As clinical practice becomes more complex, practitioners may be looking for new and sophisticated ways to streamline operations while still attaining the best possible results. As a result, these experts share their perspectives on 3D scanning for orthotics, including accuracy, pathology, patient experiences, and the impact on their practice.
Q:
In your custom foot orthotic practice, do you use 3D foot scanning technology? If yes, what do you think the advantages of this technology are?
A:
Jenny Sanders, DPM, FACPM, first used an upright 3D laser scanner to introduce 3D foot scanning technology for orthotics into her clinic in 2011. She notes that this gadget from ProLab Orthotics, which was designed by Sharp ShapeTM, provided greater data point gathering at the time. She goes on to say that scanning technology is improving, and she now uses Go4-D to record volumetric foot and ankle data in her office for custom orthotics. According to Dr. Sanders, FitStation by HP scanning technology is combined with pressure/force gait mapping to build a personalized 3D-printed orthosis.
For custom insoles for diabetic shoes, replacement insoles for current shoes, and ankle-foot orthoses, Evan Merrill, DPM, FACFAS has used 3D scanning technology (AFOs). He has had decent outcomes with insoles, but has had trouble with AFOs due to scanning difficulties and inconsistent results.
In comparison to plaster casting, all of the panelists think that such technology offers major advantages such as convenience and speed of use, the capacity to archive scans indefinitely, no mess, and device quality maintenance.
Q:
Is there any form of orthotic device that you believe is better suited to plaster or other molding techniques?
A:
When it comes to orthotic prescriptions for patients with Charcot arthropathy, Lisa Levick-Doane, DPM, FACFAS says she’ll still utilize plaster. She explains that while scanning a major abnormality may be sufficient, plaster molding captures every crack, dip, and intricacy. While a rocker-bottom deformity can be seen on a scan, not all Charcot patients have it, according to Dr. Levick-Doane.
“Another reason to utilize plaster is many cuts on an accommodating orthotic,” says Dr. Levick-Doane. “A surgical pen can readily define these marks” (on a cast). Scanning makes this more difficult because the marking is not picked up by the scanner.”
DPM Tea Nguyen concurs. Plaster, she has found, is a better tailored alternative for capturing details of a deformed foot in cases of extreme deformity.
Dr. Sanders says she doesn’t commonly witness extremes of foot pathology because she works in a sports medicine clinic. She will, however, accept a plaster cast for patients who require an accommodating device rather than a functional device. She agrees with the other panelists that scanning does not capture certain serious foot diseases in her experience.
Dr. Merrill’s preferred material for custom-molded foot orthoses and AFOs is fast-setting resin socks. He claims that resin sock casting is faster than plaster, and that the casts hold up better when he sends them to the lab. In comparison to plaster, he says there is very little clean up and no difference in the quality of the end-product custom orthoses.
Dr. Merrill says, “I don’t use plaster anymore and haven’t for at least 10 years.” “I believe that one day, every podiatrist’s clinic will have a 3D printer where they can scan the foot, insert the device prescription, and print it on the same day.”
Q:
Do you use an iPad to scan patients or an upright scanner to acquire volumetric data if you employ 3D scanning technology?
A:
Her current system, according to Dr. Sanders, is a floor scanner with nine built-in cameras. Dr. Nguyen now uses an iPad, which she considers to be more advanced and convenient than the bulky and light-sensitive upright scanner she previously used. The other members of the panel utilize an iPad with a 3D scanner attached as well.
Q:
Can you give an example of a time when you believe your selected technique of orthotic data collection made a difference?
A:
Dr. Levick-Doane believes that the time and cost reductions of 3D scanning benefit her patients across the board. She also mentions that parents can enroll their children in an outgrow program, in which the company will refurbish or build new orthotics for them at a modest fee at the time of scanning. According to Dr. Nguyen, patients enjoy the reduced mess and time investment.
Dr. Sanders is in agreement. She goes on to say that her sports medicine patients are particularly fascinated by the technology, and that she has found 3D scanning to be particularly useful for juvenile patients.
“Let’s be honest. Applying wet plaster and then waiting for it to dry while keeping the foot in subtalar joint neutral can be difficult, according to Dr. Sanders, and is more prone to error in this demographic than in adults.
Dr. Merrill explains that he wears orthotics that were created using data from a colleague’s 3D scan. He finds them to be quite useful and wears them for everyday tasks as well as running.
“Having taught the 10-point method of negative cast evaluation to students at the California School of Podiatric Medicine at Samuel Merritt University for many years, it is clear that negative casting mastery has a steep learning curve, and most students and residents will unfortunately never achieve proficiency,” says Dr. Sanders. “Because most clinics employ some type of 3D scanning, this method is the most practical.”
Dr. Levick-Doane is an American Board of Foot and Ankle Surgery and American Board of Podiatric Medicine Diplomate. She works at Kipferl Foot and Ankle Centers in Des Plaines, Fox River Grove, and Algonquin, Illinois, as a foot and ankle surgeon. Dr. Levick-Doane is also an RUSH podiatric residency program affiliate attending in Chicago.
Dr. Merrill practices in Medford, Oregon, and is a Diplomate of the American Board of Foot and Ankle Surgery.
Dr. Nguyen earned his wound care fellowship at the University of Texas Southwestern Medical Center in Dallas, Texas. She currently works as a private practitioner in Freedom, California.
Dr. Sanders is an Adjunct Professor at Samuel Merritt University’s California School of Podiatric Medicine. She works as a private practitioner in San Francisco and is a Diplomate of the American Board of Podiatric Medicine.