How I healed my foot with 3d printed cast

14th June 2017

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A Story of how I fell 3 stories height, broke my foot and used 3d printing to heal it. 

 By Keith M Azzopardi

This post is a little window into my personal world’ and how I ‘put my money where my mouth is’ to show that I truly believe that 3D printing will shape the future. 

As a co-founder of a startup your life is 90% stress, the other 5% asleep and 5% trying to de-stress. This means that if you do not have a way to vent you will eventually end up going crazy. One of my vents is rugby. 

To cut long story short, after one rough night out with the mates from rugby I found myself tripping and falling 3 stories height into bottom of the valley, which resulted in breaking my foot. This happened just before going into the farmhouse, when I crossed the road to look at the valley. I jumped on a 50cm high wall, not realising there was a sharp drop on the other side. 

We rushed to hospital. At this point my foot was so swollen that doctors were using it as viewing gallery, calling one another to come have a peak because they hadn’t seen anything like it. An x-ray was taken and after a while I was told I had no broken bones, at worst it would be some tissue damage.

Next day I went in to work. As the hours passed, having my foot hanging in a downward position, the swelling got worse and worse and the pain was unbearable. I had to leave to go back to hospital. After being made to  wait for hours and walk around endless corridors I was finally seen by a doctor but I was told nothing was wrong for the second time. 

Figure 1: Swelling of the broken foot

A friend, also a very talented physiotherapist, Matthew Camilleri, messaged me to check how things were going and told me to go over for a check-up. After Examining me he told me I needed to get more treatment and needed to go to a hospital. Thankfully I took his advice and went to a third hospital where they finally decided to conduct a MRI (Magnetic Resonance Imaging) scan.

Surprise, surprise, several bones in my foot were broken. The bones in my big toe had shattered one another, the next toe was also broken and the bones displaced and every other bone in my foot was fractured.

With these results in hand the orthopaedic specialist immediately said we need to use cast and my  response was, ok but I’ll make my own…. I’ll print it. 

The Look on his face … Priceless !! The conversation went something like this:

Orthopaedic surgeon: What do you mean you’ll print it?  While giving a look ‘you are either crazy or not all there’.

Me: I’ll 3D print it. I will scan my foot, model the cast around it (or at least Etienne, our in-house modelling Guru, would do the modelling), 3D print it and I’ll have my cast.

At this point it was a bit of a blank stare and realised that he wasn’t really clear on the 3D printing technology let alone its applications. I went on to explain a little more about the process and what I was proposing.

Orthopaedic surgeon: What you have equipment to do this?

Me: Yes!  --- with a huge smile across my face

Orthopaedic surgeon: Are you sure?

Me: Yep, I will remove all liability from you so you don’t need to worry. 

Cation: DO NOT TRY THIS AT HOME

Orthopaedic surgeon: Ok up to you. I can’t recommend it but it is your choice at the end of the day.

It went on for a while but at the end I was determined to do this. I have to admit all his retaliation had put some doubt in my mind but at least by then end of it he did offer advice on the design perspective and told me to feel free to pop in when I had anything in hand.

I went straight from the hospital to the office and got Etienne to scan my foot. Since the procedure was not standardised it was not exactly comfortable but …. it’s in the name of science. At least the scanning did not take too long. Etienne used the scan to start designing the cast around it immediately. I was expecting a simple cast, made in two parts, which could be tightened when the swelling had reduced. Etienne had other ideas, he pulled an all-nighter, putting in fancy designs, putting in perforations to make it breathable and what is more, the perforations were actually the company name. The back was also designed to look like it came out of a comic. When he showed it to me, honestly, I felt like a kid again and really wanted to get it done so I can get this on. 

Figure 2: Render of scan of foot and first prototype.

 

We started 3D printing the two parts, the longest of which took 16 hours, but then I had my cast. It is obvious we used Magigoo for reliability. With the cool designs, I felt a little like ‘iron man’ or at least ‘plastic man’.  A nice surprise came from how the supports were printed. We hadn’t designed the bottom to be flat but with the support I had a way to have a foot rest. We later went on to redesign the cast to add this as a feature.

I went back to the orthopaedic surgeon and he seemed quite impressed. One problem was that we overlooked a medical detail. Basically, the rest position of the foot is not at a 45° angle but more around the 90° mark. It wasn’t a huge problem because for the purposes of the injury it would do the job but leaving your foot at 45° angle for 6 weeks could end up shortening the achilles tendon, which may lead to longer rehabilitation periods. The orthopaedic surgeon gave me my programme for the next six weeks and told me to send pictures when I had a cast at 90° just to make sure it was correct. 

The 90° cast was quickly remodelled and 3D printed the cast for a second time and I was good to go. The first two weeks I was not allowed to put any pressure on my foot so there was no actual test on the strength of the 3D printed cast but some massive positives were already evident. The biggest advantage was that I could wash my foot even with the cast on, secondly, I could periodically take the cast off and rebandage it.  To anyone who has ever had to use a cast, It would immediately be evident that these features are a god send. To me at least the most important advantage was that I could see my foot, see the swelling go down and see the progress. The psychological gains there are immense. In general, you automatically have doubts and a lot of ‘what ifs’ in your head when you go through something like this, but seeing progress gives you that little push, that little bit of happiness that makes everything seem like it is going to be ok. 

 



Figure 3: Render of the second prototype, with ankle angle at 90° and extra support to rest the foot.

It was somewhere around this period that we were scheduled to exhibit at Fabcon 3D in Frankfurt. Again, this was a test of faith and was surprised with an unexpected positive of having this 3D printed cast. The only way to efficiently get to Germany from Malta is to fly there. So, I headed to the airport, it had never crossed my mind to tell the orthopaedic specialist that I’ll be traveling but as soon as I got to the front desk they asked if I had relayed this information and if the cast was suitable for travel.  I wasn’t going to miss this conference, so my obvious response was ‘yes’…. The reason they ask is because of the difference in ambient pressure you experience during a flight, injuries tend to swell even more. If the cast is a solid piece this would produce a lot of extra force on the injured area which will result in unnecessary pain. Luckily the 3D printed cast was made in two parts and could be tightened and loosened as needed. Again, I had a huge smile on my face ‘This thing is awesome!!!!!!’. At the show the cast also got a lot of attention to our stand and got more attention to Magigoo. The rest of the trip went off without a glitch


Figure 4: Just landed at Berlin Schönefeld airport and about to start the journey to Fabcon 3.D

The next test for the cast was starting to put weight on it, at first it was putting weight on my foot while still using crutches. The first thing you realise is that because this was designed to fit my foot’s contours, it was comfortable, even though it is made from a hard plastic.  Eventually the time came to put my full weight on my foot while still in the cast. And as things go, it coincided with an event I had. I ended up walking a few kilometres that day. Again the ‘plastic foot’ was doing its job and excelling. 

A week or two later I had a wedding of two dear good friends, Edward and Pam. As a note, Maltese weddings are something of an event and this wedding was one of the good ones. Alcohol consumption on my part was not lacking which meant that any pain which would have been present was non-existent, and the dancing and jumping went on and on.  Amazing stuff, but the next morning I realised that I had cracked the cast. The fact that I still had a cast at all was amazing considering that I am 90 kg person, and had been jumping around all night.

 Again, problem was easily solved, just 3D print another cast.

It was finally time to go back to the orthopaedic surgeon and see the results. By this time, he had actually taken interest and had read up quite a bit on the possibilities and was also excited to see the results. I didn’t mention any of the eventful stories which had happened until he had said ‘it looks good’. That was an amazing feeling, somewhat of an accomplishment, I had used a 3D printed cast designed and tweaked to my needs, and having done so much in it and proved that this thing works and works better than anything I had been exposed to before. I still have the cast and it will forever be one of my life trophies, as a token of an unforgettable experience. 

 

If you ever want to see the cast , we usually display it when we will be exhibiting - Maggio – the 3D printing adhesive. You are always welcome to pop by our booth!!!! 

Till next time … Happy Printing!!!!!.

 

 

 

 

 

 

 

 

 

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