now I don't use my bench grinder or heat gun. I guess the end results speak for themselves.Don't give up on technology as it will soon replace everything we currently do.....

 

Kevini,

brave statement to make! Suggests that your prescription/and or lab protocols were not appropriate. The metascan orthoses are rarley uncomfortable, but are they appropriate, clinically and proffesionaly?

 

I am talking about scanners that cost about $90K- $120K AUD not designed for just orthotics. The technology is in Australia in the engineering section. Jack a car up and scan the vehicle and you have non weight bearing. The spring sag. Then scanned again weight bearing and the stress points are noted. The scanned images are then sent to a printer and a miniature model is reproduced to exact scale.
The Faro Arm scanner can reproduce 1:1 down to 1:43 scale.
The foot is a mobile structure it can be scanned accurately, but how you use the date is up to the individual.
You can also us 3D Light Speed CT Scan to produce a great picture of a patients foot.

Don

 

Why is a 3D representation paramount? Does foot shape take precedence over foot function? 2D scans in conjunction with comprehensive biomechanical examination and human analysis of foot function can give you the information you need to construct an appropriate orthotic device.

I infer that you question the appropriate placement of of prescription configurations onto the foot in the absence of a 3D representation.

Please elaborate if you have the time.

 

When an lab with ethics makes an orthosis, they use the mould as the basis. They don't reach on a shelf of library parts and find one that looks right, they use the foot and a doctor's prescription. Further, to argue that a 2D scan is even a credible method of producing a device is wrong. I'm personally tired of hearing about snake-oil salesmen diminishing the value of treatment of the patients.

 

Joe, Thanks for firing off your response so quickly. While I can appreciate your personal fatigue with snake oil salesman, I'm not sure how your response elaborates on the discussion (based on the clinical or technical merit) as to why 3D representation is paramount. I'm not sure what the assumptions you made were in your response but for the sake of the discussion, its probably best to put those aside because those can be fatiguing too.

The tickler was/remains, "2D scans in conjunction with comprehensive biomechanical examination and human analysis of foot function can give you the information you need to construct an appropriate orthotic device.". I might even take that a step further and ask, why is any "image" of the foot necessary at all. A clinician with the relevant expertise could take measurements of the foot by hand and construct an orthosis from that basis. Why not? That's the question.

You argue that a "2D scan is not credible method of producing a device" as it were a fact. Without an explanation, that sounds a bit like dogma. Please explain why you believe that. Whats missing from a 2D information set? If there is missing information, is it conceivable that that information can be sufficiently gathered by other methods? Is it also possible that gathering that information by other means may actually improve the clinicians understanding of function? Contemplate that a bit.

Still unanswered.. Does foot shape take precedence over foot function? Perhaps imaging is a distraction from what really matters.

While it is clear that casting is the standard for representing a foot in the fabrication of orthoses, what are the core reasons for that standard? I realize that many clinicians and fabricators find them to be a convenient tool that have generally yielded pretty good outcomes for patients. I am not knocking the infrastructure that so many rely on, rather I'm hoping to unpack the a priori a little bit and think about what information is really under the covers of a mold. What is that information?

Its OK to remind ourselves what matters from time to time, to jolt the routine and avoid stagnation.

PS. What is that impeach Obama facebook link you embedded?? Confusing message...

 

Is a 3D representation paramount ? Probably not.

Is a 2D scan better than drawing round the foot from a clinical perspective? Probably not.

Do I even need to draw round the foot? Probably not

I don't think Craig was saying that you need a 3D representation, he was simply stating that you couldn't get an accurate representation of the 3D foot with a 2D scanner.

Of all people, I would imagine Craig to be least concerned about accurate 3D representations of the foot. Delivering the prescription variable is the key regardless of how it is done. But I could be speaking out of turn

Regards,

Robin

EDIT - Sorry, cross posting, we're on the same page. p.s. I couldn't find where Craig had written what you quoted.

 

Robin is right on my views. The only issues I have are with the scammers who try to dupe people that they can get a 3d foot shape from a 2d pressure scan.

 

The core reason? It's the right thing to do. I'm not wasting one moment discussing inferior methods of production, inferior technology, and mostly believe that by lowering our standards, we devalue the industry.

As for my Avatar on Facebook, Barack Obama has taken direct actions to threaten families with Asthma. As I have asthma, as my grandfather has asthma, and as our child, due in February, also has Asthma, and... As more than 20 million people in the United States have asthma, I consider him my enemy.

What he did

For many reasons, he needs to be removed from office and tried as a traitor to the American people. For one particular reason, his decision to remove OTC inhalers from those who need it to live, he has become my enemy. Most of you are doctors. Most of you know that this is a death sentence to some. I nearly died of it in my toddler years.

Who are these people? People who make too much to get medi-care/medi-cal, and people too poor to afford health insurance. Thankfully, for Ohio, Issue 3 actually opens the door to tell the EPA and President to go to hell.


On a happy note, our child, due in Februrary, and the mother are doing well, and I for one am blessed to have a young one on the way. On monday, we'll know if we're going to name him Joshua, or her Francella.