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. 2025 Mar;18(1):e70031.
doi: 10.1002/jfa2.70031.

The use of computer-aided design and manufacture for foot orthoses: A cross-sectional study of orthotic services in the UK

Laura Barr  1   2 , Jim Richards  2 , Graham J Chapman  2
Affiliations

The use of computer-aided design and manufacture for foot orthoses: A cross-sectional study of orthotic services in the UK

Laura Barr et al. J Foot Ankle Res. 2025 Mar.

Abstract

Objective: This study aimed to identify how computer aided design and manufacture (CAD/CAM) technologies are currently being used for insole production by UK orthotic services in the National Health Service (NHS), including any variation in the specific processes and identify barriers to implementation.

Design: A cross-sectional study was undertaken using freedom of information requests sent to all 214 NHS Trusts and Health Boards (HBs) across the UK. The request comprised 22 questions relating to CAD/CAM for insole production by UK NHS orthotic services during the 2021/22 financial year.

Outcome measures: Analysis was undertaken and presented in terms of response rate to individual questions. Where free text responses were provided, thematic analysis was conducted.

Results: Responses were received from 186 (86.9%) Trusts/HBs, those who did not have an orthotic service were excluded, and 131 responses were included in the final analysis. 70.5% (91/129) of Trusts/HBs used CAD/CAM to manufacture bespoke insoles. The most common workflow associated with CAD/CAM insole production was foot-shape capture with a foam box impression cast (86.8% (79/91)); casts transported to another site (90.8% (79/87)); foam boxes scanned into a CAD/CAM system (81.6% (71/87)); insoles designed by a technician (73.6% (67/91)) and insole produced with reduction milling (59.1% (SD 37.92)). The greatest barriers to the use of CAD/CAM were those of equipment costs and staff experience and training.

Conclusions: UK orthotic services have widely adopted CAD/CAM insole production, but fully-digital workflow is uncommon. Hybrid-digital workflow involves physical casts and their transportation, generating waste and impacting sustainability. Further research is required to understand how hybrid-digital and fully-digital workflow affect patient treatment outcomes, costs and sustainability. Barriers to CAD/CAM including costs and staff training which should be considered alongside the growing body of research around CAD/CAM technologies.

Keywords: CAD/CAM; foot orthoses; insoles; orthotics.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Study flow chart.
FIGURE 2
FIGURE 2
(a–i) Proportionate answers to individual questions from Trusts and Health Boards (HBs). (a) Which of the following best describe your orthotic service? (b) Does your orthotic service provide bespoke insoles to patients? (c) Does your orthotic service ever use foam box impression casts to capture the shape of the patient's foot, when prescribing CAD/CAM insoles? (d) Is the negative foam box impression cast usually scanned into the CAD/CAM system, or is it filled with plaster first and then the positive model scanned? (e) Are the foam box impression casts usually transported to another site to be scanned into the CAD/CAM system? (f) Does your orthotic service ever use slipper casts/plaster casts to capture the shape of the patient's foot, when prescribing CAD/CAM insoles? (g) Are the slipper casts/plaster casts usually transported to another site to be filled with plaster and scanned into the CAD/CAM system? (h) In your orthotic service, which is the most common method used to capture the shape of the patient's foot, when prescribing CAD/CAM insoles? (i) Who is usually responsible for performing the modeling/rectification of the CAD/CAM insoles that your orthotic service provide?
FIGURE 2
FIGURE 2
(a–i) Proportionate answers to individual questions from Trusts and Health Boards (HBs). (a) Which of the following best describe your orthotic service? (b) Does your orthotic service provide bespoke insoles to patients? (c) Does your orthotic service ever use foam box impression casts to capture the shape of the patient's foot, when prescribing CAD/CAM insoles? (d) Is the negative foam box impression cast usually scanned into the CAD/CAM system, or is it filled with plaster first and then the positive model scanned? (e) Are the foam box impression casts usually transported to another site to be scanned into the CAD/CAM system? (f) Does your orthotic service ever use slipper casts/plaster casts to capture the shape of the patient's foot, when prescribing CAD/CAM insoles? (g) Are the slipper casts/plaster casts usually transported to another site to be filled with plaster and scanned into the CAD/CAM system? (h) In your orthotic service, which is the most common method used to capture the shape of the patient's foot, when prescribing CAD/CAM insoles? (i) Who is usually responsible for performing the modeling/rectification of the CAD/CAM insoles that your orthotic service provide?
FIGURE 3
FIGURE 3
What are the barriers for using computer aided manufacture for custom insoles in your orthotic service?
FIGURE 4
FIGURE 4
In your orthotic service, what are the reasons for using CAD/CAM insoles?
FIGURE 5
FIGURE 5
The most common workflow for CAD/CAM insole production in UK orthotic services.
See this image and copyright information in PMC

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