December - 20199dramatically change the health and footwear markets over the next 5-10 years. Clinicians, retailers, orthotic labs, and manufacturers are partnering with technology companies to make the transition. Companies like Volumental, HP, TechMed 3D, and OLT Footcare who were all unknown in the footwear and orthotics/prosthetics industries five years ago are some of the companies leading the paradigm shift.Medical professionals and retailers can tap into the mass customization market in many ways. They can purchase scanners, printers, and materials to produce orthotics or custom sandals in a clinic, or they can scan and have a lab produce it for them. An example of a process for in-clinic production (Figure 1) would be: podiatrist scans a patient's foot and uploads the file to a partner company that converts the scan file to a format for printing. The print file is emailed back to the clinician (or accessed through cloud-based software) who then creates a virtual model of the orthotic or sandal, makes modifications in terms of arch height, posting, shell density and then prints it in his or her own clinic. Once started, the printer can print unattended, allowing the clinician to see patients or go home at the end of the day while the printer finishes a job. After printing, the orthotic/sandal will need minor finishing work such as adding straps, top covers, or other modifications. This process, while requiring capital investment and some training, results in more control of the final product, the ability to shorten turn-around time while also reducing production costs by as much as 70 percent. The author is using two printers in the clinic and can print one pair in 2-3 hours which allows for a capacity of 2-3 pairs per day. A clinician could scale up production as needed by adding more printers. OLT Footcare is the only commercially available system currently on the market that the author is aware of using this business model.New technologies are creating opportunities for orthotic and prosthetic labs as well. The ability to produce custom sandals and shoe midsoles is now a reality. Labs can expand their product lines to produce fully customized footwear. They can also serve as a production partner for those who wish to produce on-site by providing materials and modeling/software services to clinics and or retailers.Now clinicians, manufacturers, and retailers all have access to the same technology, and as mass customization becomes more accessible, consumer's expectations will increase. No longer is it necessary to invest large amounts of capital into an orthotic or footwear manufacturing facility. Production can be scaled to any level that is profitable ­ large or small. Medical professionals may choose to be their own orthotic lab or may partner with retailers to offer custom footwear. Some orthotic labs will move into footwear production and/or may provide digital orthotic modeling services that allow clinicians and retailers to manufacture on-site. Retailers will utilize the technologies to create a better in-store experience while also reducing inventory and creating an opportunity for online sales via on-demand manufacturing. Footwear manufacturers will look to build brand loyalty by producing shoes that are customized not only for aesthetics but also for comfort. It isn't to say that retailers and manufacturers will diagnose and treat biomechanical conditions or injuries but consumers win in all of these scenarios because custom footwear will optimize fit and comfort and provide health benefits in clinical and retail settings. Scanners and additive manufacturing (AM) methods such as 3D printing are the enabling technologies for footwear customizationFigure 1: A sequence of customization for sandals. The feet are scanned, a digital model of the feet is created, next a digital model of the sandal foot bed is modelled and matched to a model of the foot and then printed. Finishing work involves laser-cutting a custom outsole then gluing on a top cover, outsole and straps. (Photo credit OLT Footcare)
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