Where to have EVA orthotics fabricated?

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Hi

I am just in the process of setting up my own business but havn't yet the funds to buy any computer based foot scanning equipment.
I have been looking at trying the Orthotics Australia STS casting sock.
Has anyone tried these socks and if so how have the results been?
I believe they will fabricate the orthotics from these casts but believe that they are 3/4 length.
I would ideally like full length fabricated.
Can anyone recommend a company to fabricate orthotics. I have a grinder to adjust any or add heel raises etc extrinsically.
Is there a good computer based programme to do foot scans that can then be directly sent to a fabricator that isn't going to cost the earth or should the casting socks be good enough?
I am confident with working with orthotics, adjusting them etc.it is just the initial manufacture.
Any advice/experiences would be greatly appreciated in helping me make a decision where to start!!
I am in Queensland.

 

You already have most of the equipment, a vacuum former will set you back about $1650 and will pay for itself in a month or two, give it ago yourself, you will learn heaps and save a small fortune.
As for casting we use foam impression boxes, cheap, clean and quick, what more could you ask for.

 

Thanks for that. I guess because I havn't made any Orthotics that way since Uni I don't feel too confident doing them!! What materials do you find to be the best to use? I quite enjoyed making them myself and will have the time to do so just starting out! I guess you would only have to make about 16 pairs to have the vacuum former pay for itself.

 

Talk to Briggate medical or the like, we have found them to be quite good for both materials and the vacuum pump but there are others in the market.

Practice on yourself or family, they seem to be very forgiving

 

Hi. If you are not proficient in orthotic manufacturing, I wouldn't try. I think it's a skill that takes a long time to master. It might be cheaper, but I just don't think it makes good practice sense. I see plenty of supports made by Podiatrists (rather than a lab) & they look terrible. I think the pros out weight the cons of using a lab.

 

Have to disagree completely- except for the part about it taking a long time to master...
I believe I learnt more from making orthoses myself than from any other source. In nearly 15 years of manufacture I struggle to think of any patient who has complained about how the orthotic looked.
I certainly have had more people complaining about how an orthotic functioned (whether I made them or someone else)
I also had many patients appreciate that I had complete control of the manufacturing process and took complete resposibility for the end result- good, bad or indifferent.
Have you manufactured any orthoses Mark?
Few people who have made a significant number of orthoses themselves regret it and generally have the same experience as me. If they then use a laboratory, they will have highly developed skills at critiquing the orthoses and adjusting them.
BTW- it was not an economic decision- the time spent manufacturing eats significantly into consulting time...

 

I have to agree if you feel confident enough I would really suggest you give it a go and fabricate your own EVA devices.
OK there is a out lay for equipment, materials and your time. However i am very pleased i do all my own EVA decives. I have control over the entire process, so i actually learn what works and what doesnt very quickly.
I have found cients really appreciate it if they can see you are activelly involved in the entire process.

I use the foam impression boxes to be excellent, remember positioning is important. Cliet seated hip, knee and ankel at 90 degrees place the foot in the impression box.Foot in neutral and you apply gentle pressure onto the foot to get your impression.

pour the cast. Modify cast if required once cast dry. Generally i dont need to do to modification.

Then press your heated EVA on to the cast, I generally build it up in reverse that is i will make sure my cast is nice and smooth, place on a nylon stocking over the cast press my top cover on first, then prehaps apply ppt in the met head area for additional padding if reqiured and then press my EVA on top of this.

The reat is simply time and gradually grind it into shape.

As for materials well well that is personal chice what you are familiar with but some diffrent densities and thickness of materials are useful.

Ps just remember to take you time initally. On average i do 4-5 pairs a week.

Hopes this helps

Chris

 

It's a personal choice - if you enjoy it, that's the important bit. I made orthos for almost 4 years for another Podiatrist. I don't have time to make them or I should say I get more enjoyment from consulting, than what I would from making orthoses. The orthoses I have seen made by Podiatrists are often of poor quality (I worked for a Pod for several years & the quality of his orthos was poor both in function & appearance. I have often seen orthos made by other Pods so it wasn't just the one Pod I am referring too). I have rarely had an issue with the quality of orthos. produced by the labs I've used (there are of course mistakes made by them as there is by my assessment/diagnosis/prescription). I also take complete responsibility for the results a patient receives - good or bad or indifferent.

 

Thanks for all the replies. I have also seen some bad orthos made!! It may be that I initially send them away and perhaps make my own later on. As you say, time is a great factor.
What method do you use to create the cast or have you got gait plate/scanner?
I have been looking at the casting socks that can then be sent off or a computer gait programme where the design can be e mailed straight to the orthotic manufacturer. I will need a cost effective method initially.

 

Hi Chris,

Thanks for all of your help. What thickness and density EVA do you use? I do fancy having a go myself but also want to produce a quality product!!

 

Please don't get confused about "quality" in orthoses. It has zero to do with how they look and everything to do with wether or not they work as well as possible. As far as making EVA devices from casts, if you are usually doing no modifications then why don't you begin making direct moulded devices. This cuts out the whole plaster step and you can buy premade sized blanks that look great and involve very little machine finishing. Time form start to finish 20 min. The ski industry has been doing stuff like that for 25 years. Theres a French company called Sidas Conformable that make a great range of blanks, or at least used to.
regards Phill Carter

 

Hi

many thanks for the reply. I am looking at finding a good quality full length EVA support and then adding rearfoot, forefoot, heel wedges etc. Having used an expensive computerised programme (I didn't own it unfortunately) I found that adjustments wee still needed in medial arch area plus length and width adjustments.
I will look up the french company but I am in Oz so may go with algeos or something similar..not sure they make full length though and don't want to be adding forefoot on. I prefer fit of full length in the shoe.

Have a lot of investigating to do, opening up in 3 weeks and just sorting business cards, letter heads, materials etc...chaotic...plus have a fitness and wellbeing day coming up where I have a stand!!!

Many thanks again for all the replies.

 

Hi,
I use 10mm EVA for my soft devices. A lot of the materail is ground down in the manufacturing process.

Hope this helps.
Chris

 

There are several options on who manufacturer EVA Orthotics
Sole Performance Lab makes dual density and single density products and they also manufacture using 3D scanning and milling of MDF molds which allows the podiatrist to reorder without the mold and also ask for more corrections if required or second pairs. They also manufacturer functional orthotics as well.
Regards
Rosso

 

Why would you make your own devices?

How much does it cost to purchase one from a lab?
How long will it take you to make the device yourself?
How many patients would you see in this time?
What will your product cost be?
The numbers do not add up if you have a busy practice.

Remember that while you are having fun making a device, the patient that you do not have time to see will go to the podiatrist across the street for their new (lab made) orthotics . And their new orthotics will look a lot better than yours.

There is a saying that WHAT LOOKS GOOD WORKS GOOD

 

There is another saying that people only interested in superficial issues rarely achieve satisfaction or happiness in the long run.
regards Phill Carter

 

Trevor,
To answer some of your questions:
1. about $120
2. 60 to 70 min
3. none because I do it during the add breaks while watching tele on the weekends, or alternatively 3.
4. Materials cost max about $15 per pair except for carbon fibre.
5. I have a very busy practice and the numbers do add up, my workshop overheads are lower than the overheads on my consulting rooms.
regards Phill Carter

 

l agree with Phil except for # 3. My weekends belong to others:drinks,

l pour casts of the days work before l go home each night, then l start work at 7.00am and are finished any orthotic work by about 9.30am everyday, like anything in business its all in the planning

 

Good luck starting from scratch making EVA devices. It will be a long time before they look half decent.

The false economy will be how much wasted materials and how long your machines end up running for.


In my experience, the P&O EVA product has it over us. In fact a P&O guy gave me a few tips (re: direct moulding) which has improved the aesthetic and clinical outcomes of my devices.



But, unless you are lucky, or have the more-style-over-substance-marketing-ability, your new business will be sluggish in the short-to-medium term. Which gives you the opportunity and time to practice and get your head around them. The direct mould method only requires EVA, glue, heat-gun and grinder 60-120 grit. Good opportunity for you to compare lab and self-done. You will find there is a huge gulf until you get 500 hours under you IMO.



In the long run, despite what Trevor says, having control, and having the ability to manufacture has many benefits. From a true 'business perspective' the lab wins for a busy practice...no doubt.

But I haven't heard of too many practitioners willing to pay wholesale again if the clinical outcome was not desireable. Practitioners who have the ability to make their own, have a better quality control of externally made stuff; and are more likely to have a plan b and c...if a fails.

I would think that the practitioner who gets the lab to do everything, is more likely to go to the back room, heat gun the over-aggressive arch and flatten it "to suit".



Ron
Physiotherapist (Masters) & Podiatrist

 

Hi guys,
What I meant in point three was if I do it evenings or w/e then it is time when I would not be seeing any patients, or if I was seeing patients it would be three per hour. about $150 per hour income with 40-50% overhead cost at the clinic. In the workshop the overhead component is only about 25% max. The other thing that is not said but always true is that the time required to gain the skills only has to be done once, and the benefits are there for all your working life.....a very good return on the investment.
regards Phill

 

When do you spend time with your partners or family?
Don't you have to help with homework?
Babysit the grand kids?
Take the kids to soccer\netball training, music lessons?
At 0700 I am supposed to be out walking with my wife? We stop for coffee along the way. The clinic is only 2.5 k's from home so we are lucky there.

Use a lab and take the time to smell the roses as they say. Life IS VERY short.

 

Trevor,
That is the one argument that you have put forward that actually has merit, the rest are just not correct. I actually put in most of my workshop hours while my wife and kids are asleep. I am a natural early riser, and one day a week I chose to spend in the workshop intead of consulting, if I don't have that much to do I get a slack day, sometimes with my wife.
regards Phill

 

Hehehe, my wife get up that earlyigs:, l think not, l get up at 6:15 and arrive at work at 7:00am.. and l am back home by about 5:30pm, maybe 6.00pm?

My wife and one of our children go for walks in the evenings, weather pending, a nice slow down for the day and my children are old enough to help themselves with their homework.

You are starting up a new business, what makes you think you are going to be fully booked every day anyway?

.....5 casts were prepared Saturday at 1:00 when we closed, l have just mixed plaster and poured the 5 casts this morning....20 min

 

My wife does things like washing etc or cooking dinner that don't require my help all the time, so I do a bit of workshop stuff at those times too, not ignoring the family, just using my time to earn effectively for all the other things we want to do together that cost money. These little bits of time add up to $300-$400 worth of lab bills avoided just about every week, $15-20k a year for the same investment of time and $5k for machinery that I made 12-15 years ago. You can't duck out and see one more patient while dinner gets cooked can you?
regards Phill

 

That is what it takes, I agree.

But then there are additions etc. I would have thought.



Or do you just direct press against the un-adjusted positive cast?



Ron
Physiotherapist (Masters) & Podiatrist

 

A bit of both Ron, it depends on what the orthosis is for.

 

Hi footsteps,

What sort of practice are you setting up? Is it a general podiatry practice or focussing on a particular area? I think that this would have an effect on whether you make the devices yourself or use a lab.

There are lots of good labs out there including those interstate that people in QLD use. I would recommend calling a few of these and finding the one that most suits your style on orthotics. I'm sure they probably all do a good job, but expect a variance between each company.

Good luck with your decision

 

If you are looking for a scanner, check out Vismach.com I just bought one and am getting great results. It's not much more than the vacuum system and there is a lab with support in Au.

If you decide to make your own EVA orthotics, I would suggest 35 durometer for lighter patients and 55 durometer for heavier folks.

Good luck
Mike