In this episode of the Podiatry Legends Podcast, I’m joined by returning guest Kieran Carew from www.foothealthorthotics.co.uk FIT4, to explore one of the biggest shifts currently happening in podiatry: 3D printed orthotics.
Kieran was last on the podcast back in 2020, discussing pathology-based orthotics. Fast forward to today, and he’s now deeply involved in developing, testing, and installing 3D printing systems in podiatry clinics worldwide.
This episode is not a sales pitch for technology. It’s a practical, honest discussion about what’s working, what hasn’t, and what podiatrists need to understand before adopting new systems.
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From Engineering to Clinic Reality
Kieran shares how his background in mechanical engineering and sports science shaped the early development of in-clinic 3D printing. One of the biggest lessons? Technology alone isn’t enough.
Early systems required excessive manual calibration and technical input, creating frustration for busy clinicians. The breakthrough came when podiatrists’ feedback directly shaped the next generation of printers, resulting in plug-and-play systems designed specifically for clinical environments.
Control, Cost, and Turnaround
One of the strongest themes in this episode is control.
Kieran explains how clinics are reducing orthotic production costs by lowering lab fees from £120–£150 to as little as £10–£12 per pair when designing and printing in-house. Even when clinics outsource the CAD design, the cost savings and turnaround times remain significant.
This isn’t just about saving money. Faster turnaround means better patient experiences and fewer delays in care.
CAD Design and Education Matter
A recurring message throughout the conversation is that education is essential. 3D printing is most effective when podiatrists understand biomechanics, design principles, and material behaviour.
Kieran explains how CAD software gives clinicians full control over orthotic design, including infill density, flexibility, and targeted accommodation based on pressure data. This level of precision simply isn’t possible with traditional workflows.
The Marketing Advantage of Visibility
One of my favourite parts of the discussion is how 3D printers can become a visual asset in a clinic.
Placed in reception areas, printers spark curiosity, conversations, and social media sharing. Clinics using visible technology are seeing increased patient engagement and higher orthotic uptake, simply because patients can see innovation happening in real time.
I have a coaching client who installed a 3D printer in their reception area, which immediately generated curiosity, more orthotic conversations, and an increase in monthly orthotic numbers.
Is This the Future of Podiatry?
We also talk about the broader industry shift.
Rising lab costs, staff shortages, and clinic pressure are pushing podiatrists to rethink traditional models. 3D printing isn’t a trend; it’s part of a broader shift toward efficiency, ownership, and smarter systems.
Considering Your Next Step
If this episode has you thinking differently about orthotics, systems, or clinic workflows, you’re not alone. These are the exact conversations I have with podiatrists through my coaching and mentoring work.
There’s no one-size-fits-all solution. The goal is clarity.
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PODCAST TRANSCRIPT (unedited)
Tyson E Franklin: [00:00:00] Hi, I am Tyson Franklin, and welcome to this week’s episode of the Podiatry Legends Podcast. The podcast designed to help you feel, see, and think differently about the Podiatry profession. With me today, it’s Kieran Carew. Now. He was back on, we worked out July, 2020, was episode 93, and back then the episode was titled Pathology Based Orthotics.
Today we are gonna be talking about 3D printed orthotics. ’cause Kieran has his own 3D printing business FIT4, he’s been doing this since 2019. It saving clinics with revenue and control over the orthotic turnaround.
So Kieran, it’s great to have you on here. I bumped into you at the 2025 foot and ankle show.
Kieran Carew: That’s right. Yeah, it’s been a while, Tyson, since we spoke originally, it was, as I said, 2020. So a lot has evolved since then.
Tyson E Franklin: Yeah. And when I saw you at the Foot and Ankle show, and I saw you had your own 3D printers there, and I’ve got coaching [00:01:00] clients in Australia and overseas, and everybody is talking about 3D printing at the moment because I know you and I know you have your own 3D printer.
I thought I’m gonna get you on here to talk about this whole process. You could explain what you’ve done, your journey of putting it all together and hey, yours might end up being the best one in the world, then everybody can get it from you. And I’m not being paid to say that, so I just thought I’d point that out.
Kieran Carew: Excellent. Thank you. Tyson. I suppose to when we originally spoke Tyson back in 2020, we had just embarked on the research for developing the 3D printing system to go into clinics. And obviously when the pandemic hit was a bad thing for everyone, but it was pretty good for us because it gave us time to actually work on the 3D printing system.
And at the time we were sponsored and funded by Innovate uk.
Tyson E Franklin: Okay.
Kieran Carew: And Innovate UK teamed us up with different engineering colleges and universities in [00:02:00] order to do the research and development. So along the way, we have tested many printers, many FDM printers, I should say, that would work best in the clinics.
We’ve gone through the development process of our softwares and things, and then we went through clinical trials and what I was saying to some of our colleagues, I mentioned to you earlier before we jumped on there. We had a journey of learning ourselves because we took it coming from the engineering background that this was going to just operate quite easily inside in the clinic and there’s going to be no issues.
But what we actually did was we brought two different worlds together, the engineering world and the medical world, and when you often put two worlds together. Little cracks and issues appear up because we took it from our side. Very easy to operate printers.
Tyson E Franklin: Yeah,
Kieran Carew: very easy to design orthotics, but unfortunately, a lot of practitioners didn’t even know what a 3D printer was.
So when we went out there and we started supplying printers to clinics, the earlier [00:03:00] printers had more kind of input required from the practitioner. They needed to be manually calibrated. Now, for our team, that is very easy. They have more control over what they’re doing, but we found in some clinics, the clinics struggled with the calibration.
And if you get poor calibration. It ends up with a very poor quality of orthoses..
Tyson E Franklin: When you’re talking about the calibration side of things, you’re meaning it has to be a, like it has to know where the start point is to begin. Correct. When I used to have milling machines where we put the block of EVA material in there and to get milled out, and we had to go through the same process when we were changing drill bits, if something broke or something happened,
Kieran Carew: yeah,
Tyson E Franklin: we had to recalibrate it.
And sometimes it was easy, sometimes it wasn’t.
Kieran Carew: That is exactly what it is. And you’re also looking the distance of the nozzle where the filament, the materials come out had to be a certain distance from the print bed. Okay. So it was quite a challenge for some practitioners [00:04:00] because practitioners, someone from had in their mind I just plug in the printer, hit print, walk away, come back, and the orthotic is there and
Tyson E Franklin: that’s the way it should be.
Yeah.
Kieran Carew: And that wasn’t the case in the early days.
Tyson E Franklin: Yeah.
Kieran Carew: So as technology evolved, it has now gone to the stage where the printers are that we have, are pretty much plug and play. So we formed a partnership with a company called pcra. And PCRA are a global manufacturer of 3D printers. So they do a large range.
So basically we gave them our wishlist. And our wishlist was where we took down, comments from practitioners that we’re working with. What they would like to see is improvements. Okay. And we gave it to this company and said, look, can you put this into your printer and see if you can improve it for us?
So they developed a printer then with us, which is called branded. And basically we have all calibration and pretty much the feedback we’re getting from clinics now that we have the printers with, is that the printer is pretty much plug and play. So that then led us to the next [00:05:00] site, CAD designing.
Tyson E Franklin: Yeah,
Kieran Carew: so when it comes to designing orthotic, obviously a lot of practitioners were trained in the manual way draping. The cast or vacuum forming are often grinding. So when you’re visualizing something on a computer screen and doing 3D CAD design. It can be different. So it, there was a learning involved with that as well.
And what you find even at Tyson is with different softwares, some softwares are made so basic, they’re modular based, so it’s for ease of operation. But the problem is you’re often getting more of a library type of orthotic. Whereas if you use a proper CAD software, yes there’s learning involved, but it does give you.
Complete design control, which is a big thing. And I keep saying to clinicians, the key thing here is if you are investing your hard to earned money in technology that’s going to, in that you’re basically investing in your clinic and you’re investing to reduce your overall costs and prove profits well, you have to be willing to take the time.
[00:06:00] To learn how to use the technology and understand the technology. So it’s investment in cash and investment time initially to learn all this?
Tyson E Franklin: Oh, definitely. Yeah. It was no different when we had the milling machine. Yeah, we had the milling machine installed.
Kieran Carew: Yeah.
Tyson E Franklin: And I wanted to know how to do the design part so a patient could come in, we could do the scans, we could do the design, we could get it milled, we could finish the product off and do that process really fast.
So what do you prefer? When you install a printer into somebody’s clinic. Yeah. Do you prefer them to learn how to do the CAD design as well, or do you prefer to do the designs for them or they just have a choice?
Kieran Carew: Do you know what it comes down to? Really business. Yeah and when I say business, it comes down to what’s makes business sense for a clinician.
Because to design a set of orthotics when you get used to CAD design, can take you 10 or 15 minutes. But what I look at is could you have a nail surgery done in that period of time where you might earn, [00:07:00] I don’t know, two or 300 pounds?
Tyson E Franklin: Yeah.
Kieran Carew: So you can save maybe 20 pounds on a cab design and cost yourself.
Maybe 200 pounds or 300 pounds. So we give the options to clinicians, what they would like to do. If you want the full process where you have full control, you scan, you design yourself, and you print yourself. You have that option. You can also send the scans to us as a laboratory and we can design. And send you back the file.
So you, all you have to do is put in the printer. And in a lot of cases when that happens, it’s the admin team or the receptionist that’s dropping the file on the printer, so it’s not tying up the time of a busy practitioner.
Tyson E Franklin: So
Podiatry focuses on being a Podiatry, seeing the patients, doing the evaluations, filling in the script on what’s required, and then moving on to the next patient, and then just letting that orthotic process happen with other people.
Kieran Carew: Yeah, that’s it. And as a matter of fact, I was speaking to a practitioner last night. He has purchased two printer’s office over [00:08:00] the last 12 months and he used to be a lab owner and I believe he was on your podcast some time ago. Clifton Bradley from Sub four.
Tyson E Franklin: Oh, yeah. Yeah.
Kieran Carew: Yeah. And he mentioned to me, he said Kieran, he said, since I put this in here, he said the cost saving is massive because said the biggest problem when I had my lab was the cost of staff.
That continues turnover of staff in finishing the orthotics.
Tyson E Franklin: Yep.
Kieran Carew: And he said, I, when I sold off my lab and I went back into the clinical side, which I think he always did, clinical side anyway, he said, the big thing I was looking at is what I was paying on LAB fees. So he said by putting in the actual printers, instead of paying lab fees of maybe 120 to 150 pounds for a pair of orthotics, he said, I can literally print my orthotics for about five and six pounds.
So sometimes what he’ll do is he’ll send us the designs if he’s busy and we’ll design the athletics. So his cost is slightly higher, but he’s still a good 70 to 80% saving on what he was paying the lab. Plus the [00:09:00] turnaround is a lot quicker.
Tyson E Franklin: , I can see it from both sides.
I, I think it’d be great to know how to do the CAD design yourself, because you may get that patient that’s come in. You need to do something urgently and you want to get it done and get it out, and then at other times I can see the benefits of be seeing the biomechanical patients,
doing the evaluations and let somebody else do the design. So how much can I ask? How much is the lab fee if you’re doing the design?
Kieran Carew: Yeah. If we were doing, if we were doing this design for someone, we charge 25 pounds plus VAT. So you’re looking at your cost of productions about maybe 35 pounds in total to print your orthos.
Tyson E Franklin: Okay.
Kieran Carew: Now, if you design yourself. If you design yourself and print it yourself, you’re looking at your cost is gonna be somewhere around 10 to 12 pounds. Okay. So it’s a trade off depending on what you can be treating in that time. That’s what I’m saying. If you were doing a nail surgery in the time it takes you to design an orthotic, you have to work out which is going be more viable for your business.
Tyson E Franklin: And if you were working that out, like in Australian dollars is like [00:10:00] 70 bucks to get a pair done if you were doing the whole thing for them. And that’s including the cost of them printing it as well.
Kieran Carew: Yeah, and that’s it. So, but I do agree with you, Tyson. It’s good to understand how to design.
Tyson E Franklin: I think
Kieran Carew: so. And I think by understanding how to design, I think makes practitioners also more aware of what the importance of doing the proper testing and checks are. So when you’re looking at maybe your. Classical flat foot. Well, why is it important to check to see if it’s rigid, flat foot versus flexible?
Because I’ve seen it from time to time come into the lab, really have a scanner, a cast of a flat foot, and it hasn’t been put down if it’s rigid or flexible, flat foot. So as you know from previously run the lab, you don’t know what to do. Do I put in an arch support? Don’t put in an art support.
Tyson E Franklin: Yeah,
Kieran Carew: So I think often having the exposure to the CAD design makes you think more deeply.
You can see more clearly why I need to do all the testing checks. So I think it’s a good thing to do. The other thing that I think is quite important as well, with the [00:11:00] advancement of technology and the materials that are coming along, and especially with 3D print and the way you can change infill density so you can make your orthotic and change your density anywhere in that orthotic.
So you can obviously influence, let it be pronatory forces or supernatory forces with infill, I think it’s very important then to understand the different infill densities and what works best for maybe certain body weights . And I think education needs to be created all around that side so practitioners would know what to order because you order an orthotic or go to design orthotic in your clinic.
You say, I want a soft orthotic or semi flexible, but that’s your impression. Yeah. Of what? Simul and mine might be different. Whereas with 3D printing, you can print off samples and you can say This is a 20% guider, a 10% guider. So you can feel it and then you can order based on the actual percentage that’s in front of you.
But I think it’s, having that knowledge I think would be key as well. And I think we’re very much still. [00:12:00] In a way, at the start of the journey, our software and our printing has advanced. We have it grown out to clinics as far as Dubai in places, and it’s been working really well. But I think when I say we’re at the beginning of the journey, I think the education around what’s needed from clinicians to understand the whole process and to get the best from it, I think is at the beginning.
Tyson E Franklin: You’re gonna be at the Foot and Ankle show again, 2026.
Kieran Carew: Yes. Right there. Yep.
Tyson E Franklin: Yep. And I know when I looked at it 2025 and I thought your setup was great and you had one being printed there and you’re explaining how it does the different densities and what it can do. And I was super impressed with it.
It was very slick.
Kieran Carew: Yep. In the software, now we have even advanced further Tyson and we’ve been taking feedback from clinics. As I said, every around, every clinic has preferences.
Tyson E Franklin: Yeah.
Kieran Carew: . So the big discussion started occurring around weight-bearing scans versus non-weight-bearing scans.[00:13:00]
And as we were talking to practitioners said, often our pet hate with auto topic laboratories is you order an orthoses you order a met dome, the met dome is put on and you order repeat and the met dome comes in the wrong position. Yeah. And they said this is often a major issue from. The same maybe with sinks or Dell cutouts.
So what we looked at is harnessing the power of two technologies. So now you can take a scan, let it be using your iPhone or your iPad, or you can use a w Weightbearing 3D scanner, which everyone you want to use. But also if you have a pressure pad technology or in-shoe sensors, we can take the data from these pressure force plates, overlay it on your orthoses.
And where the peak forces are of the red pressures, we can automatically place met domes or accommodations or sinks.
So that then has given you a more accurate design. So you have your orthotic and your arch values got from the [00:14:00] 3D scan. And then you’re taking the pressure mapping from the weight bearing.
So I think with 3D printing, it’s allowing us really to push boundaries. So we’re harnessing power, and it’s not a case that you have to have a specialized pressure pad. It’ll work with the majority of ’em. Okay. You’re just taking the data in off it so the clinics don’t have to go to major expense. But the journey that we are on at the moment is footwear even.
So since you’ve seen us yeah, I think you were
Tyson E Franklin: designing, did you, were you printing out a, like a football boot?
Kieran Carew: Yeah. What we have done. Yeah. What we have done now is we’ve been testing different types of footwear. So we’ve built into our software that you have the ability to do 3D printed sandal bases.
3D printer slide or flip flops, which is including the strap. Yeah. So it’ll print this one unit. We’ve also done running spikes. And we’ve done well, we changed the brand name. You might be familiar with the Croc type of shoe.
Tyson E Franklin: Yeah.
Kieran Carew: So we call them gate airs basically. So we’ve been trialing them as well and printing and the thing is.[00:15:00]
It’s learning how to position them in the bed that you print them with minimum to no supports if you can. So you reduce the supports that you’re printing because when you put supports on to build a structure outta TPU, they’re quite difficult to remove. So we’ve been testing how to get around that and we’ve been looking at the whole area of water soluble supports.
So you’re printing basically with two materials, your support structures, which is the scaffolding in water soluble, and then you’re not your footwear. In actual TPU. Yeah, you just drop it in a bucket water afterwards and your supports are gone. So it leaves for cleaner finish. So that’s the kinda stuff we’re working on currently.
Tyson E Franklin: Okay. I’ve got some questions there before we go any further.
Kieran Carew: Sure.
Tyson E Franklin: One, ’cause these are gonna be questions that people are gonna be thinking about and these are some of the questions, some of my coaching clients who, some have got 3D printers and some are thinking about it. Someone wanted to get a second pair designed.
Once you’ve done the design for the first pair, do they need to pay again to get another pair done? Or [00:16:00] Once they’ve got the design, they can pump out as many as they want.
Kieran Carew: Yeah. When you have the design, you can pump out as many as you want. Okay. ’cause the design is saved on, you can save it in the pen drive or on your actual printer itself.
Tyson E Franklin: Ah, that’s good. That’s a big tick. Yeah. Massive. It’s a big tick for, Fit4 the cost of the printer. How much are the printer costs at the moment?
Kieran Carew: Well, the printer is part of a package, so what we found is you had to put a package of service and training involved. So there’s cost of everything and education.
Tyson E Franklin: Yeah.
Kieran Carew: So if I was explaining the package here in the uk the package would be your printer. Would be an education course around biomechanics that goes out with it. Yep. The course itself is worth about 600 pounds.
Then our engineers deliver the printer on site, set up the printer, and give you a day’s training on site. Then give you an additional training day at the lab if you want to, and then training on the CAD softwares and things. So that entire package here in the UK works out at 9,800, including the printer and full warranty.[00:17:00]
Now we set systems up out in Dubai as well, so I’m literally just back from a trip to Dubai.
Tyson E Franklin: Yeah.
Kieran Carew: And when we set up out in Dubai, we travel out there and set it up because to me, you can buy a printer, it can come in a box. And you can try and weed your way through trying to set it up and get it going.
Sometimes you might do quite easy. Other times you might if you and might not if you’re not familiar. So we thought let’s remove the headache from it. So that’s why we do it. But a practitioner has the option if they just want to take the printer from us. So we’re looking at the printer price as just a printer and so on.
Where we can ship it to would be somewhere just around maybe the 5,005 and a half thousand.
Tyson E Franklin: Do you know that
Kieran Carew: that is cheap? Yeah it’s very reasonable, but I said it’s
Tyson E Franklin: very reasonable.
Kieran Carew: To me. To me, I would definitely say you need the support package.
Tyson E Franklin: I think
Kieran Carew: so, because everything is great until something goes wrong and it does go wrong.
There’s no machine out there that is [00:18:00] flawless, and if you’re not familiar with it, you can have the biggest headache going. Yeah. So it’s often easier to look, have an engineer, come site, set it up, gimme the proper training so we know everything’s. Working perfect. And with that handhold training, it spares you the headaches and it means, yeah,
Tyson E Franklin: it, it’s one of those things, it’s like when we had our walking platform set, set up, and we had different treadmill set when we got the milling machine set up, every time we had someone come on, set it all up, make sure it was all working perfectly, spent the money and the time doing the training, and it was flawless.
Yeah, I think this is probably the best way of doing it is taking that package and making sure it’s all up and running. Like I just recently got myself the iPhone 17.
Kieran Carew: Yeah.
Tyson E Franklin: Picked it up and I got the thing and the person said to me, Hey, do you want to just set it all up here while you’re in the shop with your watch and everything else while we’re here?
And I went, ah. So I’m in a bit of a [00:19:00] hurry. I’ve gotta go. I’ll just do it at home.
Kieran Carew: Yeah.
Tyson E Franklin: You always know when something is gonna play up a little bit, and I’ve got everything working perfectly on it, except I still can’t get a thing to connect to my watch. If I had have been in the store and did it right there and then with the people, I’m sure everything would’ve worked perfectly.
Kieran Carew: That’s a seems ahead
Tyson E Franklin: because it’ll be something really simple that I’m doing wrong or this or my watch could just be buggered.
Kieran Carew: Yeah. Tyson, that’s it. I mean, we’ve come across that where we go into clinic and we’ll set up the systems and the practitioners don’t have the headache.
Tyson E Franklin: Yeah.
Kieran Carew: Whereas what we’ve often come across before is someone might buy a piece of software over the internet, a slice and software.
They try and hook it with the printer, and next thing you find is they don’t know how to rig it up to the printer. So they end up with headaches and eventually they end up calling us after they’ve frustrated themselves. So you can avoid the frustration and the way I look at this. The time you spend trying to figure out how to do things is a loss of [00:20:00] revenue where you could be running your business and on with patients.
So it’s often wise to say, I’ll make the investment to make sure everything is set up and it is flawless in what it’s doing because you’re paying to get rid of headaches and we have taken the stress and headaches since 2019 with the research and development we’ve been doing to save that stress for the practitioners.
Tyson E Franklin: But it just, the, it makes so much sense to actually do that. And I do, the other question I had written down before I forget was turnaround time. So I do a scan in my clinic, I send it off to you because you’re gonna do the design. How long does it take before the design comes back?
Kieran Carew: What we do is a maximum of three days. Okay. We do a maximum of three days. And the reason why we do a max of three days is. There’s quite a large volume that come in because we have NHS hospitals that have taken on the printers as a cost saving. And I suppose the biggest thing for hospitals is trying to meet net zero for 2035.
So the materials sit with that in 3D printing. So when you’re getting large volumes in, we say a [00:21:00] maximum for three days, but in a lot of cases. We have it back in 48 hours, but we say three days just to kinda give comfort. Because you know yourself, if you say one day and you’re two days, you have complaints.
Yeah, I know. Because if you go slightly Yeah, slightly longer than time and you bring it in early people, thank you for it.
Tyson E Franklin: Yeah. Under promise and over deliver. It’s,
Kieran Carew: yeah. That’s,
Tyson E Franklin: Yeah. ’cause the reason, people might be listening to this and they might be thinking, wow, this is a real plug for your particular company.
Which it is, and like I said, you’re not paying me to be on here. I asked you to come on. The reason I asked you to come on one, because I know you and I think you’re a good guy. I saw your equipment when I was at the foot and ankle show, and I’m looking forward to checking it even further when I’m there this year .
But it’s also one of these things, I really believe this is where Podiatry is headed in the future, where one day I can see in the future, most clinics are going to have a 3D printer. And so I think this is what the conversation needs to be heading this way and people need to be taking more [00:22:00] control and speeding up the process of getting orthotics made.
This making patients wait 7, days , 2 weeks for orthotics. I still think it’s just crazy.
Kieran Carew: Yeah. To be honest with you, Tyson, we’ve seen the change like over here in the uk we’ve seen a few, a laboratories close down over the last 12 months. Yeah. Due to rising costs rising costs, staff issues it’s horrendous.
And it’s, it means the price of the orthotic is gone up. So the clinician is not making the margins they need to in a lot of cases. So if you’re not making the margins. Is it worth having the stress if you’re dealing with things? So the 3D printing is definitely changing that. We have a traditional lab as well, which we have run.
Okay. And we have seen ourselves in the last, I would say two to three years through a transition that we have definitely gone to, about 60% of clinicians are gone across to 3D printing, and we’ve seen that. Every month we are putting out a few 3D printers every month without [00:23:00] fail. So what we’ll do is we’ll put out the printers, but when we put ’em out, we always deliver ’em to do the training to make sure people are comfortable if they wanted that side of things done.
Yeah. What we’re looking at is we see the growth and with the feedback we’re getting now from the clinics, it’s great because I had one clinic say to me, he said, on lab fees alone in one year, he said, I saved 25,000 pounds. Now that’s quite a saving.
Tyson E Franklin: Yeah, I know when we got our milling machines set up, we were doing at the time over a thousand pairs of orthotics a year.
Kieran Carew: Yeah.
Tyson E Franklin: And instead of paying a lab fee of a hundred, $120, at the time, it was costing me like $20 to get it made with the materials.
Kieran Carew: Yeah.
Tyson E Franklin: So I was saving a hundred thousand dollars a year easily by having the milling machine on site.
Kieran Carew: Absolutely. And what I see Tyson as well, to be honest with, you’re looking at, I think in the whole field of biomechanics with clinics, because we’ve been chatting to clinics quite a bit and what we find [00:24:00] is a big thing that there’s two areas that we find is some clinics are really experts when it comes to bespoke orthotics.
Tyson E Franklin: Yeah.
Kieran Carew: You have other clinics like more simple solutions such as your prefabs. And I think the gap is starting to close now because more and more clinics are going in from the prefabs. Updating their knowledge and starting to go more towards the prescription. But I also think as you have younger podiatrists graduate outta universities, they’re going to adapt to technology I think at a kind of a quicker pace because they’re embracing technology.
They’re come up with technology. So I think Podiatry will go to full circle. Like years ago you saw your patient, you took the cast. You produce the orthotic yourself, you fitted it and if you needed to modify it, you could do it. And I think 3D printing is bringing it back in that full circle.
And the big thing with 3D printing is if you do need to modify an orthotic, it doesn’t cost you the world. Yeah. Because you know your production cost is potentially, if you need to reproduce. 10 or 12 pounds, [00:25:00] so you can modify and adjust that orthotic quite easily. Now in this software that we have, we built our software into as a plugin into Rhino.
Now Rhino, when you research Rhino rhino is a very powerful CAD software. So Rhino was originally developed by McNeil in us and McNeil in the US were ship builders. So designed. This software was capable of designing ships,
Tyson E Franklin: okay?
Kieran Carew: Everything from the engine to the hulls, the whole lot designed. So it was great with curved boundaries and a lot of companies such as jewelry manufacturers, footwear and manufacturers then build their software within that.
So the harness and the power of it now, that’s what we did as well. But what makes it lovely is if you have a modification to do, you can save a file when you design this as a three DM file and also export it as an SDL. So the SDL goes in your printer, the three DM is there that you can modify it without putting yourself into any major time or cost.[00:26:00]
So it, there’s nice backup with it. Yeah. So it’s brilliant in that respect.
Tyson E Franklin: What you said before about doing the, that full circle. I have to agree with you that is what is basically happening because I do, I remember, yeah, when I first graduated, 1988, it seems so long ago, and you would, you’d do the plastic cast and there were a lot of podiatrists that were making.
There weren’t a lot of orthotic labs around and we were all taught how to make orthotics. But as time went on and people got busier because of time, they then sent it off to a lab to do. I used to do my own by hand until we got to about 70 or 80 pairs a month that I was making by hand after hours, and I went, this is getting crazy.
Then used a lab and then circled back around to the milling machine. If I still had a podiatry clinic, now I would. I would have a 3D printer. I would even be thinking about it.
Kieran Carew: Yeah, because the 3D printer is to work away on the beautiful side of it as well. From a business point of view, [00:27:00] positioning a 3D printer out in your waiting room.
Gets new patients talking about what’s going on.
Tyson E Franklin: Oh yeah.
Kieran Carew: Because I’ve seen it. When we go to trade shows, go to a trade show, go to a clinic where there’s a 3D printer, first thing that happens is people start recording it.
Tyson E Franklin: Yeah.
Kieran Carew: So when you’re in a clinic and you have patients recording this and maybe sharing social media, it’s getting interest going within your clinic.
And it also means those patients that may not have come in for orthosis are now thinking of orthoses. We’ll potentially speak to the Podiatrist. So it’s opening up more avenues and I think is the printers are safe to run out in the waiting area because the doors and everything are lockable so no one can access it, but it just runs away quietly out there because there’s no noise.
It’s not like a mill machine where you discontinue. These things are pretty much close to silent.
Tyson E Franklin: Yeah, so it’s quite good. It’s one of my coaching clients, he, set it up in his reception area. He said one, it’s better than a fish tank. His orthotic numbers. Absolutely. His orthotic numbers have [00:28:00] dramatically increased because he has the 3D printer there.
And I shot a video on this because when I was in Seattle, there were so many businesses over there that just did visually, did so many things to capture people’s attention from throwing fish to making frozen yogurt in front of everybody. You could see it in the back area. There was a cheese factory making cheese and then selling it.
And I went, podiatrists can learn from this. What can you do in your clinic that’s visually appealing that when people film stuff, what do they do with it? They share it online and people start talking about, so that’s where 3D printers I think are gonna be a huge advantage to certain Podiatry clinics and I say be first.
Don’t wait till somebody else in your town gets one. Be the first person to get one, and then let the rest follow you.
Kieran Carew: Yeah, absolutely. We’ve seen that we have a number of podiatrists [00:29:00] over here that have took on more early adapters. Yeah. And as early adapters, what’s happening is, I suppose you gain the respect of fellow practitioners because they’re looking up to you and what you find is podiatrists contact podiatrists for advice because they go to company, think I’m talking to a salesperson.
Tyson E Franklin: Yeah.
Kieran Carew: Whereas they like to take advice from fellow podiatrists. And what’s your experience? Gimme the good, the bad, the whole that. So I can see if it’s something that can, is going to fit in for me. And that’s the way it’s grown at the moment and the early adapters of the actual system that we were the working with quite closely.
They’ve been fantastic because they’ve been helping to educate fellow podiatrists as well, going through what’s important from the point of view of the checks of the patient, the way they think differently maybe, and how to prescribe an orthotic so they’re sharing their experiences and that knowledge base is starting to grow.
And that, that is, I think it’s very good for the profession, but it’s very good overall for every Podiatry because shared knowledge is a big thing, I guess. Right. We [00:30:00] all learn everything.
Tyson E Franklin: Definitely so, so you’ve got, obviously you’ve got printers through the uk, you got ’em in Dubai. Have you got any in any other countries?
Australia,
Kieran Carew: US, Canada. Yeah, we have printers currently at the moment we have ’em in Singapore.
Tyson E Franklin: Yep.
Kieran Carew: We have printers, some printers coming out to the US. We have printers in Dubai and DOA. We have printers in Ireland and in the uk. And originally you see what we were trying to do, Tyson is treat it like simply a bicycle wheel. So we said if we start off locally,
Tyson E Franklin: yeah,
Kieran Carew: we can learn from this. If there’s any problems, it’s easy manage.
Tyson E Franklin: Oh yeah.
Kieran Carew: So we only started putting them out overseas in kind of the last 12 months when we knew we were on top of things and that we could give proper support.
Because what we didn’t want to do is make a stick for own back. That you put something out there, especially with social media, ah, if you don’t do justice and with service, you can be destroyed. So we decided, look, let’s keep it local, let’s manage it well, and let’s grow it slowly, and under control.[00:31:00]
But now we’re pretty confident that we have it nailed and it’s running quite well. And as I said, the biggest part of all this. Is often the podiatrist understanding what their role in this is? Yes, because even break it into little chunks, the printer prints the orthotic, but it takes instruction from the CAD software.
The CAD software has taken instruction from the podiatrist. So it’s all starting with the podiatrist and the finished orthotic is a result of what the podiatrist decides. So a 3D printer, like the milling machines you had, they can produce the most accurate piece of garbage.
Tyson E Franklin: Oh yeah.
Kieran Carew: That you can imagine if you put in bad instructions.
So you need to understand the role from start to finish. So that’s the kind of chain that we see working with it.
Tyson E Franklin: No, and that’s why when you were talking about the package and the biomechanical education. Behind the scenes ’cause , there’s gonna be some Podiatry that their biomechanical knowledge is fantastic.
But there’s gonna be other one who it may be lacking in some areas. So I think it’s good that you do have that training in place. [00:32:00]
Kieran Carew: Absolutely. But the other side as well, you see, it’s not even just on your biomechanics of how you assess the patient.
It’s a few practitioners said to us that they have started thinking differently with what you can do to a 3D printed orthotic to achieve a result and keep a bulk of an orthotic down by just patterns. So I suppose some of these clinicians over the last couple of years, what they’ve done is they’ve done their own clinical trials in a way.
I found out what’s been working really well , so that knowledge from maybe very much experienced podiatrist or specialist in biomechanics is a big help as well to pass on knowledge to fellow podiatrist to say, this is what I found worked well, maybe for posterior tib tendon. I achieved the by doing this with the infill.
And it work exceptionally well. So it is that kind of knowledge is also, invaluable. And that’s where we have hooked up with podiatrists that have been using our technology for a long time that are very much experienced in biomechanics. Doing it. And as a matter of fact, it was even the chap I was speaking to last night, he mentioned [00:33:00] that he runs basic biomechanic courses at the moment.
Tyson E Franklin: Yeah.
Kieran Carew: And he said, my train of thought has changed. And he said, I’m thinking of how I can even teach my courses different to encompass what 3D printing is capable of doing. So everyone is starting to change their mindset of how they, they design the athletic and how they can get a better outcome and how they can reduce bulk.
That, that is what I can see is happening now,
Tyson E Franklin: especially the bulky side of things. I know when we were milling it out, because it’s EVA, it was always a little bulkier than if you were doing something at a polypropylene. But I like what you’re talking about where the podiatrists that are using this equipment, they’re almost doing their own in-house research.
Yeah, and then they’re bringing that information back to you. But now you’ve got all these collective minds together, which are in the end gonna produce an even better result or a better products.
Kieran Carew: That’s it. And that’s what’s happening. And that’s where [00:34:00] we’ve built the software. So in the printers currently at the moment, we can print TPU then we had but I said to us, we’d like to be able to print polypropylene shells.
Like your traditional shells.
Tyson E Franklin: Yeah.
Kieran Carew: So we built that into the software to be able to do the shells. We had other practitioners then said to us, look, I don’t want to be able to do the carbon rocker plates. So if you’re treating turf toe or something. Yeah. So we added that into the software so you can print your carbon rocker plates and things.
So it’s, it is continuously evolving and I think the thing with the software is software. The minute you stop developing. It becomes obsolete. So you’re listening to the market all the time and saying what else can be developed? So the next thing we’re working on is AFOs. So, there’s no reason why the AFOs cannot be 3D printed.
Now, we have done some test prints of AFOs, but we are looking at that You could get maybe a far superior bespoke AFO from 3D printing it. Because if you take a digital scan of the lower leg
Tyson E Franklin: Yeah.
Kieran Carew: And you take the dimensions of [00:35:00] that leg nice and snug from the width of the calf coming down to the ankle, your brace that’s going around the leg is going to fit, much better, rather than something that’s a bit more generic in the foot base.
It’s custom had the whole act custom. So we’re looking at the moment of building that into our software and we are leads and with podiatrists on what they want and also with orthotists. So we’re getting feedback on that continuously.
Tyson E Franklin: So I, I can see how excited you get about this. ’cause your background is mechanical.
Mechanical engineering.
Kieran Carew: Engineering, yeah.
What I did was mechanical engineering and I did sports science.
Tyson E Franklin: Yeah,
Kieran Carew: I did sports science where I get the biomechanics. But I’ve worked in the area of orthotics for the last 30 something years.
So another thing we have done, and this was designed in the software as well. This was sitting on a plane going to China. I mentioned earlier on Tyson that there’s two very much areas that we see in the whole area. You have the prefab type of orthotic and you have the actual full bespoke. Now in our CAD software, you can design [00:36:00] pretty much anything.
So my wife is studying Podiatry at the moment. She’s in her second year in Northampton University.
Tyson E Franklin: Okay.
Kieran Carew: Kids are grown up and she decided to go back and too,
Tyson E Franklin: never too old.
Kieran Carew: She’s enjoying it. And we’re sitting on plane. She was getting ready for exams, so I was a little bit bored with knowing to speak to, so opened the CAD software and decided to drop a prefab.
I got an idea for a prefab orthotic.
Tyson E Franklin: Yeah.
Kieran Carew: So this is the power that you can do inside the CAD software. So this is the device I drop. So this device is shelf format here.
Tyson E Franklin: Yep.
Kieran Carew: That has a little bit of flexibility in it.
Tyson E Franklin: So I’ll just point out to people who are listening to the podcast. Because we’re shooting this as a video.
Kieran is waving an orthotic around at the moment explaining everything. So if you’re listening, just keep listening. If you’re watching the video, then you know what we’re talking about. So keep going. Yep.
Kieran Carew: So what we did with this is I was looking at an orthotic that was simple that you could do correction.
So this area here in the heel is a disc, and this disc can [00:37:00] be flipped and rotated. So you can get varus and valgus posting. Okay? So if you want the six degree varus or valgus, you just flip it into the direction, flip it backwards. You have a heel raise. Two mils or three mils or whatever. And then here in the forefoot, these segments that are numbered under each met they’re in with Velcro, they can be removed to create offloads.
Okay? So something simple, but that is a power that the CAD softwares give you. You can drop anything. So I thought, you know, this is something simple that I could draw up and meet maybe needs of clinics with their basic needs or prefabs. So we haven’t launched that yet. I’ve been just wearing it my own shoe.
So
Tyson E Franklin: that, wasn’t done through 3D printing though, was it?
Kieran Carew: Yeah, that was something that was done in, that was something that was done in our CAD software, but I originally 3D printed it to test it.
Tyson E Franklin: Oh, right. Okay.
Kieran Carew: So I originally 3D printed it to test it because before we went off to do build injection molds and things to mass producers wanted to see that the disc and everything was going to work in it.
Tyson E Franklin: So that’s, so that you are [00:38:00] going to launch in the not too distant future.
Kieran Carew: Yeah, we’re going to launch it maybe in February time. Okay. So February we planned and the idea is to keep it, low cost. Low cost device. Yeah. But what I was trying to bring across is when you understand the power of CAD designing, that’s the point I was bringing across.
In our CAD software. You can draft up anything you’re looking to do. You just need to understand what you’re about. And that’s the power of kind of the fit you plug in. Within Rhino, you have that power to draw anything. So that is done on the plane to China and we’re going now putting out other technologies.
Tyson E Franklin: Oh, well, I’ll see it. You’ll have it, you’ll have it at the foot and ankle show.
Kieran Carew: Yeah. We’re planning to bring it to the Foot and ankle show to show that with the 3D printing things, because our idea is to show the full capability.
Tyson E Franklin: Yeah.
Kieran Carew: And the idea that we have behind it as well, and that we have to be upfront is that practitioners, they’re thinking of making an investment in any of this type of technology.
The thing that they need to be prepared to do is to invest the time to learn and often to refresh the [00:39:00] biomechanics to all that so you have the package because if you don’t have the front part, the rest is gonna be a lot more difficult to do.
Tyson E Franklin: Now I like right from the start, everything you’ve said. I agree with that.
I think having that package idea and the training behind it, because I do have another coaching client who was looking at 3D printers and she was given a couple, like on loan and they were just dogs. They were just and the company that we’re trying to work with her, she couldn’t get hold of ’em.
She’d send designs off and the thing that came back was completely wrong. If something needed to get remade, they say no, you gotta pay a whole new fee again. And she’s explaining all this to me and I go, oh no, there has to be better companies out there. So she’s pretty much given them the flick.
Now on search for something else. And I said, well, I know someone because I was talking about what you were doing and I noticed some other companies around the place as [00:40:00] well. But when I saw you at the foot and ankle show and I saw your unit, I also thought everything you were doing was actually, price wise, was extremely good.
Kieran Carew: Yeah, we kept, we decided to keep it sensible. Yeah. Because we do know we could have charged a lot more, we know we could have charged 30, 40,000 for the package, but we said if you keep it affordable for clinics, they can get the return on investment quite quickly.
Tyson E Franklin: Yeah.
Kieran Carew: But the other thing I was looking at, Tyson, that we were looking at for other countries that we could see could work quite well is maybe a concept that we were kinda come up with like micro labs.
Oh yeah. That if you had one clinician that’s a, our clinic that’s expert in biomechanics and they could become a hub for clinics around them.
Tyson E Franklin: Yeah,
Kieran Carew: and we could see something like that could work quite well where you’re getting a quicker turnaround time in your orthotics and you’re dealing with someone that you know locally and you know the knowledge and you understand each other quite well.
Because what I found [00:41:00] is often between laboratories, and I’m sure you came across it, labs change the names of material. To make a material often sound more high tech. Yeah. And get more sales. And it’s often just the same material with different names. Putting it and different price points that then causes confusion for practitioners because they often don’t know what the hell their bloody ordering.
So I often find if you have we thinking like your micro kind of lab situation. ’cause we were thinking this could work in other countries quite well, that you train a little group of people, they set up the regional little labs around the place and they provide service to other clinics that way.
Then there’s no regional clinics competing each with each other. You’re working in unison because there’s a market big enough for everyone, and at least you know what that Podiatry down the road is an expert in biomechanics. They’ve been, that’s been presenting biomechanics for years. I’m comfortable with their knowledge.
I understand the way they work so I could team up with ’em and let them produce. So we [00:42:00] saw the idea of micro labs could certainly work in different areas. Yeah. And from our point of view, something that’s very easy to support.
Tyson E Franklin: Yeah. I think in different countries that would work quite well because
having local people that are closer for some reason, there is a problem that they can get on the phone, bring up, and then somebody could be there in a short period with someone that can hold their hand. They’ve got that local support, I think is important.
Kieran Carew: Yep. And that’s something that we’re doing at the moment out in Doa.
So we flew to DOA a couple of weeks ago, and we were working with a team of clinicians out there. And it’s a company that kind of has multiple sites around Dubai that, so we set up on one, we’re spending time training the clinicians there. Then what we’re doing is we’re online then working with ’em.
I’m teaching ’em the CAD softwares.
Tyson E Franklin: Yeah,
Kieran Carew: so we did this set up the software, everything working. Now it’s a case of over the next number of weeks as they’re starting to fit patients with orthotics , we’re helping them with getting familiar with the CAD design. So one of our engineers and designers will [00:43:00] sit with their team and they say, this is what we want to put into the prescription.
So they’re sharing screen and working together. So what our practitioner will do. They’ll do, and they’re mirroring each other. So you’re getting familiar with how to do things. So that’s the way we’re working with support. And that is something that can be mirrored in any country.
We’ve done in Singapore. We’ve done it all places and it works exceptionally well. The only thing that, that we look at then is you see is the mindset of podiatrists. And medical practitioners can slightly vary on preferences. So if you go to Germany, I know EVA is the most popular material for orthoses.
Whereas in the UK it hasn’t been. It has been more kind of your poly props and things.
Tyson E Franklin: Yeah.
Kieran Carew: So different countries have different little ways, and if you have the micro labs would run by a practitioner that understands that local market and the mindset of the practitioners there, I think it works much better.
Tyson E Franklin: No, I definitely agree. So if anybody wanted to reach out to you or ask you more questions or they might wanna invite you on their podcast, what’s the best way of getting hold of you? What’s your [00:44:00] best contact email address?
Kieran Carew: Can the email or just call us? Yeah, email or call us. Yeah,
Tyson E Franklin: what’s your email?
Kieran Carew: So the email is kieran@foothealthorthotics.co.uk
Tyson E Franklin: Okay. Awesome. And simple. And the website.
Kieran Carew: And the website is obviously www.foothealthorthotics.co.uk Okay.
Tyson E Franklin: I’ll put that, I’ll put that all in the show notes for anyone who. Found Kieran’s accent a little difficult sometimes I’ll have show notes with a lot of this information in there.
Kieran Carew: Yeah. Often need a subtitle for the Irish accent.
Tyson E Franklin: Oh. Sometimes there was some of the companies you were mentioning earlier on, and I’m going. No, I didn’t quite hear that, but I’ll be able to hunt it down and I’ll put it in the show notes and get it all sorted out.
Kieran Carew: Yeah, but what we’ll do Tyson, is I’ll send you the contact information for our business.
Tyson E Franklin: Yeah, that’d
Kieran Carew: be great. If wants to reach out to us. So I’ll send you an email afterwards. You have all the contact information if you do want to share it and things.
Tyson E Franklin: Oh yeah, no, I’ll definitely have it all in the show notes. Anyone listening to this, go to podiatrylegends.com, [00:45:00] find this episode and all the information will be there.
So Kieran. I want to thank you for coming on the Podiatry Legends Podcast, sharing what you’ve been doing with 3D Printing. Like I said, I think this is the way of the future for Podiatry and look forward to having you back on at some stage. Ke, keep us updated.
Kieran Carew: Tyson, thank you very much for your time and I look forward to seeing you in February.
Tyson E Franklin: Oh yes, I’ll see. I’ll see you. It was the beginning of March will be? Oh yeah,
Kieran Carew: beginning of March. 3rd of March.
Tyson E Franklin: ISN March. Yeah. Okay. I will see you there.
Kieran Carew: See you there Tyson. Thank you very much for your time.