The rise of anatomical lasts - is this the end of orthosis prescription?
By now many of you have heard me speak on futurism in the world of athletic footwear. And you have heard me say, the future is now, because what we thought impossible 6 months ago, is possible.. today!
And, there is very little doubt that this will present challenges to our much loved status quo, and that those who will succeed in this brave new world will be able to adapt to the very large changes coming, and be nimble.
What am I talking about here?
Right now, it is possible to build a completely customised, bespoke pair of athletic shoes, utelizing 3D printing, advanced manufacturing processes, machine learning and futuristic midsole technology including 'bled materials' of different viscosity, shock attenuation and enery return, placed according to where the athlete needs them, for what purpose and even for what postion they play within a particular sport. We can do all this.. right now.
Take football for example.. the striker is actually playing a completely different game to the goal keeper.. but they wear the same shoes. Makes no sense!
And, why would shoes be a mirror image of each other? Our feet are not.
One of the biggest challenges will be how we utelise orthotic devices, because the advent, and rapid utelisation of "anatomical" lasts, makes the traditional model of orthotic prescription... impossible.
What is an anatomical last?
Well, let's step back and describe what a traditional last is, because by far the bulk of all footwear is still made from these.
Last have been around since antiquity, and they are the wooden, or these days resin molds, resembling the shape of a foot, over which the upper is formed, or “lasted”.
So you can see immediately there is another very important formula:
CRAP LAST = CRAP UPPER FIT = CRAP RUNNING SHOE
The last, in short, determines EVERYTHING.
Most running shoe companies will work off one last for their with-in category running product. So for example, performance distance product will have last X, racing flats will have last Y, and sprint spikes will have last Z.
Typical resin last – note the flat plantar surface
Last manufacturing in itself is not an exact science, and most lasts bare scant resemblance to an actual foot.
Some companies have had a fair crack at addressing this by building more “anatomical” lasts, but until very recently they were rejected by consumers because they looked weird (i.e., they looked like a foot rather than a shoe.. think about it… think about it!!)
All this is about to change, because 3D scanning of the foot is now so good that we can build very accurate bespoke lasts for athletes from these scans.
These are far more anatomically accurate, and I predict that within the next year or so, manufacturers will have vast libraries of lasts to choose from that will provide a near exact match for individual runners.
So, this is how it most likely will look:
You will take a scan of your patient's foot, and along with all important biometric data, you will feed this into an algorithm which will be uploaded to the cloud. From here, a last, specific to this athlete will be 3D printed. This is then his or hers.. forever, or at least until it needs to be changed.
This is an actual 3D printed last ; Not the complete contouring in areas around the sustentaculum tali and into the arch
This last, the "anatomical" last, is totally responsible for the look of the finished product. A footwear expert can spot a shoe built off a dodgy last at 30 paces, because it does not look right on the slat wall. The shoe should look sleek and fast, should have the correct dimensions for easy ingress and egress, and the shoe should not demonstrate any overt bagginess of the upper. Some manufacturers consistently nail this.. some consistently do not.
Now, here is the complication with anatomical lasts, because the last shape will also determine the height of the midsole sidewall.. in other words how thick the midsole looks, because it determines the point at which the upper is stitched to the midsole.
As a general rule, lasts that have a rounded contour to the plantar surface (in other words look more like the plantar surface of the foot), will appear more bulky because the side wall of the midsole has to finish higher to hide the stitching. Likewise, lasts with a flat profile to the plantar surface result in a more streamlined product. It is therefore no surprise the vast bulk of running shoe lasts are flat on the bottom!
You see, the manufacturing processes have changed so rapidly, that shoes built from anatomical lasts now look sleek and fast. And because the plantar surface of the last is shaped exactly like the plantar surface of your patient's foot, the contact between foot and shoe will now be just like a full contact plaster cast.. it is no longer flat, it is contoured to match the foot.
Full contact athletic footwear!
And, of course, you will not be able to put a traditional othotic device into this type of shoe.. it simply will not work!
Now this is not science fiction, this is happening right now, and this technology will accelerate and become the norm, because,
it will be better
In addition, you, the practitioner, will be able to have 3D printed matrices embedded in the midsole material, whether it be EVA, PU or the TPE based foams.
The shoe... is the orthosis.
Now, from my computer I hear the collective intake of breathe, and not a small amount of cussing and foul language, but, this is not a threat, not if you are adaptable and amenable to change.
it is simply a different way of going about what you do best.. help to redirect potentially injurious loads with an in shoe orthosis
Before you all start blackballing me, I will go on record and say I think there will still be a place for traditional orthotic therapy, however, your world is about to be expanded, big time.
And, it might an idea to take note of the very wise words of Jay Asher
“You can't stop the future
You can't rewind the past
The only way to learn the secret
...is to press play.”
Director of Bartold Clinical