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I am interested to know how many in the arena use neutral suspension plaster slipper cast and how many use 3D laser scanning to make their functional foot orthoses.
Of you who use 3D laser scanning, have you found that it is as accurate in effective (additional to being faster and less messy) as the plaster casting?
What scanners are people using?
Of those who have tried both and gone back to plaster ....why?
Best regards and thanks in advance for your responses.
Freeman Churchill, Certified Pedorthist (Canada)
Halifax, Nova Scotia
This is a topic I am keen on as I'm personally not sure what difference the capture method makes. I'm a foam box man myself. Nothing is cheaper quicker and more mess free, even laser scanning. I also have more control over a foam box impression, ie the less done in the lab, the better
Robin
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I see you girls checkin' out the front of my trunks
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We have been moving away from plaster casting for MGF to 3D laser scanning.
Brilliant, client is clean, it looks very professional, it takes 1/5 of the time during casting and reduces modeling to a 1/4 time and the results are out standing.
Just gona add my '2 penneth' from a CAD user perspective.
The digital scan is far easier to accurately interrogate as the image can be viewed in cross section in all 3 planes.
It does take a bit of getting used to but is far superior to eye balling negative and positive impressions.
Anecdotally I have found that scans taken directly from the feet as opposed to those taken from foams and casts are far more symmetrical in heel width and length!
I've been using 3D laser scanning for the better part of 15 years and would not go back to plaster casting. The efficiency of the process alone is worth the investment, but I've also found that cast corrections are more consistent, and hence, tolerable for the client, making for better patient outcomes. Also, much easier to make alterations to the positive model, if required.
My perspective clinically is that Laser scanning is quick, clean and effective. If the correct quality of scanner and software is used, then issues surrounding depth of data capture (Posterior Calcaneus etc) are mute points. Personally, a laser scanner allows me to capture a 3D model of the patient’s foot in any casting position that i would need on a daily basis. Using various scanners over the past 3 years for foot capture has led me to conclude that the selection of scanner is important... if you have a lab that will design and produce orthoses as you request to bespoke protocols. If you are investing then you may as well go for the best available if means allow.
From the perspective of CAD design and manufacturing, we also find increased symmetry of heel and forefoot width, better visualization and depending upon design methods... a more consistent outcome to the device manufacture process. In other words the device can be designed and manufactured to set requested standards more easily and predictably if the concern of poor casts/foam box scanning is not presenting.
Currently we have customers using 4 varieties of scanner set up, this may skew my judgement based upon the fact that the semi and full weight bearing scans are more standardized by nature, particularly when compared to casts. I am not sure if the same would hold if most customers scanned non weight bearing with no or minimal scanner contact. Some non weight bearing scans are unusable.
As always, i guess we all have our preferences and in clinic i could take it or leave it if less than 4 – 5 orthotics per week are required. The ease of use satisfies after that point.
As for scanner technology. Most scanners give adequate or even good results (3D laser scanners) i still firmly believe that it is the work by your lab that remains of paramount importance in ensuring a correct bespoke end result that matches your need.
We use The I Qube from Delcam In Lab and Clinically, i consider this the best scanner and software interface available. Although i have used the sharp shape (limited as to capture method and depth of posterior heel capture in my opinion) and "others"
The above is not to say that the end result in terms of finished device will differ.....As long as the lab knows what you want and can deliver on design. Software at the lab end also plays a large part of this.
We have captured a foot positive on both the I Qube and Sharp Shape, the end orthoses result matched to all extents and purposes. But i know which i would preferand trust to use..... and besides the I-Qube is just a far better finished piece of equipment.
Interestingly, we are part way through the process of research, evaluating the variations in consistency between scanned/casted and foam impression casts as part of a larger project. It is going to be next year before a conclusion can be expected to that....motivation dependent!!
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Steven Dowdeswell
Podiatrist (U.K)
Precision Made Orthotics Ltd
Paromed Australia supply several scanner systems incorporating the full modelling capability for the podiatrist. Our approach, with central fabrication, is to put the modelling/prescription in hands of the podiatrist, i.e. the health practitioner that is prescribing the orthotic device and has seen and examined the patient. The podiatrist hence has full autonomy with the prescription of their orthotic device.
Tried scanning. Didn't like it. Went back to foam.
I also tried scanning and went back to plaster. I personally found it very difficult to obtain a good scan. Part of the problem for me was as I presed against the 4th and 5th Met heads to position the foot, my thumb wouldget in the way and the met heads were missing on the scan.... With plaster you just pop out your thumb print and you have a perfect negative cast.
I have a question for those using foam boxes.... are you capturing the impression semi or full weight bearing? Do you get the patient to hold their foot in a certain way? or do you just get them to stand in the foam in relaxed/resting stance?
Sorry for going off topic but I have never really used foam boxes and I'm having trouble understanding the biomechanical concept behind the method and the resultant corrections that go into making the devices from the impression.
Thanks.
The Following User Says Thank You to Berms For This Useful Post:
I have a question for those using foam boxes.... are you capturing the impression semi or full weight bearing? Do you get the patient to hold their foot in a certain way? or do you just get them to stand in the foam in relaxed/resting stance?
You capture the impression in whatever position you want to, much like POP. I favour the three point pressure technique, although others are available. I don't allow the patient to weight bear on it but I do push about 20 odd kg through their leg with the knee fully flexed.
Here you go squire. Did a video here. I'm sure there are better ones.
You capture the impression in whatever position you want to, much like POP. I favour the three point pressure technique, although others are available. I don't allow the patient to weight bear on it but I do push about 20 odd kg through their leg with the knee fully flexed.
Here you go squire. Did a video here. I'm sure there are better ones.
Thanks Robert for the video.... I also found an earlier thread you started comparing foam and plaster and it answered all my questions.
THanks, Berms.
The Following User Says Thank You to Berms For This Useful Post:
My clients are using the 3 D Laser scanner (Radscan) made by Oretek.com. The Podiatrists are very happy with the scanner and the results. I am happy too as the complete 3 D Laser Scanner is only $1200 making it very affordable. For further info, go to Oretek.com, Joe Jared, the owner of Oretek, has posted much info on scanners.
I had a laser scanner demonstrated to me a while ago; it scanned in 10 seconds. Fantastic! Erm, unfortunately it took the rep about 30 minutes to set it up, fiddle with the calibration, etc. During which time I could have done about 180 box casts. Back to boxes for me; I can live without the extra 'accuracy'
I had a laser scanner demonstrated to me a while ago; it scanned in 10 seconds. Fantastic! Erm, unfortunately it took the rep about 30 minutes to set it up, fiddle with the calibration, etc. During which time I could have done about 180 box casts. Back to boxes for me; I can live without the extra 'accuracy'
Once the scanner is properly set up, it is rare that you need to 'fiddle with the calibration'. The Entire scanning process takes less than 2 minutes and the lab has your scan which is of much higher quality than scanning a foam impression.
The scanner pays for itself within a year as you don't have to pay for foam boxes or shipping boxes to your lab.
I think the biggest advantage is that patients perceive you to be up to date with the latest in technology when you scan and it instills confidence and they perceive they are getting a better product.
Once the scanner is properly set up, it is rare that you need to 'fiddle with the calibration'. The Entire scanning process takes less than 2 minutes and the lab has your scan which is of much higher quality than scanning a foam impression.
Hmmm? Hows that?
Quote:
I think the biggest advantage is that patients perceive you to be up to date with the latest in technology when you scan and it instills confidence and they perceive they are getting a better product.
I've tried scanning. It was kinda fun. I'm back to POP now though.
My slight gripes with scanners currently are:
(1) The way they often require a certain flow through to the lab per month (assuming you have been given the scanner). I don't like having orthoses 'targets'.
(2) The way some people using the scanner often market it as being superior to other modes of negative model production.
I suspect with time number 1 may change. As scanners get smaller/cheaper buying them outright may be more feasible for most. I suspect number 2 will not change.
I don't think a scanner will automatically give you a better quality of 'cast'. It will be different. I think a lot of the time if you are comfortable with one method of capture and know how manage the whole process to work for you it can be painful to move over to something different. That can be true from POP to foam box, or from those to scanning.
Scanners are not all equal, they will have strengths and weaknesses. To a certain extent the jump can be minimised by picking a scanner that can cope with something close to your current working method.
That said if I were shopping for a scanner today I would look for something that could cope with multiple methods of capture, weightbearing, semi, non and also capture of POP and foam box. That way you are not limiting the clinical choices you make because of the technology.
I think there are significant advantages to a CADCAM process that are yet to be exploited by the majority of labs. But they will be. When this becomes the norm it will make more sense to have the digitising done at the clinic end, tied in with more flexible digital prescriptions and direct designing options.
I also think that there is potential to start integrating scanning into the assessment process and more directly to design. This would mean the scanner had additional value to the clinical and prescription process rather than just being an alternative method of capture. Currently I am aware of scanners that have the physical capability to do this, but no systems that would allow this to be done in any meaningful way, but this is almost just an implemantation issue.
Plaster casting vs 3D Laser scan
Linear Mode
