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Orthotics Q&A

Is 3D Scanning Eclipsing Traditional Casting For Orthotics?

As clinical practice becomes increasingly more complex, practitioners may be seeking new and advanced options to streamline operations while achieving optimal outcomes. Accordingly, these panelists discuss their experience with 3D scanning for orthotics, sharing their insights on accuracy, applicable pathology, patient experiences and the impact on their practice. 

Q:

Do you use 3D foot scanning technology in your custom foot orthotic practice? If so, what do you feel are the benefits of this technology? 

A:

Jenny Sanders, DPM, FACPM originally incorporated 3D foot scanning technology for orthotics into her practice in 2011 with an upright 3D laser scanner. At that time, she explains this device from ProLab Orthotics and designed by Sharp Shape provided superior data point capture. She adds that scanning technology continues to improve and she now uses Go4-D to capture volumetric foot and ankle data for custom orthotics in her practice. Dr. Sanders says the scanning technology from FitStation by HP combines with pressure/force gait mapping to create a customizable 3D-printed orthosis. 

Evan Merrill, DPM, FACFAS has employed 3D scanning technology for custom insoles for diabetic shoes, replacement insoles for existing shoes and for ankle-foot orthoses (AFOs). He relates good success with the insoles but notes issues with AFOs due to difficulties in scanning and less consistent results. 

All of the panelists agree that such technology offers key benefits including ease and speed of use, the ability to archive the scans forever, no mess and maintenance of device quality in comparison to plaster casting. 

Q:

Are there any types of orthotic devices that you feel are more conducive to using plaster or other molding methods? 

A:

Lisa Levick-Doane, DPM, FACFAS shares that she will still use plaster when it comes to orthotic prescriptions for patients with Charcot arthropathy. She shares that scanning a significant deformity may be adequate but plaster molding catches every crevice, dip and detail. While one can capture a rocker-bottom deformity on a scan, not all patients with Charcot have this in common, explains Dr. Levick-Doane. 

“Multiple cutouts on an accommodative orthotic is another reason to use plaster,” saya Dr. Levick-Doane. “You can easily define these marks with a surgical pen (on a cast). This is more difficult with scanning as the scan does not pick up the marker.” 

Tea Nguyen, DPM agrees. In her experience with cases of severe deformity, she has found plaster to be a better custom option to capture details of a misshapen foot. 

Due to practicing in a primarily sports medicine clinic, Dr. Sanders shares she doesn’t often see extremes of foot pathology. However, she will still take a plaster cast for patients needing an accommodative device as opposed to a functional device. She agrees with the other panelists that in her experience, scanning is not able to capture certain severe foot pathologies. 

Fast-setting resin socks are Dr. Merrill’s material of choice for custom-molded foot orthoses and AFOs. He relates that in his experience, resin sock casting is faster than plaster and the casts hold up better when he sends them out to the lab. He adds that there is very little clean up and he notices no change in the quality of the end-product custom orthoses in comparison to plaster. 

“I do not use plaster anymore and haven’t for at least 10 years,” notes Dr. Merrill. “I believe that one day there will be a 3D printer in each podiatrist’s office where he or she can scan the foot, enter the prescription for the device and print it out the same day.” 

Q:

If you use 3D scanning technology, do you use an iPad to scan patients or do you use an upright scanner for volumetric data capture? 

A:

Dr. Sanders explains her current system is a floor scanner with nine built-in cameras. Dr. Nguyen currently uses an iPad, which she feels is more sophisticated and convenient than the cumbersome and light sensitive upright scanner she used to use. The other panelists also use an iPad with a 3D scanner attachment. 

Q:

Can you share a particular case or instance in which you feel your chosen method of orthotic data capture made a difference? 

A:

Dr. Levick-Doane feels the time and cost savings of 3D scanning make a difference across the board for her patients. Parents can also enroll pediatric patients in an outgrow program by which the company will refurbish or make new orthotics for the child at a low cost at the time of scanning, she adds. Patients also appreciate the decreased mess and time investment, according to Dr. Nguyen. 

Dr. Sanders agrees. She adds that her sports medicine patients in particular are impressed with the technology and has found 3D scanning especially helpful for pediatric patients. 

“Let’s face it. Applying wet plaster and then waiting for the plaster to dry while holding the foot in subtalar joint neutral can prove challenging, and is especially prone to error in this population more so than adults,” maintains Dr. Sanders. 

Dr. Merrill relates that he personally wears orthotics made from data captured in a 3D scan by a colleague. He finds them very effective and wears them for daily activities and 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 apparent that there is a huge learning curve to negative casting mastery and most students and residents will unfortunately never attain proficiency in this skill,” says Dr. Sanders. “Since most clinics use some form of 3D scanning, this technology just makes the most sense.” 

Dr. Levick-Doane is a Diplomate of the American Board of Foot and Ankle Surgery, and the American Board of Podiatric Medicine. She is a foot and ankle surgeon at Kipferl Foot and Ankle Centers in Des Plaines, Fox River Grove and Algonquin,Ill. Dr. Levick-Doane is also an affiliate attending for the RUSH podiatric residency program in Chicago. 

Dr. Merrill is a Diplomate of the American Board of Foot and Ankle Surgery, and is in private practice in Medford, Ore. 

Dr. Nguyen completed a fellowship in wound care at the University of Texas Southwestern Medical Center in Dallas, Tx. She is currently in private practice in Freedom, Calif. 

Dr. Sanders is an Adjunct Professor with the California School of Podiatric Medicine at Samuel Merritt University. She is a Diplomate of the American Board of Podiatric Medicine and is in private practice in San Francisco. 

Orthotics Q&A
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Guest Clinical Editor: Jenny Sanders, DPM, FACPM
Panelists: Lisa Levick-Doane, DPM, FACFAS, Evan Merrill, DPM, FACFAS and Tea Nguyen, DPM
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