Paola Piqueras Fiszman, Luis Fernando Soriano López, Sandra Alemany Mut, J. David Garrido Jaén, José Montero Vilela, Javier Silva García, Alejandro Gamón Sanz, Xavier Andrade Celdrán

Instituto de Biomecánica (IBV) Universitat Politècnica de València (Edificio 9C) Camino de Vera s / n (E-46022) Valencia (Spain)

The Instituto de Biomecánica (IBV) has developed BOXIAL, a 3D scanning system for the digitalization of impression foams and unloaded feet, based on an iPad and a depth sensor. This tool makes it possible to obtain, in just a few seconds, high quality 3D surfaces compatible with the main CAD design software for plantar orthoses. The user-friendly and intuitive design of BOXIAL will help to improve operational efficiency and to automatize the communication between podiatry clinics and the manufacturer, thereby reducing error rates, costs and time.

OBJECTIVE

Although the podiatry sector began using foot scanners over 15 years ago, the implementation of this technology has progressed very slowly. So much so that nowadays only a small number of clinics use foot digitalization systems.

Nowadays, many podiatry clinics still use plasters or impression foams to capture the shape of the subject’s foot, as a preliminary step before creating plantar orthoses. This process is uncomfortable for the subject because it requires time to obtain correct molds, it is invasive, because the foot has to be manipulated, and - particularly with plaster molds - the subject can end up rather dirty. Also, the physical molds that are sent to the manufacturer can break or become damaged during transportation, and numerous errors can occur during the manufacture of the orthoses, resulting in insoles that do not adapt properly to the subject. In conclusion, working with physical molds, as many clinics still do nowadays, can give rise to inaccurate results, and, as it is not an optimized process, it can generate high and ofttimes unnecessary stock and shipping costs.

The objective of BOXIAL is to generalize and accelerate the digitalization in podiatry clinics, in line with the needs for versatility and functionality of many professionals, and to increase the overall efficiency of the process.

BOXIAL is an advanced, versatile and flexible 3D scanning system, specially designed to digitalize impression foams and unloaded feet, generating a high-quality 3D surface of the plantar footprint or the foot in just a few seconds. The resulting file is compatible with software programs used to design and manufacture plantar orthoses.

BOXIAL makes it possible to automate the process of capturing and sending anthropometric information that is relevant to the manufacturers, contributing to a reduction in time and errors from the moment a person requests a podiatry solution until they obtain it, increasing their rate of satisfaction with the services provided by the podiatry clinic. In this way, its use is geared to:

• Improving health care and assistance to diagnosis and prescription by podiatry professionals.

• Modernizing and optimizing the processes associated with the design and manufacture of insoles, currently suffered by companies that provide these services.

TECHNOLOGY

BOXIAL works exclusively with iPad devices, to which a depth sensor is attached. The BOXIAL system, as it is based on iPad, has reduced dimensions and weight, which make it a portable device (Figure 1).

Figure 1. BOXIAL 3D scanning system.

The app is intended to be used by the podiatrist in their clinical environment, being very intuitive and easy to use. The process consists of 3 simple steps.

Step 1. New subject

The creation of a new subject consists of filling in the fields with whatever clinical and personal information may be considered relevant (Figure 2). If required, there is an option to attach photographs as supplementary information. The system automatically integrates the subject’s information with the subsequent scan, thereby ensuring the traceability of the treatments. This is made possible by using digital foot information from the moment it is captured.

Figure 2. New user screen in BOXIAL

Step 2. Scanning

BOXIAL allows for two modes of capture: impression foam and unloaded foot, which means that it is possible to comply with the protocols governing the diagnosis and prescription of plantar orthoses by podiatrists. Also, one or both feet can be scanned.

Figure 3. Guideline images for scanning unloaded feet.

In either of the two capture modes, BOXIAL offers a quick guide to assist the professional during the scanning process, indicating the necessary space, how to prepare the item to be scanned, how much distance should be kept, and the protocol to follow in order to obtain an optimal result. (Figure 3). Once the scan has finished, the resulting 3D surface is obtained automatically (Figure 4), and the user can verify it with 3 different viewing modes.

Figure 4. Resulting 3D surfaces.

The scanning process is completely innocuous for the user, there are no risks or contraindications for their health.

Step 3. Managing the information

The podiatrist can check all the scanning sessions that have been carried out and search with different filtering options (Figure 5). He or she can:

• Generate an automatic report, partially editable, with the patient’s basic information, together with the images resulting from the scan.

• Send a .zip file of any session by email, at any given time.

• Delete the session and

• Send the information of the scanning session and the files to the manufacturer's client and/or order management system without having to leave the application.

Figure 5. Measurement history screen.

BOXIAL is very accurate. The accuracy of the system has been verified by means of a standard foot that has been digitized with a high-precision system, obtaining a reference CAD model. Once scanned with BOXIAL, the standard foot was compared with the reference CAD model. Figure 6 shows a map of the distances between the two. The accuracy is comparable to the current standards of similar products which cost considerably more. In the area of the plantar arch support, one of the most important areas for the design of therapeutic insoles, it can be observed that the surfaces practically coincide, except for a small area with a deviation of no more than 0.5 mm.

Figure 6. a) 3D model obtained with BOXIAL, b) reference CAD model, and c) map of distances between the two models.

CONCLUSIONS

By using the BOXIAL system, podiatry professionals can obtain 3D scans of impression foams and unloaded feet in just a few seconds and can send the result and the prescription to the manufacturer instantly. BOXIAL is a lightweight, portable and easy-to-use system that provides reliable and robust results that are compatible with the standards of CAD design tools. In this way, BOXIAL makes it possible to: 

• Improve patient care by using clean and efficient technology.

• Improve the traceability of patient information, saving money by avoiding the transportation of physical molds, and saving time by not having to deal with all these procedures.

• Automatize the communication processes between the podiatric clinic and the manufacturer.

• Digitalize processes and improve productivity, which will result in cost and time savings for the manufacturer in the design and manufacture of therapeutic plantar orthoses.

This will reduce the error rate and optimize the interaction between the end customer and the manufacturer.

ACKNOWLEDGMENTS

The IVACE and FEDER funds for their support of the project within the framework of the IVACE aid program for R&D projects (project code IMDEEA/2019/18).