“Making top products faster and more efficiently”

Hempel GesundheitsPartner GmbH based in Berlin, Germany, has been using the diabetes module for Bodytronic ID:CAM for a number of months now for making milled orthoses that are used as the basis for the diabetes-adapted cushioning of the feet. The free online application offers benefits for suppliers and patients alike.

The Bodytronic ID:CAM system offers great advantages for making diabetes-adapted foot orthoses,” says Torsten Awe, master orthotist at Hempel GesundheitsPartner GmbH. “The online application makes for a much faster and more efficient overall process than before, and it allows for made-to-measure premium products with a top level of precision and quality.” He knows what he is talking about. As the head of the department for orthopedic shoe technology, he has been taking advantage of Bodytronic ID:CAM since early 2018 to shape milled orthoses, and since the fall of 2018 he has been using the “electronic last” for making diabetes-adapted foot cushioning.

Five days instead of two weeks

The specific practical benefits of the diabetes module for the Bodytronic ID:CAM online application are obvious to Torsten Awe: “It could easily take over two weeks to make foot orthoses in the past ,” the 45-year-old explains. “With Bodytronic ID:CAM, our patients now receive their diabetes-adapted foot cushioning within five working days. Once we have gathered all the data, the shaping itself is a rather quick process. The milled Bauerfeind orthosis arrives within 48 hours, or often even on the next day. It is then joined to the shoe and adjusted. Thanks to the high degree of precision, this is also a rather quick process.” The whole process has therefore become faster, simpler and less complicated. “It is significantly less effort for us now,” says Torsten Awe.

Absolutely necessary: identifying the foot status

Of course, the strong acceleration of the process is also beneficial for patients such as Michael Kenzler, who is now supplied with his individual made-to-measure full foot cushioning much faster. The 38-year-old is an insulin-dependent patient with type 1 diabetes. He suffers from minor sensitivity deficits in his left foot and an arch decreased/splay foot on both sides. He currently wears protective shoes with a foot orthosis with soft cushioning. Today he is picking up his first diabetes-adapted foot cushioning based on ErgoPad ID:Diabetes. At the start of the treatment process, Torsten Awe examines the foot status with regard to lesions in the form of pressure sores and he performs a surface sensitivity test. The next step is a 2D scan of both feet bearing the full body weight while standing up. This scan shows the current pressure load in detail. The 2D scan data record is the first part of the data required for shaping with Bodytronic ID:CAM. The second data record comes from the 3D scan of the foam imprint that was then made under partial load. This scan is preferably made using the Pure hand-held scanner by Rothballer, but other technical solutions are also compatible. All data is simply imported into the Bodytronic ID:CAM application via the plug-in buttons. Optional additional data of the insole or from further foot pressure measurements can also be uploaded here.

A high-precision product

Production of the customized milled orthosis can begin once all relevant data has been fed into the online application. First , the orthosis category “Adapted for patients with diabetes” is selected, and then the user chooses between the Advanced or Professional editing profile. The pre-design and the general shape of the foot orthoses is selected under the tab “General”. The technician then chooses the material and specifies the shoe size and the length of the foot orthosis. The position of the lowest points must now be defined in the 3D model. “The size of the insole can still be individually adjusted, to allow for the cushioning to be fit precisely into a wide range of different shoe types. This is another great advantage of the application,” explains Torsten Awe. In addition to this, it is also possible to specify the edge thickness in 1 millimeter increments. This allows for cushion layers to be applied more precisely. The same is true for the option “Cover allowance”, where the base layer is calculated based on the selected material thickness of the cushion layer, to ensure that the shaped and the calculated surface topography continues to provide for the desired full foot cushioning and thus for the best possible redistribution of pressure. The cushion layer and top cover are selected before this step. The user can choose their own materials or opt for one of the Bauerfeind combinations of Vepur, Poron and Lunairmed specified in the system. For Michael Kenzler’s foot orthosis, Torsten Awe chooses a combination designed by his company with a microfiber top cover – marking the end of the entry process. He is now able to send the order directly to Bauerfeind, where the foot cushioning is milled with a precision of a hundredth millimeter using state-of-the-art technology and delivered within no later than 48 hours. Finally the cushion layer and top cover are applied in the workshop, and the foot orthoses are fitted into the patient’s shoes. Good to know: the production of diabetes-adapted milled foot orthoses using the Bodytronic ID:CAM system and electronic lasts is usually accepted by the health insurance funds, subject to a quotation. It should be explicitly mentioned in the quote that “electronic lasts” are used.

Expertise as a basic prerequisite

The diabetes module of the online application may take just a few steps and may be easy to operate. However, the orthotist’s expertise and technical experience is still a basic prerequisite for manufacturing diabetes-adapted foot cushioning. After all , the technician does not only have to competently assess the foot and to identify any problem areas. They also must choose a suitable blank and optional cushion layers and top covers and decide which specifications are best suited for the case at hand. Their know-how is just as crucial later on, when the foot orthosis is fitted into the shoe and when making the final adaptation for the patient. One thing is certain: the perfect diabetes-adapted foot orthosis along with all the advantages for the supplier and the patient is only possible if great expertise is combined with the digital system solution.
Another benefit of the online application is the fact that all saved data is available for future treatments and for documentation purposes. This is how Bodytronic ID:CAM ensures full reproducibility and allows for identical foot cushioning to be produced at the push of a button.

Free storage space thanks to outsourcing

Digital foot orthosis production is also worthwhile for suppliers with regard to their own machinery. The online application makes their own expensive and high-maintenance milling machines redundant. The orthoses are shaped on-site, but the milling takes place at Bauerfeind’s premises. This means that precious space will be freed up, also because it is no longer necessary to keep pallets full of raw materials in the storage area. “We are going to phase out our two milling machines in the future, and to handle all milling work for foot orthoses via Bauerfeind,” says Torsten Awe. “The system works smoothly, there is no need to buy expensive software, and we are even able to use the technology on the go, when we visit our patients.” The introduction of Bodytronic ID:CAM has been a complete success for Hempel GesundheitsPartner GmbH. “It’s all in all the ideal solution for milled orthoses, and for diabetes-adapted foot cushioning in particular. Everyone involved benefits from the system even now, but it is also going to pay off on the long run,” explains managing director Andreas Hempel (see box).

Images: Bauerfeind, Thomas Lebie