TOM-CAT™ Scanning vs. Casting
Temple University has completed a comprehensive study to compare differences between TOM-CAT™ scanning technology and traditional casting methods for foot orthotics. The study included a partnership with SOLO Laboratories to provide the cast analysis of both the plaster casted orthotics and TOM-CAT scanner. The goal of this article is to give physicians a more objective assessment of TOM-CAT™ scanning technology and how it compares to casting methods used to create custom molded orthotics for their patients.
This study was performed and written by Howard Palamarchuk, DPM and associate investigators at the Temple School of Podiatric Medicine.
Temple University Abstract
Introduction:
When casting for custom molded orthoses, physicians are often faced with many options in obtaining a negative impression. The overall goal of orthotic intervention is to correctly portray the contour of the foot (arch height as well as rearfoot and forefoot width), and especially the forefoot to rearfoot relationship, while stabilizing the foot and subsequently the lower extremity during gait. With the direction of our profession moving toward electronic medical records (EMR) and physicians moving to maximize their patient interaction and de-emphasizing time with often untidy plaster, it is important to re-visit the prospect of alternative means for preparing custom molded orthoses.
Orthotic treatment is based on an understanding of a complex coupling of rotation of the lower extremity with pronation and supination of the subtalar joint. Successful treatment with orthotic shoe inserts is dependent on careful evaluation of the patient, obtaining the most accurate impression of the foot, and milling of a properly fitted orthosis. The primary objective of this pilot study is to compare plaster casting impression versus topographical scanning methods prior to milling orthoses. The secondary objective is to optimize an established protocol for use of the TOM-CAT™ topographical scanner to provide the best possible patient outcomes. This is the first study to critically compare neutral position plaster casting with topographical optical scanning in a prospective trial with implications for further evaluation of static and dynamic gait parameters.
Methods:
Drawing attention to two methods of creating a custom molded foot orthosis, a three dimensional computer generated model (TOM-CAT™ - Total Orthotic Measurement by Computer Aided Topography) was compared to the current gold standard of plaster casting. A blinded prospective cross over cohort study was created to give physicians a more objective assessment to support the use of either modality of obtaining custom molded orthotics for their patients. Thirty subjects were scanned and cast with the products being sent directly to SOLO® Laboratories (Kutztown, PA) for fabrication of the devices. Each scan and cast was coded and randomized with a standardized numbering convention. All subjects were cast and scanned by experienced podiatric physicians with greater than 10 years of experience in podiatric orthopedics and sports medicine as faculty at the Temple University School of Podiatric Medicine (Philadelphia, PA). A vernier caliper (accurate to 1/100 meter) was used to precisely measure orthotic length, orthotic width (forefoot/midfoot/heel) of positive casts obtained. In comparing collected data, an un-paired Student's t-test was utilized where significance was established to a p value of less than or equal to 0.05.
Results:
Results show that there is no statistically significant difference in the dimensions of orthoses milled from plaster or topographical scanning modalities. (p values < 0.05) The current study performed an objective review of the custom molded orthoses milled from plaster and those that were scanned using the TOM-CAT topographical scanning system. No statistically significant difference in the physical dimensions of the Solo Laboratories custom molded orthoses was observed. Areas of further research will utilize the current experimental model and incorporate statistically valid subjective parameters to measure patient satisfaction in order to perform a more detailed comparison between the two modalities. Further, static and dynamic gait parameters will be measured and correlated to biomechanical / kinematic outcomes. Lastly, the authors will perform a detailed cost analysis to determine which method is more fiscally preferable. With the combination of subjective and objective data, a comprehensive analysis of the two methods of obtaining orthotic impressions will be achieved.
Of note, future research will more than likely involve a collaborative multicenter trial to include representative faculty from Temple University Foot and Ankle Institute Gait Study Center.
For more information regarding this study please visit: www.sololabs.com/temple
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SOLO Labs operates a state-of-the-art manufacturing plant that couples the latest in computer driven technology with the personal hand-made care of skilled craftspeople. We take health care providers' prescriptions and faithfully build quality products that combine the prescriber's skill with ours to the benefit of the patient.
Our latest innovation is the TOM-CAT™ Computerized Foot Scanning System. This high-tech device eliminates the need for messy plaster casting in orthotic prescribing, saving time and money. To learn more about the TOM-CAT™ system, visit www.tom-catsolutions.com.
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