Since the dawn of the orthotics and prosthetics industry, competing interests have forced prioritization to ensure business viability. Here, we dive into the origin of this conflict and present solutions to address them to ultimately maximize the wellbeing of patients.
First conceived in Egypt thousands of years ago, prosthetics have since undergone a tremendous amount of innovation. Belonging to a noblewoman dated to 950-710 B.C.E., the first functional prosthetic was a toe made of wood and leather, as shown below.
More than a toe.
The Egypt Toe has been shown to fulfill important biological functions for its wearer. Not only did it serve a mechanical role by restoring walking abilities, but its semblance to a real toe likely contributed to psychological wellbeing [1, 2].
As sandals were the footwear of choice in Egypt and required a big toe to stay in place, the prosthetic seems to have played a cultural role as well . Whatever the rationale, it was important enough to have it manufactured, custom-fitted and buried with the wearer – it had become part of their identity.
In addition to artificial body parts, other devices exist to restore function and one's livelihood. Known as orthotics, they stabilize and/or guide movement rather than replace a body part. For example knee braces are worn to prevent or rehabilitate an ACL or PCL injury for example.
In the world of orthotics and prosthetics (formally known as the O&P industry), the ultimate objective has indeed been to empower patients functionally and emotionally - to give them autonomy, comfort, and sense of wellbeing and wholeness. In essence, it is to restore their sense of identity.
As the devices evolved over time, their ability to meet the exact needs of the wearer improved. Each patient is unique, and their medical device must strive to be meet this individuality - to be seamless with the wearer. Ultimately, having a device that is continuous with the body and its needs is essential for functionality – visually and mechanically, it strives to restore, not simply replace.
Although an orthotic or prosthetic should be anatomically seamless (i.e. custom-fit), they can in fact differentiate themselves aesthetically from a real limb. While some patients may want them to be as realistic as possible, others could want them to be more creative to capture their lifestyles, character and interests. Many artists and medical professional have now started to manufacture custom limbs with the objective of not only restoring identity, but empowering and augmenting it through fashion.
Medical professionals responsible for this branch of medicine are appropriately known as orthotists and prosthetists. While the wellbeing of their patient is their primary concern, the reality is that the extraneous pressures of epidemiological and economic trends create competing interests.
They are not only preoccupied by the health of their patients, but also by the arts and economics of their trade. They are artisans dedicated to their craft yet need to meet tight quotas to ensure business viability. While patients benefit tremendously from custom orthotics and prosthetics, the manufacturing is a tedious process. Consequently, other features that could add functionality must be sacrificed to ensure business viability.
In summary, meeting business objectives has required that compromises to the functionality and craft be made when making custom braces and prosthetics. This is highly unfortunate as both the patient and clinicians are not meeting their full potential.
Fortunately, this may be lessened, or even disappear, as novel technologies and processes emerge that will unlock greater design and manufacturing freedom.
Breaking the compromise
At Shapeshift 3D, our mission is to create a world where the uniqueness of individuals is embraced and reflected in what we wear. We do so by democratizing mass-customization through a scalable and accessible platform that creates custom-fit devices with no compromise to intricacy and features.
We are betting on a variety of technologies and leveraging them for the ultimate benefit of the patient; these include but are not limited to 3D scanning, 3D printing (aka additive manufacturing or AM), and artificial intelligence in design for AM.
We believe there is an urgent need to solve the compromise faced in the O&P industry and are dedicated to enabling its medical professionals to surpass and distinguish themselves and ultimately to help their patients.
Using 3D printing for orthotics and prosthetics unlocks many possibilities for creating structures that were previously not manufacturable and could be the key to increasing the functionality of the devices. However, although it can manufacture them, the digital customization of products containing complex features remains a complex task - albeit limiting viability and scalability once again.
Making custom the new standard
As discussed with regards to O&P, the customization of products is essential but limits the designer to incorporating features that can be easily morphed to the patients’ body.
Thanks to Shapeshift 3D software and adjunct technologies, this limit is now obsolete. We do not require device simplicity for automated customization, but rather encourage the maximization of functionality and creativity without being tied to limited feasibility.
For thousands of years, O&Ps have cared for patients by restoring their wellbeing. At Shapeshift 3D, we restore the O&P’s ability to do so.
The need for custom goes beyond additive manufacturing for orthotics and prosthetics. As defined by the industrial revolution, we live in a world that requires the standardization of products for economic viability. Yet, there is no ignoring the fact that we are dissatisfied with one-size-fits-all approaches. Over the past couple decades, society has fought against it and advocated for the respect of the individual’s needs and for bespoke solutions. We want to be treated for who we are, not who we are like.
1. Binns, C., Fact or Fiction?: No Big Toe, No Go, in Scientific American. 2007, Scientific American, Inc.
2. Coughlan, S., Oldest prosthetic helped Egyptian mumy walk in News. 2012, British Broadcasting Corporation.
3. Finch, J., The ancient origins of prosthetic medicine. The Lancet, 2011. 377(9765): p. 548-549.