Phits 3D printed orthotics.
Ever since I was around 10-years-old and measured for a new pair of back-to-school Hush Puppies, I have been very aware of my lack of arches and rolling ankles - otherwise known as 'flat foot'.
Fast forward 17 years, my mother, similarly cursed, recently returned from her doctor prescribed with some run of the mill size-six orthopaedic insoles dug out from a pile in her doctor's desk and some advice for me to take heed of. Hardly the story I had in mind when I envisioned a piece inspired by my mum who has more pairs of shoes than an average Clarks store but in an attempt to avoid the same fate, I started to look more closely at orthotics. Orthotics are devices worn in the shoe to correct foot and ankle problems. Similar to how a problem in the ear often comes hand-in-hand with symptoms in the nose and throat, any misalignment or abnormality in the foot can result in issues with the lower limbs all the way up to the knees, hips and lower back. Devices range from standard off-the-shelf insoles all the way to highly customised devices made from patient specific data.
Technavio's market research predicts that the global foot insoles market will grow at a CAGR of close to 7% between 2017 and 2021 and 3D technologies will play a significant role in that. That's because companies like Podfo, Wiivv and RS Print are exploiting the creative freedom these technologies offer to deliver data-driven customer-specific insoles, which fit more accurately and deliver better patient outcomes.
For comparison, I started my search with a pair of over-the-counter insoles from a high-street store, a mid-range pair costing around £30. They were relatively comfy, seemed to do the job, but just didn't fit properly and after a few days of wear, the insole itself began to move around and cause mild pain.
The right Phit
I decided to pay a visit to Ruth Partridge, Chartered Physiotherapist BSc (Hons), MCSP at Conwy Physio Clinic in Wales to find out if 3D printing could be the answer. The clinic specialises in physiotherapy and sports injury and is one of only a handful of healthcare providers in the UK which offers custom 3D printed orthotics by Phits, the high-end solution from RS Print, a joint venture between rs scan and Materialise. The clinic has been offering footscan technology since 2014 and as the only facility in the area to do so, has found itself a niche in providing to everyday patients, sports enthusiasts and the area's rambling community alike.
"It gives us more strings to our bow," explains Ruth. "We can offer more services, people will call up specifically for a foot scan or orthotics and of course if we're here, we're assessing someone for something else we can deal with it rather than having to refer them elsewhere, so it does give us a broader spectrum of tools."
Personalised correction is printed into the lattice structure.
The process begins with a physical assessment to determine levels of flexibility and stiffness along with a few lifestyle questions to ensure you're getting the right solution whether you're an avid runner or on your feet all day at work. As an editor, most of my day is spent sat at a desk so no specific running shoes were required but I did report some mild knee and lower leg pain.
Most people's feet will fit into a standard shoe size but it's unlikely both will be dynamically identical and, as it turns out, I am no exception. My left foot is much stiffer and would therefore require a different level of correction compared to the right.
The scan process takes around 20 minutes. First, the patient stands on the footscan mat which gives dynamic pressure measurements using sensors measuring at speeds of up to 500 Hz. The patient then walks back and forth across the mat to get an accurate gait analysis reading. It takes a few attempts to capture enough images of each foot in to get an overall digital profile. This provides information about pressure points, which part of the foot you are landing on when taking a step, if you're showing any signs of excess pronation, and so on. This data is then instantly available for the therapist or practitioner to view on screen where they can then create a pair of customised insoles tailored to the scan information in a simple design wizard. The insole is then ordered for manufacture and can be delivered to the patient in two weeks for 199 GBP.
"It's easy enough to run the foot scan and then when you go through the design it's quite intuitive," Ruth adds, noting the ease of adopting the technology into the clinic. "It's like anything, once you get used to the flow of it, it's really simple."
Dynamic footscan data is used by the clinician to create the orthotic.
First steps
The technology was first developed in the 1980s by rs scan founder Jempi Wilssens, a record-breaking athlete and engineer who wanted to help people to stay injury free. The first scanner was built from a modified photocopier and installed inside Wilssens' small sports shoe store in Belgium. By 1994, at the request of Adidas' CEO who wanted the company to be the first sports brand in the world that could advise an injury-risk-free shoe using foot measurements, a new foot scan system was developed. As commercial interest grew, so did clinical applications, and as a result in 1998, rs scan International was established.
"[Wilssens] understood the necessity of orthotics, when a shoe wasn't helping enough or wasn't the right fit, so he created an insole based on an algorithm which he got from the foot scan data," explains Tom Peeters, Brand Manager Phits Insoles. "It was a good insole, scientifically proven by the British Navy, and he wanted to digitise the complete process and came across 3D printing. He started experimenting but pretty soon found out that to scale and make this economically viable he would need a very solid partner to make it happen and that's when he coincidentally ran into Materialise in a research project which resulted in the first R&D of 3D printing for orthotics."
The two formed RS Print in 2014 which led to the creation of Phits. The company has since served around 30,000 people with custom insoles worldwide from manufacturing facilities in Europe and North America. Phits' orthotics take the form of a lattice structure which are manufactured using selective laser sintering and PA12 due to its strength and durability. This means devices can withstand the forces of daily wear and also last much longer than traditional insoles usually milled from rubber or cork. They also look a lot sleeker and if the fabric cushioning on top begins to wear after a few years, patients can simply have it recovered without having to have their correction re-produced.
Insoles printed with SLS in PA12.
"It makes the orthotic a lot more compact and lightweight, you don't have the bulk of an insole that's been made by hand," Ruth explains. "A lot of the correction is printed into the device, so it becomes easy to fit it into people's shoes and that increases compliance because it's all well and good putting an insole in but if they are not going to wear it because it doesn't fit into their fancy shoes, you might as well not bother. From an orthotic perspective that's the major perk really and is largely why we changed because we were getting feedback whereby the handmade orthotics were just lifting them too far out of the shoe. For example, if you've got correction built in through the heel, your heel can end up slipping out. You don't get that with the 3D printed ones because they're nice and slim."
Phits has identified three core markets; healthcare, sports, and workwear. Inspired by the sporting activity in some of their most popular territories, the company has developed insoles specifically for sports such as skiing, cycling and golf. Cross country skiers, marathon runners, pro cyclists and beyond have already benefitted from these devices and that can only continue to grow as demand increases.
"Every one of these specific applications has its own unique specifications and different characteristics," says Tom. "It's about understanding the need and the specifications and then characteristics of certain movements of a certain sport or activity."
Moving forward
Other major players like HP are seeing the value and last year the tech giant launched its FitStation platform with over-the-counter insoles manufacturer, SuperFeet. The plan is to provide an end-to-end solution for the scan to manufacture of custom insoles with its HP Jet Fusion Technology and the technology is already being adopted by the NFL. Going one step further, UK-based engineering solutions provider, KW Special Projects recently teamed up with orthotics manufacturer Podfo and Newcastle University to create a 'while you wait' service for personalised 3D printed insoles. Part funded by Innovate UK, the overall goal is to create a functioning process by early 2019. In a recent release, KWSP's Managing Director Kieron Salter noted the potential for the technology to reduce time and development cost in producing orthotic whilst also giving clinicians a new tool to facilitate accurate on-the-spot measurement.
3D printed orthotics are tailored to individual footscan data.
These developments, whilst signalling a technological change, also point to a shift in business models. Tom sees two possible tracks; small and medium podiatrists who will install the scan technology in house, and also larger orthopaedic groups transitioning towards 3D printing.
"These large prosthetics groups really want to start thinking about how they can transform from traditional manufacturing to a completely digitalised process with 3D printing," explains Tom. "Of course, we want to produce orthotics but it's not our purpose. Our purpose is offering the technology, the tools to provide orthotics and whether we print them and service these individual practices or we service and support the larger groups with know-how and guide the transition, we know it is coming. It is something we need to embrace, and we need to be ready to guide these people into the next level of manufacturing to a more durable and more environmentally friendly process."
But most importantly, do these devices actually work? I've been wearing mine for several weeks now, building them in gradually starting with only a few hours each day. They are comfortable, robust, fit perfectly and I can't be sure if it's too early to tell yet but the pain I was experiencing in my knees and lower legs has disappeared. Unlike the off-the-shelf pair which felt bulky and harsh, these fit discreetly and are even personalised to the point of including my name within the print - a non-functional touch but a nice example of the benefits of mass customisation.
Working within this industry, I sometimes take for granted that the technology applications I see every day, whether 3D printed orthotics or medical models, are not commonplace. When I returned from collecting my insoles after a brief test walk along the Conwy harbour, I showed them to my mum. Had these technologies been readily available at the doctor's office, there is no doubt that the benefits would have outweighed the cost. Perhaps as adoption and accessibility increases within the healthcare sector, more people will be able to reap those benefits too.
