The Prosthetics and Orthotics Podcast
The Prosthetics and Orthotics Podcast is a deep dive into what 3D printing and Additive Manufacturing mean for prosthetics and orthotics. We’re Brent and Joris both passionate about 3D printing and Additive Manufacturing. We’re on a journey together to explore the digitization of prostheses and orthoses together. Join us! Have a question, suggestion or guest for us? Reach out. Or have a listen to the podcast here. The Prosthetic and Orthotic field is experiencing a revolution where manufacturing is being digitized. 3D scanning, CAD software, machine learning, automation software, apps, the internet, new materials and Additive Manufacturing are all impactful in and of themselves. These developments are now, in concert, collectively reshaping orthotics and prosthetics right now. We want to be on the cutting edge of these developments and understand them as they happen. We’ve decided to do a podcast to learn, understand and explore the revolution in prosthetics and orthotics.
The Prosthetics and Orthotics Podcast
Unveiling Digital Solutions for the O&P Industry with Luc Boronat
Luc Boronat, head of the digital division at the Eqwal Group and CEO of Qwadra, discusses his journey and insights on the meticulous balance between clinician responsibility and design automation in the prosthetic and orthotic industry.
Join us as we explore the story of a visionary who has reshaped the Orthotics and Prosthetics industry through innovative CAD/CAM solutions. From humble beginnings with a ZX80 computer to creating digital tools that replaced outdated plaster models, this journey showcases the power of blending engineering with clinical expertise. Discover how these tools evolved from internal innovations to marketable solutions, addressing real-world clinician challenges and ultimately shaping a company that supports Certified Prosthetist-Orthotists globally.
In the realm of advanced 3D printing in orthotics, we delve into the use of foaming TPU material for custom insoles. Learn about the clever solutions developed to maintain printer functionality in continuous operations and the strategic positioning of soft insoles in the European market versus global preferences.
Special thanks to Advanced 3D for sponsoring this episode.
Welcome to Season 9 of the Prosthetics and Orthotics Podcast. This is where we chat with experts in the field, patients who use these devices, physical therapists and the vendors who make it all happen. Our goal To share stories, tips and insights that ultimately help our patients get the best possible outcomes. Tune in and join the conversation. We are thrilled you are here and hope it is the highlight of your day. This is the Prosthetics and Orthotics Podcast. With Yoris Pils and Brent Wright. We are super excited to share with you some of the recordings and interviews of people that we met at AOPA 2024. So our first guest is Paul Godonis, the CEO of Myomo, so let's lean in and listen to what he has to say.
Speaker 2:Hello everyone, my name is Joris Peebles and this is another episode of the Prosthetics and Orthotics Podcast with Brent Wright. How are you doing, Brent?
Speaker 1:Hey Joris, I'm doing well Doing a little traveling to the gloomy metropolis of Cleveland, ohio, okay.
Speaker 2:What brings you to Cleveland Ohio?
Speaker 1:So I'm actually hanging out a little bit with John Naft. He's from. Combscan. I tried that and I actually managed to get that so, uh, yeah, so doing that, and we're just talking a little bit of 3d printing, and then he's doing a lot of stuff with um myomo, which is the kind of the exoskeleton for people that have had a stroke or, you know, a loss of a function of a limb, and so it's been really interesting to learn about that.
Speaker 1:you know, and I love coming and seeing other people's practices. Then we talk shop, and, yeah, so it's been really great.
Speaker 2:I love the cone scanner product because it is something that could really democratize this and make this super easy with, like your phone and everything and and I really like those kind of enabling products. And, yeah, we should do an episode about this exoskeleton thing because, um, you know the the same thing that makes robocop can also make people walk again. You know, it's very interesting if, if this will actually happen, and and when it will happen, and, uh, and then to what extent?
Speaker 1:yeah, no, no, 100%, and it's super cool. He actually had a couple fittings yesterday and to see what the people so what's really neat is they really concentrate on outcomes or outcome measures. So what can you do without the brace on and what can you do with it on? And it's a night and day difference. It's incredible. Um yeah, uh. Well, I'd love to do an episode on that. We can definitely get somebody from my mo in there, for sure.
Speaker 2:Cool man, we should, okay. So, um, do we have a sponsor? I think we have a sponsor from this, this kind of like 3d printing design service kind of thing.
Speaker 1:Yeah, advanced 3d yeah, have you ever heard of yours?
Speaker 1:it's crazy I have not, I'm not familiar, I think with so, uh, yeah, so advanced 3d is a is a contract manufacturer, but we also try to meet you wherever you are on your journey. Uh, whether you're just learning to scan, you're wanting to 3d print or you move to definitive sockets to do that, and then we also, if you have a product that you want to bring to market, we can also help you with that. And so we're in North Carolina. You get to work with myself, tyler and Paul, and then we met Katie on the couple episodes ago. She's amazing and try to help you wherever you are on your digital journey that's super cool, man.
Speaker 2:And and you guys, what do you guys print in? Actually, because you've got well, hp, obviously, but what kind of materials can I order parts from from you guys?
Speaker 1:yeah, so, um, we do the multi-jet fusion. Uh, color five, so the 580, we can do pa 11, 12, tpu, and then we've recently brought on PK 5000 from Jabil.
Speaker 2:Really, you can talk to people about this, because I'm super excited about that. We should do a PK 5000 thing, because that is really exciting that you managed to get that to work, and then you're going to use this for prosthetics. That's incredibly strong material.
Speaker 1:It really is an amazing material and, believe it or not, we're going to have the guy that invented it on our podcast very soon, so that should be very fun.
Speaker 2:Super cool. All right, then we'll leave a lot more on that. Okay, so who do we have on the show today?
Speaker 1:Well, I'm super excited to have Luke Bruna on today. He is the head of the digital division at the Equal Group and he's also the CEO of Quadra, and so Luke and I have known each other for a while and I'm really looking forward to just hearing his journey. You know where he's found himself now, as part of, essentially, the conglomerate of equal, but he was his company that had been around for a while. Rodin was acquired a couple of years ago, and so it's been a. I just am really looking forward to that. And he's been doing some amazing stuff, not only in the prosthetic and orthotic space, but also in this idea of clinician personal responsibility, design, automation, and so there's just a lot to unpack in this episode.
Speaker 2:Awesome dude. Welcome Luke to the show.
Speaker 3:Thank you, thank you, brent, thank you, joris, for inviting me to share my journey in the O&P.
Speaker 2:So how did you get started with the O&P?
Speaker 3:Well, are you sure that you want to go in this?
Speaker 2:You're not even probably going to be the furthest back. We're going to go lately. So we've been getting back to the 40s and 50s, so don't worry, don't worry, yes, we do the very beginning.
Speaker 3:I started at the very beginning my journey in 1983 ah, a kid, just a child, I was yes, yes, I was just 15 years old and uh, my mother said me that uh omp company just nearby us was looking for an apprentice. Then you know, at 15, it was two words that I don't know ONP, no idea, what is it, and apprentice. Then I say yes, why not? And then I started my apprentice in a very small ONP company located in Bordeaux in France, who was specialized in only orthotics. I don't learn at the beginning the prosthetics.
Speaker 2:Okay, and one thing that's really interesting, because I know that France, to a certain extent also Germany, they have these apprenticeship programs. In America, they don't really have this. Yes, and so do you think it's a really good thing because you started as an apprentice? Do you think that's something that France, for example, example, should totally continue doing, because it really teaches people a craft and and a very hands-on way of learning things?
Speaker 3:at this time it was quite only the, the only way to um, to, to, to learn the NP field. Now it's completely different. Uh, it's a different study, but at this time you need to work seven years in a workshop, only starting to see patient under the responsibility of the other cpos, and after seven years I was able to be certified by the ministry of the veterans equivalent of the euro veterans in in us, who was taking care mainly about the, the, the onp device. At this time it was quite the only way. I think the first school was created in 1982, quite in the same time to learn how to be a CPU in France in a different way than to the apprentice. Now it's different and it's impossible to start at 15 years to learn this type of works.
Speaker 2:And when you got started making orthotics, what would you do? Was it a lot of leather wood, carbon fiber? What were the materials you worked with?
Speaker 3:I entered in the workshop for the first time and I discovered a forge and a machining lathe, because in this company at this time, we build everything from scratch, from aluminum, iron, leather, everything. We have a machining lathe, as I said, to also produce the screw. Everything that is probably at the beginning shaped my sense of independence. I learned to use all this old machining and how to be independent and produce everything. Yes, something that has followed me throughout my career all along the way.
Speaker 2:Yes, and what has changed? If you look at the materials, what are like the big things that you think are really like? You know that when you started with the lane and stuff like that, you know what has really gotten people.
Speaker 3:Uh, you know a lot, a lot further than they used to be as I said you in 1983, it was just the beginning of the arrival of the polyethylene, who was a game changer for the body jacket, for example. At this time we produced a lot of body jackets in plexiglass, you know, and the arrival of the polyethylene was a kind of revolution.
Speaker 2:Okay, and then how long did it take for you then to get more into prosthetics and stuff like that? Was it a long time, or did you focus really on orthotics for a really long time?
Speaker 3:No, I mainly focused only on orthotics all along my career. As I said, after seven years of apprentice I was certified. It was 1990. And I worked at this time mainly on idiopathic scoliosis patients and cerebral palsy scoliosis, yes, mainly during 10 years.
Speaker 2:Okay, and we know that some of these braces and things have been 3D printed. Did you end up using 3D printing back then as well, or soon for this application, or not really?
Speaker 3:soon for this application, or not really. Well, my first experience with 3d printing was during the in 2006, probably where we tried to produce our first ak bk sorry um sockets in fdm okay, okay, and.
Speaker 2:And did you think, oh, my god, this is the future, this is going to be everything? Or was it like, oh no, this is never going to work?
Speaker 3:probably both. If you have a good imagination, you can think that it's, uh, it can be a revolution one day. Uh, at this time, it's the, the, the materials that we use. It was probably abs, I don't remember so well, but yes, it was abs. Then with a very long process to um, to to produce it, but, yes, for sure that we, we, at this time, imagine that, uh, it will. It will be a big game changer in in the profession and how is it?
Speaker 2:is it taking a lot longer than you expected? Did you expect everyone to have 3D printers already, or you know how do you think it's going?
Speaker 3:For me, for us. I don't want to minimize the 3D printing, but I want to say it's only a tool and today there is no one answer to all the only I mean one printer, one answer to all the needs of the CPUs, as they have a workshop with many machineries. Probably in a few years they will have different 3D printers, you know, to produce different aspects to the temporary sockets, to the definitive sockets, with carbon fiber inside, or for body jacket with polypropylene, or also with the HP technology body jacket with polypropylene, also with HP technology, with the TPU, with very, very good material for the ONP. The answer today is diversity, from my point of view.
Speaker 2:Okay, I like that approach. You're seeing it as a machine. It's not a revolution. It's just another tool we use. It's like a mouse or a lathe or whatever. I think that's a very kind of hype-free way of looking at the technology. And how about for insoles, specifically and stuff like that? We've seen a lot of uptake in insole production with primarily TP or polypropylene with desktop printers or relatively inexpensive. Do you think that's going to get much bigger?
Speaker 3:Yeah, definitely yes, the. We have 3d printers who print a foaming tpu and the. The market is a probably a little bit different here in europe than in us, uh, where we have a lot. We produce a lot of soft insoles, I mean with cat cam, uh CAM, by carving like a TP form or something like this, and now with 3D printing with TPU, with FDM, that it's already something that we have on market since some years.
Speaker 1:So I want to hear a little bit about. So I find it interesting, I didn't realize how involved you were on the scoliosis side of things, and I want to hear about how that also helped you to create the rodent you know back in 2003,. Like, what was the journey to be? Like?
Speaker 3:Hey, I need a digital tool so I don't have to, uh, have mess with these massive plaster models yeah, I need to come back in 1980 when I was I bought, I was 12 and I bought my first personal computer. At this time it was a zx80. I don't know if you know that it's from a company, uh, sinclair, in a english company, and at this time it was a ZX80. I don't know if you know that it's from a company, sinclair, an English company and at this time you know you receive the computer, you have to weld all the components before to plug it on the family TV and start programming. That is my first experience and my first journey in the I want to say IT. And all along my career I started to. I developed some softwares, mainly for the, for managing the production in the workshops, and one day I was very interested by 3D. And then I continued developing some softwares and in 1997, in the group where I'm working in France, we decided to invest in the Swedish system, at this time named K-PodCAD. It was bought by Osu. After it was a CAD-CAM software working only by scanning. And, yes, we started our experiences with this type of tools and we reached rapidly the limit of the tools because we wanted at this time to invest in the system, always to scale up the use of the CAD CAM but also to scale up the central fabrication.
Speaker 3:At this time we was taking a plaster cast, as you know, and sending plaster cast, and there is no sense for that, and we wanted to really have a tool not only to show that we are using CAD CAM, but really a tool to scale up the company at another level. Then I developed the first software for only designing body jackets and scoliosis body jackets and at the same time we developed our first carver. It's with a partner nearby us in the area or nearby us in the area, and that's the first experience that I had and that we had in the company with the CAD CAM. In the same time we need to also develop a complete workshop of how to produce polyurethane blocks to carve in the carver. Then we we developed all the tools. I developed all the tools the Pro8n blocks, the software and the cover.
Speaker 3:At this time, for sure, the 3D scan was very expensive and then it's why we were concentrated at the beginning on the body jacket and we developed some 3d libraries working by measurement only that we don't need to uh to take a full 3d scan. And progressively, when the the price of the scan decreased during the 2000. It started in 2008, 2010. Then we can scale up more about device. We need more accuracy, like A4s, ak, bk. But yes, mainly that.
Speaker 2:And I'm interested that you guys have always kind of like you notice, well, okay, you make the whole solution right.
Speaker 3:Yeah.
Speaker 2:Was that because you had to do it, or because you wanted to control it? Or you think that was a good product for people to just have the material, the software, the machine, everything together?
Speaker 3:yeah, as I said, you the, the, the, the way to be independent and to um, to, probably because we are our dna and my dna is from the ONP field. I never feel comfortable with, I mean standards tool from the industry. And then we decided to develop it for our internal use and, as we were a company a little bit well-known ONP company, a little bit well-known in France, that we have many visitors at this time and each time they saw our tools to produce, they wanted to buy and that's why we decided to put it on the market and to sell the full solution.
Speaker 2:And was it difficult for you to get into. So you're trained to do all this podiatry stuff and all of a sudden it's software, it's machine, it g code. How did you do that? You just learn everything yourself, or did you? Yeah, how did you kind of do that?
Speaker 3:at the beginning I want to say yes, but now, now we hopefully I don't, I still don't develop and we have a lot of engineers and, uh, very clever people who are ended up better than me at this time. But yes, yes, it was a way to learn all these type of things to, to connect all these tools to make a full solution for the, the np market. Yes, so.
Speaker 1:so one thing that I find fascinating luke about this journey, what it sounds like, is they you created the tools essentially for yourself because you needed it. And then you have these guests that come in and they look around and they say, where can I buy that? And you're like, well, uh, where I think I need to start a business and to be able to sell it. So I think that's fascinating to me because I think that there's there's so many people that look at the O and P market and they're like, hey, we can build tools for them, but they don't actually have an understanding of the pain that we go through as clinicians, or even the evolution of how we've gotten to where we are. Secret sauce, I guess, if you would say, is you have all this experience from not only making your own aluminum and iron stuff now to programming and all that, but you have this vast experience of being very focused on solutions from real problems that you have.
Speaker 3:That's true. That's what drives me at the beginning, but still driving the company. We are lucky to have this digital division. Now we're connected to this big group of equal with more than 250 clinics worldwide, and we are still connected to the patients, and all the engineers who are working now with us have the ability to see the patients, to understand the needs of the clinicians, and that's still driving the opportunity to support the CPOs worldwide.
Speaker 1:Yeah, well, before we get into that side of things, I just wonder, like, how do you decide as a person, especially on the software side, what solutions you need or what problems you need a solution to right? So how do you filter that? So definitely at Rodin, when you had your client base, essentially, or your customer base, and now, with a bigger customer base, with maybe some people that are experienced, some people that aren't experienced, how do you filter those things of, hey, these are features that we want, which one? How do you choose?
Speaker 3:A good question, thank you. Probably at the beginning it was more easier because the choice of diversity, of the Sorry, I want to mean. Now there is more diversity of technology and the choice is more difficult to choose the good direction. At this time the problem was clear and there is not so many solutions, but, as you said, rapidly. We build a community of users internally, but also we build progressively. We have many customers worldwide and when we gather them we work on that and we analyze the needs and then the best idea wins each time and we were very reactive and developed fast the new tools to give access to and answer the needs of our customers.
Speaker 2:Let's talk a little bit about Carvers, because you guys make a number of Carvers, right. So what's the latest and greatest in the world of Carvers? Are these things getting cheaper, more convenient, faster? What's happening in this carver development?
Speaker 3:Yeah, we started with a 3D axis carver and it's not really 3D. It was not really 3D axis carver, it was 2.5 axis because we obtained the 3D by the rotation of the mold. Then it allowed us to make all the positive shapes that we need. It was a little bit different when we wanted to carve. As you know, in Europe we are making a lot of custom-made seats with negative shapes that we need really to have five axes of freedom to do that and it's why we developed a branch who integrated the robot solutions but for, I think I mean for the, the daily things akbk, body jackets, uh, helmets and so on, made by carving Two and a half carvers was well enough at this time Again in 1997, it doesn't exist really and we needed to develop everything and still we have more than something like 160 machines worldwide working and still working on that.
Speaker 3:Of course, with the arrival of the 7-axis robot, it was also a game changer in terms of time To carve now a body jacket in 12 minutes. It was not possible at this time with a carver but it's possible now with the robots.
Speaker 2:And these kind of robot-driven machines. Right, is it going to be much more expensive to buy one of those or is it just a no-brainer because of the speed? Is it just going to? Maybe the investment's a little bit more, but then the speed is going to win it back for everyone really quickly.
Speaker 3:It's still we have. It's why, sorry, everyone really quickly. It's still we have a. It's why, sorry, we still have an offer with Carver's. But in terms of productivity, yes, it's more expensive, but in terms of productivity, it's more interesting to have this type of robot. Of course, you need to reach a certain level of production to be able to make the amortization of this type of investment okay, and what are you seeing?
Speaker 2:of course, you guys have got more a global perspective here. The podcast we end up talking a lot more about the us often. Yes, uh, you know. Are you seeing a shift towards kind of more central fabrication, c-fab type of stuff? Are you seeing mom and pop shops do a lot more fabrication in house? What are some of the trends you're spotting on the machinery side of things outside?
Speaker 3:What we always wish is to give the tools for the CPOs can be as much as they can be independent I mean control their own orthopedic correction, control their own way to produce. But in the same time we see that concentration on market and concentration on market may create a big CFAB and the need of big tools of production like robots.
Speaker 2:Okay, and do you think this kind of centralization is going to continue across the world? Do you think there's going to be more bigger companies, or do you hope that the smaller shops are going to be really empowered by all these machines and they could maybe in the future, automate more and do more with automation and maybe have to spend more time with patients?
Speaker 3:It's what I wish to keep this diversity on the market, because diversity makes the offer for the patient at the end a variety of treatments. And that's what is important for me, for us, for the patient to have access to a variety of treatments. But, as we see today, there is a big concentration on the market.
Speaker 2:And how about software? I mean, you used to have a complete CAD-CAM package. Now you've got more automated of automated workflows. Where do you see this going? Do you see people wanting like really, you know, really powerful cad tools, or do you want, or do you think that people just want to? You know, press a button and then out pops uh, you know the device I.
Speaker 3:I see both needs. Uh, still a big central fabrication need I? I want I mean horizontal offer, that's a software we're able to correct a fo but also an insult, but also body jackets. But in the same time we see also some very specialized clinics, very vertical, who make only helmets, who make only 3D printing body jackets. Then the answer is not always the same and it's why we have kind of different offers for different approach depending on the needs of the clinic.
Speaker 2:Okay, and I understand that you're. One thing I really saw was really interesting is that you make a mobile unit as well, carver as well. And do you see? You know most of the orthotics and prosthetics market seems to be very focused on the rich kind of the OECD country people right, the billion richest people on the planet and we know there's like a much bigger market out there in also developing countries and also really poor countries and they have different needs. Do you think that that's? Are you guys making tools for those people as well? Do you think that is going to be? Because it seems like that could be where all the growth is right. If these guys get richer, they'll be able to afford more sophisticated devices and they'll power a whole new wave. Is that something on your radar as well?
Speaker 3:Yeah, yeah, is that something on your radar as well? Yeah, yeah, we are working with a lot of NGOs worldwide and then, when we analyze the needs, there are a lot of mainly different than what are the CPOs in the I want to say rich countries? Then the approach is a little bit different. What are the, the, the, the CPOs in the I want to say rich countries? Uh, then, uh, the approach is, uh is a little bit different and, um, we want to, uh, to have an answer to that also and we want to keep that on our radar.
Speaker 2:Um, because, uh, the, we, we, we have to serve all the the, the patient, uh, all the patients worldwide. And yeah, tell us a little about because you guys made, uh, you made your own printer right the arcade which is like an insole, uh printer right, that was um and uh. Having come from that business, I bet that was a lot of fun right compared to, compared to carvers and stuff like that, where it's all a bit more definitive and stuff that. Uh, what was that whole process of developing a printer like?
Speaker 3:yeah, we wanted to, we wanted to um to to digitize the, uh the the podiatrist, uh the podiatrist, and then uh we search a way to have a printer who is able to uh produce continuously. It's mean that uh, all along the day, the the podiatrist can design with the patients uh the, the, the insoles, and send directly uh to the printer and the printer, uh, 24 hours by seven, can print uh and you know that the arcade printer is printing on the, on the belt, uh automatic belt belt. Then you don't have to make intervention between two printing and then it's allowed the printer to print 24 hours. And we are using a TPU, foaming TPU, and we are able to print 17 different density with only one printer. That allowed us to simulate quite all the materials that the podiatrists are using for the insoles and, yes, it was challenging and we developed this printer during the COVID.
Speaker 2:It was a COVID project. There I learned to bake, no. And so how do you do this stuff? Because, okay, 24-7 operation, that's nice, you're going to put in a bunch of more expensive parts and make some longer lasting things. How do you do it, for example, with nozzles? Rightzzles, right, because start, stop clogging nozzles is a nightmare. How did you manage to kind of circumvent that?
Speaker 3:um, I think it's a little bit too technical for me. Uh, if I uh how we manage the, the nozzle death. It was a critical at the beginning, uh, to find the the way, find the way to clean up the nozzle, and we find a solution with a specific metal that we use where the foaming TPU is not.
Speaker 2:And also I love that you're using foaming TPU. I think it's difficult to understand just how enthusiastic both Brent and myself are about foaming TPU generally and what you can do with it and just how lightweight it is and how many different kind of densities and properties you can simulate with this material. We think it's really amazing. I know my favorite material in the world is probably PCL, actually polycaprilectone, and then maybe I think Brent is right now moving towards more peak. But I think one of our favorite is this foaming TPU, just because it's so versatile.
Speaker 2:And how do you actually kind of dial in these kind of different hardnesses, softnesses, and you kind of dial in these kind of different hardnesses, softnesses and you kind of use that material to the fullest? Because it's one of these things where people probably don't think that much of the fact that you can have a material, change the extrusion temperature and extrusion speed and then you get different properties. Right, you can make something harder and literally you could make something harder and softer in the same print and even in the same layer or area. Even so, how do you kind of design for that or how do you explain that to customers?
Speaker 3:Yeah, it was the main challenge. You know, the plan was to try to digitize the podiatrist. And then, of course, the podiatrist is concentrated on his patients. Of course a podiatrist is concentrated on his patients and we don't want to teach them how to use a slicer, how to use this and this, and it's why we integrate completely the scanner, the software and the printer. That to obtain the 17 different density, we play between the foaming, as you say, by the time, by the speed, but also about the infill of the three printing, and, as we are printing on the belt with an angle of 30 degrees, that we always print the contour, that it's a very clean product at the end. That's an important way because there is not so much post-processing just to get what you need and that's all. That was the challenge, to really simplify the way. And it's each time our challenge, you know, to translate the industrial tools to simple tools for our customers and for the ONP and the podiatrist.
Speaker 2:And how would you look at this? I mean from a positioning standpoint. It's very interesting because we have people that are trying to do this with Creality printers, like literally that. So the printer is super cheap, it's essentially disposable, but there's a lot of manual labor involved with getting it out of the build platform. There's a lot of tweaking as well. Then now we have the option of doing it with the bamboo labs, which is what I'm trying to do at my house, which is, of course, more expensive but better, and then you've got, like you know, you could, I guess, also do a lattice-based insole kind of on an MGF printer, and you guys are kind of in the printing in the middle of it. You guys are kind of in the middle of it. Do you think that the less handling and the focus on this TPU material, that's going to make this the best solution? Or is this, you know, for a particular type of practice, you really are the best solution? What's the positioning of this thing?
Speaker 3:I don't think that it is the solution for everything, but again, it was as you know that we are based in Europe. It was more analyzed for the European market for these needs, even if we have now solutions in Canada also. But the podiatrists in France are using in Europe soft materials and this is the answer of the small podiatrist company who produce something like beginning of five, 10, 15, the pair of insoles a week. And even if we have central fab who have 11 machines and produce more than 2,000.
Speaker 2:Oh, wow, yeah yeah, yeah, and it just comes right. It goes off the belt and it comes down into some receiving bin or something.
Speaker 3:Yeah, it's for at the end of the day, it's for another.
Speaker 2:Okay, and how big are the spools of material you can put in there, because that's also another issue, of course, right, material you can put in there, because that's also another issue, of course.
Speaker 3:Right, yes, we have two big spools of four kilo that it's a row to print, uh, 100, pair, 50, voice pool and there is automatic changing in the pool on the system, on the printer. Then, uh, when you, you, when you launch the printer, you, you can print something like 80 or 100, depending on the size, of course that's cool, that's not bad.
Speaker 2:And how long does it take? There's like a couple of hours. You managed to do that.
Speaker 3:It's an average of one hour 20 minutes by install season.
Speaker 2:Okay.
Speaker 3:Almost three hours a pair Okay.
Speaker 2:Nice, nice. And so talk to me about the soft and hard insole thing, because I just think it's really weird that like half the world is like soft insoles is the way to go and the other half is like no, no, we need some carbon fiber hard stuff. Why is this a historical thing that just happened, or is one better or?
Speaker 3:no, probably yes, in in, in mainly in france, the schools are teaching only this, uh, quite only this type of technology, uh, for correction of the of the foots, uh, with the soft materials okay, so it's just, it's a regional preference.
Speaker 2:I still think it's really weird germany.
Speaker 3:Little bit difference north of europe. Little bit difference North of Europe. A little bit different UK also. It's more mixed, hard and soft.
Speaker 1:I'm kind of curious too, luke, just on your experience and your vast amount of travel worldwide is. I know our listeners are always interested in how these regional differences, so we talked about hard and soft. But let's say, like, um, even you know AFOs, um you know, in Europe, versus an AFO in the United States or Canada. What are some things that surprise you about some of the differences? Um, there, and and it can be related to our crazy system of L codes and billing or something else what are some of these differences that you see that are regional?
Speaker 3:It's often also why we need to provide different solutions because of the reimbursement price and don't need to travel so much. If you stay in Europe, between some countries, An AFO can be reimbursed, or code 300, 600, 1,000. It depends on the country. Then we have to adapt the technology of how to produce according, of course, to the reimbursement price. We have to adapt the technology of how to produce according, of course, of the reimbursement price. Technically, we are making for an AFO and to correct a foot. We are quite all making the same, roughly the same things In terms of details, of designs and of functionality. Of course there is diversity, but we don't see so much difference on that. The main challenge is to adapt the solutions to the price.
Speaker 1:Gotcha, so you would say that the philosophies of bracing are very similar, but it really comes down to how those philosophies are impacted via the fabrication method.
Speaker 3:Yeah, driving by the what we call reimbursement prices.
Speaker 2:And just if we're looking at digitization, so just scanning, 3d printing, all that kind of stuff is there a country or region in the world that's much more mature, that's adopting the 3D printing of these technologies much faster, or is everybody kind of going at the same rate?
Speaker 3:There is, depending on the size of the company and maybe the concentration of the market started a little bit more earlier. In Europe Then we have biggest companies, then probably in the US there is more POPs, still, as you say, pops and MOMs companies. Then the level of investment is a little bit different, the capacity of investment in CADCAM and the feedback on the investment also. Then we started to digitize China, for example, 10 years ago, and there was a big gap, you know, on the rest of the world I don't see so much difference, probably in Europe a little bit more. The technology is more adopted, yes, earlier, adopted, okay and talk to us a little bit about Equal.
Speaker 2:So, first off, because we know it's one of the biggest groups in 3D printing. But Equal itself is well, maybe not so not really well known to a lot of Americans. Perhaps, or maybe they're, I don't know. But talk to us a little bit. What is equal exactly? Um, equal.
Speaker 3:It's, um, as I said to you, that I, uh, we work, I work always in the ONP company and I enter in the 1990, 94 in a in a. Already a group of 70 people was named La Garigue and it's a typical French name, and we began to be a big group in France and then we scaled up with some investors and then we needed to have a name to cover all our activity worldwide. And then it's why, two years ago, we created the Equal Group and then that's the origin of the group. It's a big group of O&P companies in France and now Switzerland, Belgium, Spain and UK, where there is three main activities. You have the DNA of the group is the clinics, you have the component division and you have the digital division.
Speaker 2:And do you think that well, if we're looking at that, I mean, we could understand that doing all these different things at the same time could really have these economies of scale happening and stuff. Do you think is that the secret to being a part of a group like this that there's more money available to make more tools or something like that?
Speaker 3:Yeah, to gather all these activities is give the power to serve better the patients.
Speaker 1:So I didn't even think about it in the three separate ways. But being able to really control in a good way all three of those your components, your manufacturing and then obviously the clinical side components, your manufacturing and then obviously the clinical side is a great way for the vertical integration to grow everybody together. And Equal seems to have a quite diverse portfolio to where you have guardrails right of what's available within even the digital tools, but then you also are able to play in a very large sandbox on an eight-lane road, essentially. So I think that's pretty neat.
Speaker 3:Yeah, you use a good word variety, diversity. Yeah, you use a good word variety, diversity. And we need to serve. And we have to serve I mean not only equal, all the ONP company, the diversity of patients and we need to have access to a diversity of tools, but in the same time, to give the freedom of the CPO front of his patient to choose what is the best for his patient at this moment and not only because it's accessible in the group.
Speaker 2:That's a wonderful sentiment, Luc. So, Luc, thank you so much for being on our podcast today.
Speaker 3:Thank you.
Speaker 2:And Brent, thank you for being here again today.
Speaker 1:This was so cool. Yeah, luc, thank you for sharing your experience and a little bit more of your journey. Just the vastness of the experience hearing about your journeys making your own computer when you're 12 and making your own essentially raw materials to make the braces and such I love that and, yeah, I just look forward to continuing to see what is next for you guys for sure.
Speaker 3:Thank you very much to welcome me and thank you for your contribution to the ONP community. On what you have made, it is a significant impact.
Speaker 2:So thank you so much, everyone for listening as well. This is another episode of the Prosthetics and Orthotics podcast, and you have a wonderful day.
Speaker 1:Hey, and that's all we have for you today. Thanks for listening to the prosthetics and orthotics podcast and thank you to Luke from Quadra from sharing his insights and experience. If you enjoyed this podcast, please give it a like, follow, subscribe and tell all your friends. And until next time, have a great week.
