I entered the O&P profession more than two decades ago. At that time, nearly every device in the lab was fabricated through hands-on plaster work or traditional metal and plastic fabrication techniques. The workflow was almost entirely manual, and the lab environment revolved around plaster casts, positive molds, and technician-driven modification.
My entry into the field was not glamorous. Like many people who find their way into O&P, I started doing the basic work that keeps a laboratory running. After school, I spent a few hours each day emptying trash bins in the lab, pouring plaster molds, breaking apart casts, and helping wherever I could. It was typical grunt work, but it provided an early introduction to the fabrication side of the profession.
Over time, I began taking on more responsibilities in the lab. When the opportunity allowed, I started assisting with fabrication tasks and learning the technical side of orthotic manufacturing. That early exposure eventually led me to pursue formal technical training.
For many clinicians and technicians working in O&P today, digital technologies are becoming an increasingly visible part of daily practice. From 3D scanning to CAD-based device design and additive manufacturing, the profession is gradually moving toward more digitally integrated workflows. Looking back at how these technologies were discussed 15 years ago provides a useful perspective on how innovation actually unfolds within clinical practice.
After approximately six years of hands-on laboratory experience, I enrolled in the orthotic technician program at Century College to expand my knowledge and technical skillset. During my time in the program, I also served as a teaching assistant for one semester.
After graduation, I returned to the technical side of the profession for several years before deciding to continue my education by attending the orthotic practitioner program at Northwestern University Prosthetics-Orthotics Center (NUPOC), where I was first exposed to additive manufacturing technologies.
In the machine room there was a Stratasys 3D printer, which represented one of the earliest exposures many of us had to the concept of digital manufacturing within O&P. Seeing that technology sparked an early curiosity about whether rapid manufacturing could eventually play a meaningful role in O&P fabrication.
That led to a research paper in 2011, in which I examined the question, “Could rapid manufacturing realistically become sustainable within traditional orthotic and prosthetic laboratory workflows?”
Following graduation from NUPOC, I completed my residency and transitioned into clinical practice. Over the past decade, my clinical work has focused primarily on cranial remolding orthoses, an area of the profession that has experienced some of the most rapid digital transformation in recent years.
Over nearly 26 years in the field, I’ve witnessed significant technological changes in O&P, and I felt it was an appropriate time to revisit the original research question. Looking back at that early hypothesis offers a unique opportunity to reflect on what the profession predicted about digital manufacturing, what actually happened, and where the technology may be headed next.
Around the time I was attending NUPOC, O&P was having more frequent discussions about rapid manufacturing and additive manufacturing technologies. These ideas were appearing in engineering journals, research conferences, and occasionally within professional O&P conversations. Many of these conversations centered on whether emerging digital technologies—such as 3D scanning, CAD, and additive manufacturing—might fundamentally change how O&P devices were produced.
At the time, these concepts raised an important question for the profession: Could rapid manufacturing become sustainable within traditional O&P laboratory workflows? Fifteen years later, the profession has the benefit of hindsight.
The 2011 Question
When I wrote my research paper, additive manufacturing was still viewed as an emerging technology. Industrial systems such as selective laser sintering were already being used in aerospace and engineering fields, but their presence within O&P was very limited.
At the time, most O&P devices were still fabricated using workflows that had remained largely unchanged for decades. Plaster casting, positive mold modification, vacuum forming, and composite lamination were the standard processes used across the profession. These methods were well-established workflows that consistently produced reliable outcomes but were also labor-intensive and dependent on skilled technicians.
Early research suggested that digital design and additive manufacturing could improve efficiency, enable repeatability, and allow for more complex device geometries. However, the limitations were significant—high equipment costs, long production times, and limited material performance. The potential benefits were obvious, but many clinicians and technicians were understandably skeptical about whether additive manufacturing could match the durability, flexibility, and reliability of traditional fabrication methods. The central question at the time was not whether the technology was promising, but whether it was practical.
It is interesting to revisit that question with the benefit of experience. Some of the predictions made during that time proved accurate, while others underestimated the complexity of integrating new technologies into established clinical workflows.
What We Thought Would Happen
In the early 2010s, buzz around additive manufacturing began to appear in engineering conferences, research papers, and industry circles. Within O&P, there was a great deal of optimism surrounding additive manufacturing. Many believed that digital workflows would rapidly replace traditional fabrication methods. If patient anatomy could be captured with digital scanners and device designs could be created using CAD software, it seemed reasonable to imagine a future where devices could be manufactured directly from those digital models.
Devices such as AFOs, cranial helmets, and prosthetic sockets were frequently discussed as candidates for fully digital production. There was also speculation that automated manufacturing could reduce reliance on traditional lab-based workflows.
These ideas were not without merit. The potential advantages were clear: improved consistency, digital storage of designs, faster reproduction, and expanded design capabilities.
However, the assumption that additive manufacturing would replace traditional fabrication underestimated the complexity of clinical workflows and the importance of material performance, hands-on modification, and practitioner experience.
What Actually Happened
Over the past 15 years, digital technologies have significantly influenced O&P, but not through replacement.
Instead, the profession has moved toward integration.
3D scanning has become widely adopted, allowing clinicians to capture patient anatomy quickly and store digital models for future use. CAD-based design tools have improved communication between clinics and fabrication facilities, enabling digital file transfer rather than physical mold shipment.
At the same time, traditional fabrication methods remain essential. Thermoforming, lamination, and manual modification continue to play a critical role in producing final devices.
The most significant transformation has not been the replacement of fabrication methods, but the digitization of the design, communication, and decision-making processes that surround them. One of the key assumptions during that period was that advancements in fabrication technology alone would drive widespread change. In practice, adoption was influenced just as heavily by clinical decision-making, workflow design, and the realities of day-to-day patient care.
Additive manufacturing has found value in specific applications, particularly rapid prototyping and design iteration, but it has largely become one component of a broader workflow rather than a standalone solution.
Looking back, it is clear that the profession did move toward digital workflows—but the transition occurred through gradual integration rather than sudden disruption.
Practical Applications
For clinics exploring digital manufacturing, one of the most important lessons from the past 15 years is that successful adoption rarely begins with purchasing a 3D printer.
The most valuable starting point is developing an understanding of digital workflows and how digital inputs translate into clinical decisions. This includes gaining experience with 3D scanning, CAD-based design, and digital file management.
For those interested in additive manufacturing, working with third-party providers can offer a practical entry point. This approach allows clinicians to evaluate design concepts, material performance, and workflow integration without the need for immediate capital investment. One of the areas where digital technologies have had a particularly visible impact is in patient-specific orthotic design. Over the past decade, digital scanning and CAD-based design tools have increasingly been integrated into clinical workflows. These technologies allow clinicians to capture detailed anatomical data, monitor changes over time, and design devices with more precise control over pressure distribution and biomechanical intent. This level of consistency in data capture and design has been one of the more meaningful, and often underappreciated, impacts of digital integration in clinical practice.
Even when the final orthosis is fabricated using traditional thermoforming techniques, digital workflows have significantly improved documentation, consistency, and treatment monitoring in this area of care.
Ultimately, the greatest value of digital technology lies not in the equipment itself, but in how it enhances communication, design consistency, and clinical decision-making.
Looking Ahead: The Next Phase of O&P Manufacturing
Looking forward, the next phase of transformation in O&P will be defined by how digital tools are integrated into clinical workflows rather than by fabrication technology alone.
One of the most significant developments will be the continued evolution of parametric and automated design systems. These systems have the potential to generate device designs based on biomechanical rules and patient-specific data, improving consistency while reducing variability between clinicians. In practice, this could allow a clinician to begin with a baseline design that automatically adjusts to anatomical landmarks, alignment goals, and treatment objectives, reducing manual modification time while preserving clinical intent.
Artificial intelligence (AI) may also begin to play a role in design support. By analyzing large datasets of anatomical scans, device geometries, and treatment outcomes, future systems could assist clinicians in identifying optimal design parameters. More importantly, these systems may begin to shift how clinicians interact with device design—moving from fully manual modification toward guided, system-assisted decision-making that maintains clinical intent while improving consistency. For example, AI-assisted tools could suggest trim lines, pressure relief zones, or correction strategies based on similar patient presentations. While these systems are unlikely to replace clinical judgment, they may increasingly serve as decision-support tools that enhance efficiency, improve reproducibility, and help standardize aspects of design that have historically depended on individual experience.
Hybrid manufacturing approaches will likely continue to define the field. Rather than replacing traditional fabrication, additive manufacturing will complement it, supporting complex geometries, rapid prototyping, and specialized components, while traditional methods such as thermoforming and lamination remain essential for final device fabrication. This blended approach allows clinicians and labs to leverage the strengths of each method rather than relying on a single process.
However, several challenges must be addressed. Education remains a key barrier, as clinicians must be trained not only in using digital tools but in understanding how they influence clinical outcomes. Workflow integration is another challenge, as new technologies must align with existing clinical and fabrication processes. Without this alignment, even highly capable systems may struggle to gain widespread adoption.
Despite these challenges, the direction is clear. The future of O&P will not be defined by a single technology, but by how effectively digital tools are integrated into systems that enhance efficiency, consistency, and ultimately patient care.
Rapid manufacturing technologies did not replace traditional fabrication within O&P. Instead, they became part of a broader digital transformation that has gradually enhanced how clinicians design, document, and manufacture patient-specific devices.
After nearly 26 years in the profession, it has been fascinating to watch these changes unfold. Revisiting that original research question now provides an opportunity not only to reflect on how far the profession has come, but also to consider how the next generation of clinicians and technicians will continue to shape the future of O&P care.
Jose L. Gonzales Jr., CO/L, has worked in the O&P profession for more than 25 years with a clinical focus on pediatric orthotics and cranial remolding orthoses. His work has increasingly focused on digital workflows, additive manufacturing, and the evolving role of technology in clinical practice. He is the creator of ForgeAxis, a developing platform focused on helping clinicians and organizations integrate modern workflows, digital tools, and systems thinking into practice.
Author’s note: A longer version of this analysis expanding on the original 2011 research question has also been developed as a white paper, available as an open-access resource through ForgeAxis by scanning the QR code. 
Image credit:
Shubham Dhage/unsplash.com
