Techmed Talks

The Secret to Accuracy in Footwear: The Dacey Story

August 20th – 2020

Dacey Orthotics Services
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In this episode of the TechMed 3D Podcast, Kate Stern talks with Stuart Rees, the orthotic manager at Dacey Ltd.
Stuart tells us about the secret to accuracy in footwear in your company in Cardiff, South Wales in the UK.

Here is an edited transcript of their conversation.

Kate Stern. I’m here with Stuart Rees, the orthotic manager at Dacey Ltd. Stu is speaking to us from Cardiff, in South Wales in the UK. How are you doing Stu?

Stuart Rees. I’m doing good thanks, Kate. Weather’s a bit cooler today in Cardiff, but all good.

 

Kate Stern. Great to have you here. So Stu, what does an orthotic manager do exactly?

Stuart Rees. Okay, so there’s a few things that I do.

Part of it is running our team of orthotists. We have 15 orthotists who work in the NHS environment throughout the UK, mainly in England and Wales. They see approximately 20 to 25 outpatients per day for products that range from simple insole orthotics to bespoke spinal braces—any device you can think of, really, for the human body. So that’s part of it: managing them, making sure that they’re in their clinics. I think we do about 150 clinical sessions a week, so it’s quite a big number.

The other part of it is running the factory that we have in Cardiff, in South Wales, as you mentioned. So we’ve got a staff of about 120 in total in our Dacey bespoke facility, and we make our insoles, our footwear, KAFOs, AFOs, DAFOs, spinal braces, bespoke protective helmets, anything that you can think of, even the traditional leather devices—we make them all in-house. So basically making sure that processes are in place and the quality is kept to the standard that we want it to be. So quite a varied role.

Kate Stern. Mm-hmm. A lot of moving parts for you to manage.

Stuart Rees. There are. But it’s enjoyable, you know. I’m very lucky, I love my job. I loved working with the patients. I don’t do so many clinical activities these days, but when I was in clinics, I absolutely loved it. Just doing the maths, I think I saw an average of 20 patients per day, 100 patients per week, and really enjoyed it. And equally so, you know, I enjoy spending time in the factory and designing new products and new processes, like the TechMed device.

Kate Stern. Have you had a hand in designing any new products recently?

Stuart Rees. Yes, we have! Since we’ve embraced this technology, we’ve designed our own foot platform, and we’re on the second prototype. So our idea is to have a package, basically like a briefcase, and inside that briefcase, you would have an iPad Mini 5, an occipital structure sensor version 2, pre-loaded with software such as MSoft, and there would be a stand with an adjustable platform—a transparent perspex adjustable platform. So our clinicians would take that around their clinics, and if they need to scan someone for footwear, for an ankle support, you know such as an AFO or DAFO, then they could use that device.

We’re on the second prototype. We were pretty pleased with the first, fortunately, TechMed gave us a little bit of feedback on the first one, and we’re on our second prototype and that should be coming—well, it should be back with me next Tuesday. All going well, we’ll have that on the market in about three months’ time.

Kate Stern. That’s great! Are you using TechMed technology in this prototype or this is a different thing?

Stuart Rees. With this prototype, we don’t need to [build a different thing]. We’ve 3D-printed it; it’s in 24 separate parts and then we bolt it together. That’s one of the great things that we’ve found with TechMed and also with 3D printing.

One of our companies is Orthotix, where we do off-the-shelf products as opposed to bespoke, and if we want to work on prototypes for those—such as thumb splints (like we have in the past), or when we made our own off-the-shelf AFOs and DAFOs—then we just take some scans and we 3D-print them. So the TechMed system is great because it allowed us to do that.

Kate Stern. What else are you doing with TechMed?

Stuart Rees. Well, it’s changed us. It’s changed the way that we work, completely. We’re a very traditional company. We’ve been going since 1972. [It’s a] family-owned company, Dacey Ltd. And a large part of our work are making bespoke footwear— stock, modular, and a lot of bespoke footwear.

We can make footwear for any foot shape and size. Previously, what that entailed was a conversation with a patient which would usually be something like 20 minutes. Then you would reappoint them about a month later, and that would be an appointment for about an hour, where you would take a plaster of Paris cast, and then we would wait for a courier or a Dacey delivery van to come and collect that. Usually, it could be a week or two before that cast even got to Dacey and was poured, so the turnaround on footwear would have been six to eight weeks.

Now, in the clinic, we can do our consultation, we can take out our iPad, take a scan then and there, so we don’t need to reappoint the patient, and then we just email that immediately to our CAD department at Dacey, and they can print out our lasts, which takes about two hours. So that alone shows the dramatic difference that technology such as 3D scanning has allowed us.

And on top of that, it’s worth noting the [difference in] accuracy. As I touched on, I’m very proud of the industry that I’m involved in. However, some of the ways that we do things are viewed as quite old-fashioned.

For instance, if you came in and you needed some bespoke shoes, one of the standard ways of measuring peoples’ feet is to put your foot on a blank sheet of paper, draw around it, and use a tape measure and take some circumferences, and a wooden foot stick, usually, for foot lengths.

Now, that surprises some patients when they come in. Because I think they’re expecting something kind of fancy. You know, if you go to the optician’s, they’ve got the latest technology to assess your eyesight. In orthotics, we don’t really have that. So the difference in going from drawing around someone’s foot and using the tape measure, and the variability that you can get from that [vs. 3D scanning] [is huge].

I’ll just throw in an example, actually. About two years ago, when we first started considering 3D scanning, we did a trial. It was a very basic trial, but we did a trial nonetheless at Dacey. We got 20 orthotists from different sectors—some Dacey orthotists, some colleagues of mine outside of the company, and some NHS orthotists —and we gave them the same scenario.

 

Kate Stern. I love that idea of having your different clinicians measure feet before and after [implementing the new technology]. I wish more shoe manufacturers would do that because I swear their sizes are so inconsistent.

Stuart Rees. Well, that’s true! And that’s one of the reasons, really [for bespoke shoes]: commercial footwear can vary dramatically. With their last sizing, you could have—I’m guessing now—but [maybe] 8 to 10 millimeters’ difference in the widths and the lengths. So we try to get consistency now, and it’s made a huge difference to us. We can turn around more footwear, so it’s allowed us to recruit more staff. And the quality is better.

Kate Stern. What was the process like for implementing this new process, the TechMed scanning method?

Stuart Rees. Well, it was quite an interesting one, because we thought “How can we improve on this scenario where we all have an inconsistency (in what is deemed a very simple device)?”

So I contacted the Welsh government. They were incredibly helpful. They put me in touch with a company called PDR Wales. They do maxillofacial work, so they do 3D scanning, and they’ll print components in lots of different materials to do facial reconstruction. They work with hospitals around the UK. So they were incredibly helpful [as well]. I had a few consultations with those guys, and we tried some different bits of technology to see what worked.

I think it showed me [what] the cost [would be]—because bearing in mind, I’ve got 15 orthotists on our team, and I’ve got to buy one of these devices for each one of them, so I couldn’t afford £10,000 for each orthotist—so within an occipital structure sensor, it’s about £500. We decided to purchase one of those and go down that path.

The next step was to decide what software we would use. So we go to Leipzig—it’s called OT World Trade Event in Leipzig, that was coming up a couple of months afterwards—so we went there, and I went around a couple of the stands, it was probably about four or five of the exhibitors who were dealing with 3D scanning (TechMed being one) and I then went away

“So we ended up working with those guys [TechMed], and the customer support has been second to none, they have been superb. For someone like me, who is a complete layman—didn’t understand the technology at all—they were incredibly helpful. And they still are.”

Fortunately, these guys gave me a short timeframe to trial their product, which was invaluable, and we tried all of the devices, and I ended up coming back to TechMed because theirs just seemed to be not only the most user-friendly, but the most reliable. I found some of the competitors would crash.

And actually the key deciding factor for us was because we were still working in small numbers, we were still only scanning potentially one or two patients a day. [TechMed] did a pay-per-scan, where you could purchase tokens via their website and just pay for what you use. As opposed to some companies which want you to buy an annual license, which can be quite expensive, and it wouldn’t have warranted what we were doing at that time.

So we ended up working with those guys [TechMed], and the customer support has been second to none, they have been superb. For someone like me, who is a complete layman—didn’t understand the technology at all—they were incredibly helpful. And they still are.

They’re currently doing, or at least they appear to constantly be doing updates on their systems, which is wonderful, because they’re just keeping ahead of the game. That’s great because they brief us on it and they give us advice on what we should be doing.

It’s also worth noting we don’t just use it for the footwear here. Dacey is broken down into three companies.

So if I just tell you a little bit about those: We’ve got Dacey Bespoke, which is what I manage. Our MD is a chap called Bob Cooper, so we work alongside Bob and manage that side of the company.

We’ve got another company called Orthotix, which is an off-the-shelf product company, which is fantastic, because a large percentage of the population don’t need bespoke items, you know, because they’ll just fall within the small-medium size bracket. So that’s a company that we started about 15 years ago, and it’s just grown exponentially, because e-commerce means people can just buy our products from around the world.

And as I touched on, if we’re working on new prototypes, we can scan for those, 3D print them, and trial them, and fortunately we have great feedback because of our orthotists on-site.

And then the other side of our business is the podiatry side, Ace Feet in Motion, where our podiatrists deal with people from all walks of life. So we have people who just book their appointments and they come in because they’ve got problems with flat feet or achilles tendons and such, but they also deal with high-end sport, so they deal with the Welsh rugby team, Cardiff City athletics, some of the premier league players. So we get to trial on some of these people. It gives us great insight into the products.

And they [the podiatrists] use the scanner on their insoles. If you’re coming in as a private patient, you want a good service. You don’t just want to put your foot in a foam impression box to get a pair of insoles. It looks far more professional when they come into our gait lab—we have a two-meter gait lab—they can do their walking, they can do their running; and then after that we take a 3D scan of their foot, and then we make their insoles, which are commonly referred to as, you know, FFOs or orthotics. We make them on-site their while they wait. 3D scanning has allowed us to do that. So that’s a huge improvement for the industry. And it offers some great potential advancements for the future.

I think for what we’re using it for, it’s probably quite basic—making footwear, making lasts. There are other companies—Crispin Orthotics, in particular—who are far more advanced than us. They’re going a stage further, where they’re 3D-printing actual devices, their AFOs and things, and then selling them to the consumer, and their bespoke helmets. (No pun intended.) I take my cap off to those guys. What they’re doing is incredible. It’s great for the industry. It’s great for the patients.

I think it’s encouraging more people to come into the industry as well. You know, there was a national shortage of prosthetists and orthotists, which is what we are—we train as prosthetists and orthotists, and then at the end there are some opportunities where you can dual-role, you can do both, but most of the time you choose whether to be an orthotist or a prosthetist.

There has been a shortage of people coming through, because most of the time people just don’t know about the industry. Maybe it’s just not “sexy” enough for people to want to come into the industry and do that.

But with this new technology, I think it makes it exciting. You look at the advances in prosthetics: the carbon fibers, the titaniums, it’s improving the function of the prosthetics and it’s also improving the weight. With the 3D scanning as well, it will bring more people into the industry, which is only a good thing.

Kate Stern. So it sounds like the whole process went really smoothly for you, of implementing the 3D scanning?

Stuart Rees. It was really easy, yeah. Well—it was really easy once we started using TechMed. I know that sounds like an advert for TechMed, but it was.

When we first got it, I bolted on the exhibital structure sensor—myself and our operations manager, a chap called Kerry Bogdon—and we tried using the software that was what we were supposed to use, at the beginning, and we just couldn’t use it. We thought “Is it our incompetence, or what?”

But then once we downloaded the TechMed [software] and the alternatives, we got the hang of it very quickly. We’re talking 30 minutes—as quick as that. It was quite easy.

The difficulty is because we’re trying to scan 360 degrees of a foot at an angle, it’s an awkward thing to capture. If we were going to do a scan of a torso or a head, you can have someone standing up or sitting down and you can walk around them to capture those body parts.

We want a semi weight-bearing foot, so that’s why we designed our own platform. It’s called a Platformed. Basically, the foot can be positioned on it, and with the transparent perspex, it allows us to get underneath with the scanner and then go around the foot and the ankle and capture the 360 degrees.

“with TechMed… we would just scan, and it would capture, and it was done. We found the accuracy in our footwear improved dramatically.”

I think that’s where TechMed came into its own: when we were trying the competitor’s software, it was fine when we were just capturing the top of the foot, but as soon as we wanted to go to the underside, in that transition from plantar to dorsum aspects of the foot, it would just kind of crash. We’d lose the scan, and then we’d have to start all over again.

Which isn’t a nightmare, because you know, we’re talking 30 seconds here, as opposed to a lot longer taking casts, but we never had that with TechMed. We would just scan, and it would capture, and it was done. We found the accuracy in our footwear improved dramatically.

When you make footwear you always add a little bit to the last anyway. You don’t just take a scan and then make the footwear to the exact scan, because your shoes are going to be too tight. Usually you take your scan, you add a particular amount of measurement to the end to give space for the toes, and if you’re having an insole in there as well you have to add space for that to the last. So we tried a little of that but that didn’t take long to get right.

Kate Stern. Great! Well, I want to note that Stu is not being compensated for this in any way. [Stu laughs in agreement.] He has volunteered as a TechMed customer to do this interview… Thank you so much Stu, it was great chatting with you.

Stuart Rees. Thank you very much Kate, I really enjoyed it.

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