Keeping Orthotic Manufacturing in the Hive

An old beekeeper once said, "A real beekeeper loves to go into the hive to see the bees at work." I'm always fascinated by the synergy of the hive-the bees never seem to rest, and the end result is a product that is perfect, unique, and lasting. The really cool thing is that even though they go far and wide to collect the best materials, in the end, everything is done in-house. In today's fast-paced pedorthic practices, we seem to be sending more and more of our products out of the "hive" to be produced by others rather than building the product in-house. With scheduling constraints, patient demands, and cost concerns, outsourcing looks good on paper. However, in a results-oriented world, the time spent fine-tuning a pair of foot orthotics that someone else made can eat up the profit and still leave the patient with devices that are less than desirable. Furthermore, devices that have gone through several adjustments after fabrication to get them exactly right are difficult to duplicate should the patient desire a second pair. Exceptional fabrication skills are essential for a pedorthist to have-the profession is, after all, rooted in craftsmanship. We are the professionals who can work magic with a great set of foot impressions, properly crafted positive casts, and the best materials-all done within the hive. The person with the eyes that evaluated the patient and with the hands that made the cast, pulled the plastic, and fit the device to the patient's foot can be one and the same. During my pedorthic career, I have had the opportunity to work with several foot orthotic fabrication labs, and as is the case with any industry, some are spectacular and others leave a lot to be desired. Some large labs are more concerned with pushing out orders and creating orthotics that are not rejected, and as a result, the lab undercorrects the casts or chooses devices from a library of shapes, even when practitioners are ordering custom orthotics. So the orthotics that are delivered are not bad enough to return, but too generic to accomplish the desired results. You may have encountered these types of devices yourself: You have a pair of orthotics that require arch adjustments, changes in heel posting, or repositioning accommodations, but because of the choices made by an outside lab, you find that your options to resolve the issue are limited. I believe the best solution is to start making orthotics for your patients yourself. Learn the techniques that work for you and your patient population, and become a master certified pedorthist. Even though many of us do not have the space for a plaster sink, grinder, and gluing table to complete the entire process in the hive, newer technology may provide a hybrid solution that will allow you to design a custom orthotic for your patient while partnering with an external vendor for the milling portion of production. Eliminating plaster mess and the space considerations of traditional fabrication will keep your clinic looking professional while allowing you to craft the best devices that your patients can buy. You can cast or scan the patient, design a truly custom foot orthotic using a CAD program with the latest graphic software, and then e-mail your design to a site that will produce anything from rough shells to finished products for you. The software and machinery required to design and produce devices in this manner are no longer cost prohibitive and the learning curve isn't as steep as it once was. Although I am sure there are a number of options for this type of solution, I am personally familiar with two companies in this market: TOM-CAT Solutions, Ivyland, Pennsylvania, which produces the TOM-CAT 3D Foot Scanner, and Osiru- Soft Research and Engineering, Van Wert, Ohio, which produces the OreTek system. While these types of systems are not appropriate for every practice, they do allow practitioners the option to design their own orthotics. I have had an opportunity to preview the TOM-CAT orthotic design software and find it very easy to use and budget-friendly. I have worked with the OreTek software for many years and welcome the option of having the company mill devices designed with its software. With both of these systems, you can order positive casts that are ready for pressing, or direct-milled polypropylene orthotics that are ready for sanding and covers. In either case, the result is a custom orthotic that is made based on your patient's foot, not a stock library shape. There is a great deal of satisfaction as a pedorthist in fitting your product to your patient and achieving the desired outcome. If you decide to use an outside fabrication lab, go the extra mile to find out exactly how it makes your devices. Ask the lab if it works with your casts in a traditional manner and builds positive casts for pressing, or uses digital technology to create "digital casts," if it uses shape libraries or prefabricated shells. Push your lab to fabricate the best possible product and hold it to the same standards to which you hold yourself. We are practitioners, in practice, learning from every patient every day. Do the work in the "hive" and the buzz will be all about your work-perfect, unique, and lasting. Howard Hillman, CPed, is currently practicing at Signature Custom Orthotics Lab, Brighton, Colorado.

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High Heels a Snap with New Prosthetic Foot

UMich Seeking Volunteers for Upper-Limb Prosthetics Survey

UMich Seeking Volunteers for Upper-Limb Prosthetics Survey

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