3D PRINTING Adding new dimensions to personalized healthcare

PHITS AND FOOTSCAN Empowering tools for O&P and Podiatry

PRODUCT INNOVATIONS Increasing patient satisfaction

factsSETTING NEW STANDARDS FOR FOOT ORTHOTICS

NOVEMBER 2018

MARATHON LEGEND AND PHITS PIONEER

Paula Radcliffe

phitsinsoles

phitsinsoles

@phitsinsoles

ADDING VALUE THROUGH ADDITIVE MANUFACTURINGIt’s been only 4 years since RS Print launched its 3D print foot orthotics solution at OT World in Leipzig in 2014. In those early days, people told us it was way too early for such a high tech solution. But we stubbornly believed Phits would succeed.

In these 4 years our services and our team evolved and the product became a true brand: Phits. Competitors popped up and a lot of them already disappeared, but Phits is here to stay as the global reference for 3D print orthotics.

We would like to say thank you to our very first customers: they knew that it was about creating added value, about offering more accurate and more durable devices, about incorporating functionality that couldn’t be created with traditional manufacturing methods. Combining objective dynamic gait analysis data with their own expertise.

As acceptance of 3D printing grew, the general belief was that it was still too early for the majority of the industry. As we speak, 3D printing remains a black box for a lot of people in our professional field. That’s why, in this Phits facts, Nico Roose, production manager at Materialise, will explain the benefits and limitations of common 3D printing technologies and which technology fits which application.

Although still in its early stages, several big players have now started to see the benefits of 3D printing for their activities. Most of them quickly realize that they need a solid partner with solid backbones to guide them: that’s where Phits makes the difference. As you will find out, we respect the input of our Phits Expert to make sure our innovations and developments are expert driven.

In the meantime, the Phits Expert network internationally expanded with people who truly believe that digitizing the patient journey is the way forward. A network of clever experts that understand that their core competence is not only craftmanship, but foremost focus on servicing the patient. Further in this magazine, Jo Lucas an experienced orthotist from the UK and Eva Bostyn, a young Belgian podiatrist, share their experiences with you.

That’s where footscan and Phits create added value for the individual health care expert: it’s a technological tool that enables you to design and deliver the right, durable and reliable solution for you patients.

So whether you’re an innovative individual health care expert with an outsourced production or a big multi office company looking at implementing your own 3D-printing facilities: Phits is an added value to your company and to your product and service range.

It’s time to make your move.Tom Peeters

Brand Manager Phits Insoles at RS Print

EDITORIAL

TABLE OF CONTENTSEDITORIAL 3

THE FOUNDATIONS OF PHITS 4

PAULA RADCLIFFE - FIRST HOUR PHITS PIONEER 6

3D PRINT TECHNOLOGIES 8

Nico Roose - Production Director of Plastics at Materialise 8

3D print technologies 9

Vimal Reddy, DPM on the added value of 3D printed orthotics 11

CASE STUDIES 12

Treating hallux rigidus with Phits 12

Treating plantar fasciitis with Phits 13

PRODUCT INNOVATIONS 14

Slim Phits 14

Wide Phits 15

BACK ON TRACK - PATIENT TESTIMONIALS 16

PHITS EXPERTS : JO LUCAS - THE LAKES ORTHOTICS (UK) 18

PHITS EXPERTS : EVA BOSTYN - POSTILLION (BE) 22

ALLISON RUSSELL - ATHLETIC TRAINER DALLAS WINGS 25

PHITS DISTRIBUTORS 27

MAKE YOUR MOVE, BECOME A PHITS EXPERT

The Phits Expert network is the world’s primary network of 3D print foot orthotics providers. Contact us to find out more about products, services and Phits Expert training programs.

Join today, contact sales@phits.com

certified expert3D-printed insoles

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CONSORT DIAGRAM OF THE FLOW OF PARTICIPANTS THROUGH STUDY

MATERIAL DURABILITY

As you can read on the next pages, Phits are printed with a technology called Selective Laser Sintering (SLS). This is a powder based technology that layer by layer sinters the powder to make it a solid object.

The powder used to print Phits is Polyamide 12 (PA 12), which is commonly known as nylon powder. This is a very light material.

The combination of the SLS technology and the PA 12 seems to be the best possible combination in terms of durability.

Rotation tests performed on PA 12 sintered objects show that the material does not wear out if it’s stressed below 20 Mpa or 2000N/cm2.

200 N/cm2 is already exceptionally high for a human footstep. Under normal circumstances, it is safe to say the PA 12 printed base of Phits is very durable and very lightweight at the same time.

IN THIS ARTICLE YOU CAN FIND MORE ABOUT THE SCIENCE BEHIND PHITS, BUT BEFORE THAT WE WANT TO GIVE YOU A SHORT INSIGHT IN THE ACTUAL PURPOSE OF PHITS: WHY ARE WE USING 3D PRINTING TO CREATE FOOT ORTHOTICS?

Phits Insoles are produced by RS PRINT, a joint venture of two Belgian companies, both world class leaders in their field:

� RS SCAN INTERNATIONAL (www.rsscan.com), specializing in the field of gait and even body analysis, globally respected for their footscan pressure plate and gait analysis software.

� MATERIALISE (www.materialise.com), a pioneer and leader in 3D print applications and software.

RS Print was founded to produce the best possible orthotic based on dynamic gait scanning. Rs scan international had previously developed the so called D3D orthotics, directly based on the footscan anal-ysis: a modular system to create orthotics with EVA components. The results were excellent, but it faced some challenges: labor intensive, difficult to repro-duce, a bit bulky and limited durability.

Phits is the 3D print 2.0 of the D3D orthotics, using the same logic and the same algorithms.

But why 3D printing? Rs scan was looking for a solu-tion to tackle the above issues: they wanted auto-mated, reproducible, more accurate and above all more durable orthotics. They found that 3D printing offered great possibilities, but they needed a solid partner to meet durability, accuracy, scalability and automation requirements. Enter Materialise.

It is important to understand that Phits is not merely copying the D3D system, but adds value for the following reasons:

� Durability of the printed base

� Reproducibility due to automizing design and manufacturing

� Ability to integrate intrinsic dynamic corrections in one single material, resulting in a very thin and light orthotic.

AT THE BASE OF PHITS: SCIENTIFIC RESEARCH

In general, there is little scientific research and liter-ature about the effect of foot orthotics, but there is scientific evidence about footscan and about the effect of the D3D orthotics, the Phits’ predecessors.

In 2011, dr. Andrew Franklyn-Miller conducted two research projects in the British Navy:

1. Testing the predictive value of the footscan risk analysis The study taught us that we can use the Footscan® pressure plate and gait analysis software to predict lower limb injury risks, based on the subject’s dynamic pressure scan. Of course, not every ‘high’ risk patient will eventually have an injury. The opposite goes for a ‘low’ risk patient, they also have the potential of developing a lower limb injury. However, the calculation of the system and the prediction derived from it, are a great tool to give feedback to your patients.

2. Foot orthoses to prevent injuries during mili-tary training In the second study of Dr. Franklyn Miller, there was a proven reduction of the injury rate by providing the ‘medium’ and ‘high’ risk subjects with orthotics based on the same algorithm. ‘Medium’ and ‘high’ risk subjects in the control group who were not wearing these orthotics, had up to 60% more injuries than subjects with the algorithm based orthotics.

Read the full studies on our website: http://www.phits.be/en/professionals/documents

THE FOUNDATIONS OF PHITS

Group Risk Patients n = 400

Injuries n = 82

Injurie RateHours Training

Control High/Medium 200 61 1:1600

Orthotic High/Medium 200 21 1:4666

Absolute risk reduction

CER - EER(0.74-0.25)=0.49

Number needed to treat 1/0.49=2

Assessed for Eligibility

n=624

Randomized High and

Medium Risk n=400

Excluded n=224

Not met criteria n=219Did not Consent n=4

Other n=1

Analyzed n=200

Excluded from analysis n=0

Analyzed n=200

Excluded from analysis n=0

Lost to Follow up n=0

Discontinued intervention n=0

Lost to Follow up n=0

Discontinued intervention n=0

Allocated to not receive orhtotic

n=200

Allocated to receive orhtotic

n=200

risk category Number of patients n=200

% of total Number of injuries sustained n=57

High 42 21 27

Medium 56 28 14

Low 102 51 16

Fishers test - high risk vs. medium p<0.0002, high vs low p<0.0001, combined vs low p<0.0001.

TESTING THE PREDICTIVE VALUE OF THE FOOTSCAN RISK ANALYSIS

FOOT ORTHOSES TO PREVENT INJURIES DURING MILITARY TRAINING

5

PAULA RADCLIFFE

More info about runners’ lab? www.runnerslab.be

Interested in becoming a Phits Expert? Any other inquiries about Phits or RS Print: www.phits.com or sales@phits.com

big foot surgery in 2013, they pretty much recon-structed my navicular area and then we changed the design a little bit again.

You refer to the 2013 surgery. It was a multidiscipli-nary approach that got you back on your feet, that got you running again. Did the Phits insoles play an important role in this process?Absolutely. They were already important during recovery, but I think the insoles played the biggest role in enabling me to be able to get back to running and run the London Marathon one more time. You see, the original injury dates from 1994 when I had an nonunion stress fracture and Jempi (Wilssens, founder of runners’ lab and rs scan international) and the team helped me to get back running then with the orthotics and managed to help me throughout my whole career, but in 2012, it collapsed fully and I had a lot of arthritis and osteoarthritis, really a lot of damage in the joint. The doctors said they could fuse it, but then I could never run again. Then they said they’d try a big surgery with bone graft, with microfracturing the cartilage and a lot of repair work done and cleaning up. Maybe I could get back to running a little bit, maybe I couldn’t, but at least I wanted to try this. So I had the operation in August and I didn’t run anything until April of the following year, until then, it was only a lot of walking. When I started running again, we created a different pair of orthotics, because when I walk I need a different Phits insole compared to when I’m running. After the walking I was able to gradually get back to running and then very gradually built up the training. Until some-time in 2014 when it started to become possible that I could run London one more time. And then even… I remember even six weeks before we were still changing little bits with the orthotics to make it okay for race day. And then on race day it was great.

And you continued running ever since, a lot. Do you wear Phits insoles for every run?Yes! I never run without them, even for walking I use the insoles, they are always in my shoes. I don’t think I ran without my orthotics since 1997. And certainly since I got the Phits insoles, every run is done with them.

When you first heard about 3D printing for orthotics, were you surprised about this tech-nology for orthopaedic devices?I think I was indeed a little bit surprised, but when you see it and you’re able to experience how durable

it is and how functional it is, it quickly becomes something that you get used to, something you expect in that part of your life. It’s interesting to see it in different areas now. If the children have hurt themselves and they go to hospital, they might end up with 3D printed splints. And now we see 3D printing actually being used to make the whole shoe, it’s so exciting.

Can you describe the difference between the tradi-tional orthotic and the Phits 3D printed orthotics you wear now?Well, the biggest thing is the durability. They simply don’t wear out! You can keep using them, you can run a lot of miles in them and they basically don’t show much damage at all. Only the top cover wears out and these are easily replaced. The rest, it stays there the whole time. And I think it’s more precise than the traditional orthotics. Because it’s exactly the same each time that it is created. And it is lighter. It doesn’t deform with heat and get as soft as with the traditional ones… Sometimes with the older ones, if it was very warm, they would built up, or they would get a hole or they would deform a little bit. The Phits insoles don’t do that.

Thank you so much for sharing your experiences with us!

LATE SUMMER, PAULA RADCLIFFE, WORLD RECORD HOLDER ON THE MARATHON (2.15.25), VISITED PHITS EXPERT RUNNERS’ LAB NEAR ANTWERP (BELGIUM). OUR PHITS TEAM HAD THE HONOR TO INTERVIEW PAULA, A TRUE PHITS PIONEER SINCE THE VERY BEGINNING.

Paula, you were one of the pioneers to run on 3D print Phits orthotics, you have been using them for four over years now. Are you still satisfied with the Phits orthotics?Oh yes, very much. I still have the original pair, they last so well! When I come back to check here at the runners’ lab, they pretty much just need to recover the top cover and then they are good to go again. So I have two or three pairs and I switch them between the shoes and leave them in the ones that I am running and walking the most in.

That’s awesome, great to hear! You went through a lot of footscan examinations through the years. What do you as a runner still learn from a footscan analysis about your feet, about your gait, about your body in general?It’s really interesting to get the chance to study and to see in slow motion how you run. Sometimes how you think you run, is not at all how you do. By seeing the footscan analysis, I think you become more in tune with your body. So I’ve been coming here since

1997 and I’ve seen how the orthotics themselves have evolved a lot. And now we have the Phits insoles… that’s a big step forward in durability I think, but also towards function and weight… and how easily it fits into your shoes.

If you look at the corrections that the Phits insoles give you, can you link this to what you see on the Footscan?Yes, yeah, I can. But I think maybe because I’ve learned over the years and I’m interested in it. So when I come here and I run up and down, then immediately I go to the screens to check and to see. And it is a big difference. When I run barefoot, if I run in shoes without the insert and then if I put the insert in and run. You feel better in your body, but it’s nice to also see it confirmed on the images and on the Footscan.

How the corrections for my own orthotics evolved? I think my running style stayed pretty much the same. I had bunion surgery in 2009 and then we had to change around a little bit. And when I had my

By seeing the footscan analysis, you become more in tune with your

body

7

MARATHON LEGEND AND FIRST HOUR PHITS PIONEER PAULA RADCLIFFE

“MY PHITS SIMPLY DON’T WEAR OUT!”

3D PRINT TECHNOLOGIES

THROUGH PERSONALIZED HEALTHCARE, 3D PRINTING CAN

CHANGE THE WORLD PHITS INSOLES ARE 3D PRINTED, BUT WHAT IS 3D PRINTING AND EQUALLY IMPORTANT, WHY AND WHEN WOULD YOU USE IT? BUZZWORDS AS “INNOVATIVE”, “REVOLUTIONARY” OR EVEN “DISRUP-TIVE” POP TO MIND WHEN TALKING ABOUT 3D PRINTING. ISN’T THAT STRANGE FOR A TECHNOLOGY THAT ALREADY EXISTS FOR MORE THAN 20 YEARS? WHY IS IT STARTING TO CHANGE THE PRODUC-TION PROCESSES OF LOTS OF MEANINGFUL APPLICATIONS ONLY NOW?

We sat down with an expert in the field, Nico Roose, Production Director Plastics at Materialise, head-quartered in Leuven (Belgium) to talk about the fascinating technology behind Phits Insoles.

How long has 3D printing been around?3D printing has been around already since the 80’s when the first three-dimensional objects were printed based on digital data. Imagine, it was the time most people had never ever touched a computer or a mobile phone!

What do you consider as the main difference between 3D printing and traditional manufacturing?In conventional manufacturing processes, material is mostly removed from a block of material, think of carpenters carving wood, or milling and drilling of metal objects. Secondary processes are used, like making a mould as base for a series, and bending or forming of shapes. Smaller parts were maybe welded or screwed together.

3D printing on the other hand is a so-called “addi-tive” technique: parts are built up out of material,

layer by layer, from a 3D virtual model. That’s why “additive manufacturing” or “AM” currently is the most used term to refer to the group of 3D printing technologies.

The limitations of 3D printing were mainly related to the available materials and its properties. The hype created around 3D printing in the early 2000’s made us believe the sky was the limit, and everything could be printed, and everyone would have his own multifunctional home 3D printer. The industry has a better understanding of the value and the limitations of the technology as gradually more and more stable technologies, combined with a broader material range are becoming available to the market. Real meaningful applications are co-cre-ated by technology experts and specific industries to serve the real needs of a market making use of the real benefits offered by 3D printing.

What are some of these meaningful applications of 3D printing?The first applications of 3D printing were mainly in rapid prototyping, to speed up the product devel-opment cycle by having quickly available models or prototypes, both cosmetic as well as functional.

In recent years, the industrial market is also evolving towards applications where end use parts are directly printed and used in machines, or airplanes, the real additive manufacturing.

Medical and paramedical applications like Phits surfaced very fast. By combining patient-spe-cific medical scan data with the possibilities of 3D printing, patient specific appliances could be printed that were used in surgery, optimizing the treatment concept and outcome.

About MaterialiseMaterialise incorporates 27 years of 3D printing experience into a range of software solutions and 3D printing services, which together form the backbone of the 3D printing industry. Materialise’s open and flexible solutions enable players in a wide variety of industries, including healthcare, automotive, aerospace, art and design, and consumer goods, to build inno-vative 3D printing applications that aim to make the world a better and healthier place. Headquartered in Belgium, with branches world-wide, Materialise combines the largest group of software developers in the industry with one of the largest 3D printing facilities in the world.

SELECTIVE LASER SINTERING (SLS)

Powder-based processes start with a material in powder form. A first layer of powder is deposited by the machine onto a building platform, and an energy source (laser or light) will be projected on those selective areas of the layer that need to be part of the model, and will add the right energy for the parts to sinter or melt together. Selective Laser Sintering (SLS, plastics) and Selective Laser Melting (SLM, metals) are the two most common powder techniques. After one layer is built, the building plat-form will lower slightly, and a new powder layer is put on top and the process is repeated. As such, layer by layer, the intended model will be shaped.

These techniques typically can handle a quite broad range of materials, with acceptable mechanical properties for many func-tional domains, and is the most wide spread tech-nology in the market.

STEREOLITHOGRAPHY (SLA)

When the material used in the process is in liquid state, we are talking about resin-based processes. A building platform is positioned just below the liquid level in a vat or container filled with resin. As the liquids or resins are light-curable, a laser or other light source will also add energy to those selective areas that need to polymerize and light-cure to be part of the model. The building platform will now sink one layer deeper into the vat, a new liquid layer comes on top of the already cured aspects, and the process can start all over. During the building, also a support structure is built along to support the intended parts from moving and falling during the manufacturing process. This support structure needs to be removed after the parts are unloaded from the machine. Stereolithography (SLA) it is the “oldest” of the 3D printing techniques, but still largely spread and used. The materials in these technologies typically have slightly less performing mechanical properties, but surface quality of the end parts is superior.

FUSED DEPOSITION MODELING (FDM)

Rather than starting from a vat of liquid or a powder bed, there are depositioning tech-niques that just place the material where it needs to be in the model. Typically, the material wire or filament on coil is unwound and heated in a nozzle, to position small droplets of material exactly where needed. After posi-tioning, the droplets cool down and harden out imme-diately. This technology of Fused Deposition Modeling (FDM) is also used in lots of the smaller, cheaper desktop 3D printing machines, however the industrial grade machines allow to process materials with much higher temperature resistance and stability, making this a commonly used technique in e.g. aerospace industries. It’s what pop ups in most people’s minds when asked about 3D-printing.

3D PRINTING TECHNOLOGIES: THE BIG 3

9

did you know

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MY PATIENTS JUST SEEM HAPPIER WITH THESE 3D PRINTED DEVICES

Vimal A. Reddy, a DPM in Jacksonville, Florida, is a certified Phits Expert since early 2017 and has helped hundreds of his patients back on their feet with Phits. What are his thoughts on digitalizing the scanning process and on 3D printing as a manufacturing technology?

“Orthotics have been around for a long time and there was very little evolution in terms of manufacturing technolo-gies, in terms of how they’re made until now. Now you have devices, 3D printed, that are extremely light, one of the char-acteristics that patients love about them. They’re very light yet at the same time they can provide the same control that the traditional orthotics could provide. So now you have a device that you can put in many more shoes which results in more patient compliance and that is a huge advantage.

There’s more to Phits than only 3D printing. Number one is the footscan technology itself, the fact that it’s electronic, it’s digital. I really like that. The ease of scanning someone, the ease of designing the actual orthotic and the fact that you’re on the cutting edge of technology. Patients appreciate that you are always on the forefront of what’s coming up next. The material used for the 3D printing process, makes the device a lot lighter and a lot more user-friendly.

There’s added value in the fact that you can educate the patient and they can see exactly what you’re thinking on a level where they couldn’t see before. In the past, it was hard to explain it to the patient, to connect with the patient. Here you can connect more effectively and kind of explain to them what is going on in the process and why and how you’re making them and I think that’s highly valuable.

I think that’s a huge benefit for the patient that we can have them do a gait analysis to identify how they’re walking and that we can correct it digitally and go over the corrections with them to tell them exactly what’s going on.

Feedback has been excellent, patients really love their orthotics more than ever. And especially patients that have had the traditional orthotics in the past. When they get these new orthotics they’re euphoric about how light they are and how easily they can get them in their shoes. They just seem happier with these 3D printed devices.”

VIMAL A. REDDY, D.P.M. FIRST COAST FOOT & ANKLE CLINIC

www.firstcoastfootclinic.com

Visit www.phits.com to find a Phits Expert near you

Especially in the personalized healthcare, 3D printing has already shown how it can change the world. The hearing aid industry fully shifted from traditional techniques to perfect-fitting 3D printed ear-shells. In medical applications, like orthopedics and dental, the shift is happening right now. And with personal-ized glasses and insoles, the eyewear and footwear industries are ready to close the leap.

How does 3D printing work exactly, and what are the differences between the technologies?All 3D printing technologies have in common that they create an object starting from a computer file, in a layer by layer approach. Depending on the technology, the material form that is started from can differ from powder, or liquid to material on wire. Some techniques will just deposit material exactly where needed, other techniques will uses lasers or other light sources to selectively indicate those material particles that need to be part of the model. Although a large variety of smaller techniques or slightly different principles is available in the market, the 3 techniques described above cover majority of the industrial oriented 3D printing market.

Which type of 3D printing is used for the manufac-turing of Phits Insoles?As discussed before, using 3D printing to create personalized insoles allows to differentiate based on the foot dynamics of each individual. Size, shape and strength can be adapted in the design, and anatomic differences can be taken into account, improving

functionality and comfort. Phits insoles are specif-ically printed with Selective Laser Sintering, in a very fine powder of nylon (Polyamide) material. To develop meaningful applications as the insoles, it is important to combine the needs of the product with the technology and material of choice. The material-technique combination of SLS with PA material allows to create perfectly functional insoles at the right accuracy and detail, but also strength, flexibility, and durability. Printing the special texture you can find on your insole is adding this extra strength without adding too much material, resulting in functional, very light weight insoles. With laser sintering, it is also possible to build a larger amount of unique insoles at the same time in one print batch, adding to fast and reli-able delivery of insoles. For products like Phits, so called “mass customization” products, scalability and speed of service are important aspects.

Other technologies also often need a support structure during building, which needs to be

removed afterwards. For laser sintering, once out of the powder, and blasting the remaining powder dust away, the insole bases are immediately ready for final finishing.

How do you see the future of 3D printing? More mass customization products like Phits?3D printing can be a real game changer in many applications. Too often, when companies start to look into 3D printing, they choose something easy to start with, but then the added value of 3D printing is less visible and less tangible. I truly believe that co-creation between the industry and the technology experts like we have at Materialise can pinpoint the right applications where 3D printing can really add value. Specifically in the mass customization, as we already mentioned, the full adoption of the hearing aid industry towards 3D printing. Also in orthopedic and other medical appli-cations, the value of 3D printing is becoming more obvious. And certainly in the wearables industry, with footwear and eyewear as ambassadors that have already embraced the technology, we will see a huge revolution in the next coming years.

More info at www.materialise.com

Nico RooseNico (MASc in electro-tech-nics and automation) is the Production Director Plastics at Materialise Manufacturing, Leuven, and supports the different production sites of

Materialise to offer efficiently and reliable a huge variety of 3D-printed and related products to the market.

Nico joined Materialise in 2002 to develop patient specific dental guides and grew into product and production management of the dental business. In 2015 he joined the industrial manufacturing segment of Materialise, first within the laser sintering production, later broadening scope to oversee all plastics production.

11

CASE STUDIES

PATIENT � Male

� 43 y/o

� Wears working shoes

COMPLAINTS � Fatigued feet and legs

� Bilateral hallux rigidus

PHITS DESIGN � Meta bar 2 mm

� Meta 1 – 3 mm - stiff

PATIENT � Male

� 40 y/o

� Chronical Plantar Fasciitis bilateral

� Short calf muscles

COMPLAINTS � Pain during and after running

DYNAMIC MEASUREMENT

� High medial arch

� Deviant COP

� Quick forefoot contact

� Medial side forefoot not used (left more than right)

ZONES � High forces on lateral forefoot left

� Short heel contact

� (small) difference in medial and lateral force heel

� Assymetrical values left - right

RISK ANALYSIS � Although low global risk…

� 3 risk zones on his feet

� Linked to patient history: very interesting case

ORTHOTIC DESIGN � Guiding towards pronation

� Supporting medial arch

� Supporting metatarsals

� Heel wedge

� Forefoot corrections

� Plantar fasciitis relief

CASE STUDY

HALLUX RIGIDUS CASE STUDY

PLANTAR FASCIITIS

13Are you suffering from foot pain?

Visit www.phits.com and contact your local Phits Expert

IMPORTANT NOTICE! Although the above mentioned case were successfully treated, the suggested corrections cannot be expected to automatically cure similar pathologies with other patients, nor guarantee a successful outcome on patients with similar pathologies.

SLIM PHITS, WIDENING THE RANGEWhat? The thinnest possible Phits, suited for shoes with limited space. Lode Bosmans: “Over the past few years, we have been looking at ways to create a more flexible and thin orthotic by removing the lattice structure. The challenge was to find the balance between stability and flexibility. This results in a very thin, yet very robust orthotic that offers more flexibility but at the same time offers sufficient support for the patient.”

Why? Create an orthotic that literally fits into any shoe.Sander Van Nieuwenhoven: “Our Phits Experts already mentioned that for some patients and for certain types of shoes, the already rather thin Phits were not thin enough and that sometimes they simply don’t like the idea of the lattice structure leaving their marks on the footbed of a dress shoe. In the survey, the Phits Experts also asked for a somewhat more flexible type of comfort insole.”

Limitations? For the time being, yes.Lode Bosmans: “Yes, there are 3 limitations compared to the original Phits: first, by removing the lightweight structure, you can’t integrate the heel corrections, both wedge and offset, in the Slim Phits orthotics. Also, at this moment we did not find the solution to add our well known forefoot corrections yet. For these corrections, the Phits Expert still has to use the orig-inal Phits. Nevertheless we are researching solutions for these features and we hope to add them step by step.

Added value? A Phits-all solution to serve a wider range of people with Phits.Sander Van Nieuwenhoven: “We believe this will help our Phits Experts in finding the proper orthotic for their patients and we think it can even open a whole new market for them. By offering this Phits with less pronounced corrections, you can present a very wide product range and it will be easier to convince people who are a bit skeptical towards our original Phits. For us, next to a more comfort-like orthotic, it can also serve as a more preventive device in for example working or safety shoes. It really enables the Phits Experts with a Phits solution for virtually all their patients and clients.”

Two innovations to make Phits the reference orthoses in your practice

In Spring 2018, the Phits team conducted a survey amongst Phits Experts across the world, asking them about their expe-riences and furthermore about their expectations. Based on the feedback we received, the Phits team chose to develop two new Phits product types: Slim Phits, a slimmer pair of Phits, on one hand and on the other hand a wider type of Phits especially designed for people with very wide and flat feet. Lode Bosmans, R&D Manager at RS Print, responsible for the implementation of the updates and Sander Van Nieuwenhoven, Project Manager Phits Insoles, give us an inside view on the innovations.

NOVEMBER 2018 INNOVATIONS

WIDE PHITS, CLOSING A GAPWhat? The Phits for people with wider and, in some cases, flatter feet.Lode Bosmans: “The wider type was co-created in close collaboration with the Dutch orthopedic group Livit, one of the biggest Phits clients worldwide. They came up with the request and together we found the solution in essentially widening the narrow type. This might sound a contradictory, but thanks to its shape, the narrow type was the ideal starting base to develop an orthotic for people with really wide and sometimes very flat feet.”

Why? Providing a solution for a specific foot type -or even a specific foot condition in some cases.Sander Van Nieuwenhoven: “The wide Phits should allow us to help all people with wide feet. Until now, it was difficult to provide Phits for this type of foot, especially with a wider heel, in combination with a thicker, softer top cover for more comfort.”

“A large part of the Livit customer is diabetic or rheumatic and this group is still increasing. The population grows older, which is in itself of course a positive effect of improved healthcare, but at the same time, people tend to become less mobile. A second, hopefully reversible macrotrend, is an increase in obesity, resulting in more diabetes type II which can have terrible consequences for the lower limbs, particularly for feet. Together with Livit, we successfully tested the new shape on a test population with wide, yet healthy feet.”

Limitations? No other than the original PhitsLode Bosmans: “We keep the same logic for the wider type. The wide Phits has all the functionality of the existing comfort type. ”

Added value? A durable solution for those who need it mostSander Van Nieuwenhoven: “Until now patients with wide feet were served with for example normal EVA material, but these orthotics wear out very fast and they tend to be very bulky. The wider Phits, by the way also available in a Slim Phits version, provides a more robust, durable solution that can be easily refurbished but keeps the func-tional base. This saves a lot of money for the patient and labor and time for the experts. Exact replicas are of course also possible, just like with any other Phits, which also saves a lot of labor time in designing and manufacturing.”

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NOVEMBER 2018 INNOVATIONS

PHITS AND SLIM PHITS CHARACTERISTICS COMPARISON NOVEMBER 2018

They don’t seem to wear out at all

These insoles changed my life

Less knee pain,better stability

PHITS SLIM PHITS

Lattice structure v x

Ski and cycling type v xOrtho base v x

Directional stiffness v x

Wide - comfort - narrow base v v

Local stiffness v v

Heel wedge v x

Heel offset v x

Low lateral edge option v v

Meta bar v x

Meta pads (t-form, teardrop) v v

Forefoot correction v x

Patient ID v v

BACK ON TRACK! WHY PEOPLE LOVE THEIR PHITS SO MUCH...

Extremely high arches have always been a struggle for me. This means extra pressure on my heels and toes, leading to stiff toe joints and excessive wear and tear on my heel cushions.

After a long distance running race, I was in a lot of pain, and my heels were nearly destroyed.

I received the insoles, and they completely changed my life!

They alter the pressure points, distributing them primarily under my arches.

This relieves the pressure on my heels and toes in a way that I thought was impossible.

Ragnhild, Norway

I’m a passionate hiker, I enjoy spending time in the mountains or on long nature trails. About three years ago, walking became nearly impossible because of an aggravating gonarthrosis in my left knee.

My surgeon left with me with two options: a knee prosthesis or a an osteotomy. We chose the osteotomy to correct my leg axis, as the gonar-throsis was mainly situated on one side of the knee.

It’s a radical surgery were the bone under the knee joint is nearly fully sawed in two pieces and a wedge is being used to correct the axis. Suddenly, I had a longer leg, you can imagine the impact on my posture and gait and the corrected posture started causing continuous pain under my foot.

If I wanted to explore the moun-tain trails again, I had to find a durable solution and that’s when I found Phits foot orthotics: a massive improvement! They’re perfectly adapted to my feet, I’m wearing them in all my shoes for over a year now and they don’t seem to wear out at all!

Herman, Belgium

I’ve tried numerous off-the-shelf and custom orthotics to help support my very flat feet.

Nothing seemed to really help or feel like it was supporting my feet the way I wanted until I tried the Phits Insoles. After wearing them for both work and running, I noticed reduced knee pain and overall better stability.

I was so sad when my shoes were stolen along with my pair of Phits. Luckily, my data was still on file and I was able to order another pair of this great addi-tively manufactured product!

Brett, USA

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BASED IN THE PICTURESQUE VILLAGE OF LOUND, JUST OUTSIDE RETFORD, NOTTINGHAMSHIRE (UK), WE WALK INTO THE LAKES ORTHOTICS TO MEET WITH JO LUCAS, PHITS EXPERT AND THE ORTHOTIST BEHIND THIS CLINIC.

“The clinic is in a converted annexe to my own home, so I don’t have a very long commute.” Jo welcomes us smiling. “We live in a quiet village with very little traffic – in fact due to the equestrian centre at the bottom of our garden, you are more likely to see lots of horses instead of cars! We are surrounded by the Idle Valley Nature Reserve – perfect for walking, biking, bird watching, and getting some good coun-tryside air.”

Jo is one of the Phits pioneers in the UK, but her career path is rather remarkable: “Prior to becoming an Orthotist I was in the Intelligence Branch of the Royal Navy. I left to pursue a career as a Prosthetist but as our UK degree is in Prosthetics and Orthotics it gave me an insight to the world of Orthotics. I liked the highly technical nature of orthotics – my

military background gave me quite a technical mind. I also liked the vast subject area, meaning I would never be bored in my job!”

Before she established her private clinic, Jo worked for a number of years in the NHS, the UK’s public health system. “I found the pressure of juggling work and childcare extremely difficult. Due to restricted budgets I wasn’t able to do my job as well as I would like, and wasn’t able to access the absolute best in orthotics that the industry had to offer. I set up The Lakes Orthotics in 2014 to allow me to work around my family life and give my clients the best service I could, allowing me to spend quality time assessing, planning and treating.”

It took her some time to find the right tools that matched her mindset: “I was originally looking for a scanning system to allow me to stop using foam impression boxes or plaster casts and I stumbled across Footscan at BAPO in 2017. I am a bit of a technophile and I’m drawn towards anything that can make things easier and more streamlined. I love using Footscan as it gives me a much clearer clinical picture and picks up gait anomalies that I may never see with my own eyes.”

The footscan not only empowers herself as an expert, it also helps her clients: “I find the footscan analysis really engages the client as they can see the images and they want to know more about what is going on with their gait. I have always found that the more understanding of the condition a client has, the more compliant with their treatment they are likely to be.”

Asked what the major advantage of the footscan is, Jo is very clear: “I personally think dynamic gait anal-ysis is the absolute best basis for prescribing foot orthotics. By mapping the precise movements of the foot during gait it allows me to pinpoint where I want corrections to be to achieve the desired result.

The Root Theory in which I was trained is still rele-vant but it does not form the basis of my orthotic design. Static scanning is much less accurate and doesn’t give any indication of what the foot is actu-ally doing during gait. Knowing what is happening with the foot at one particular point in the gait cycle

can only give us a tiny bit of information. Knowing the precise kinematics of the foot from the moment of heel strike to the point where the foot leaves the ground gives me far more relevant information and allows me to finetune the prescription and ulti-mately design the best orthosis for the client. The human foot is in contact with the ground for such a short period of time with each walking step, so getting as much information as possible is essential.

Footscan gives me detailed information about each step allowing me to design the most accurate insole possible and also ensure the prescription is specific to the left and right foot.”

Jo also takes the time to guide her clients through the results of the gait analysis. “Following the scan-ning I always sit down with the client to go through the results. I choose the most important information and the information that the client is likely to relate to in terms of their condition.”

“My experience is that the clients like to see what is happening with their feet, and if they can have more of an understanding of what is going on during their gait, and the reasons for the problem they are having, they are more likely to be compliant with their treatment and have a more successful outcome. My clients often come to me after using orthotics previously and not having a good result. I usually explain the difference between static anal-ysis and dynamic analysis and the reasoning for using the dynamic method and the usual response is ‘that makes much more sense’.”

INTERVIEW PODIATRIST

JO LUCAS - THE LAKES ORTHOTICS (UK) “I’M CONSTANTLY SEARCHING TO IMPROVE MY CLIENTS’ LIVES”

PHITS IN O&P - JO LUCAS (THE LAKES ORTHOTICS, UK)

The software is really well designed

and very intuitive

19

Clients really appreciate this extra information and although it might seem pretty obvious to engage the client, a lot of healthcare experts don’t have that time with their clients because they spend too much time in their workshop (re-)working handcrafted devices or of talking back and forth to a central lab. Which brings the subject to 3D printing.

“I had never considered 3D printed insoles until I purchased my footscan system. The little ‘Phits’ tab in the software intrigued me so I questioned George Cummins (Director at Gait and Motion Technology, the UK footscan and Phits Distributor), who installed the system. After his explanation and some research in the techniques I knew I had to get them in my clinic. In my opinion the benefits were huge – lightweight, very slim, and super strong and hard wearing. These were all things that my clients are constantly asking for and with Phits I can now provide that. The majority of the insoles I provide are Phits 3D printed insoles.”

Jo also points at other perks of the Phits services: “The software is really well designed and very intuitive, which makes ordering very easy. I love the amount of corrections available and also the fact I am actually putting in these details myself. Previously I would write a paper prescription and explain on paper what I am trying to achieve, for the technician to then interpret this and create the orthotics. I have much greater control over the orthotics now and I know that what I’ve ordered is exactly what I am going to get.”

A quick look in her clinic tells Jo’s love of ice hockey, and in particular, the Sheffield Steelers. That passion is also reflected in her professional activities as an orthotist.

“I treat a lot of figure and hockey skaters and I find they are having much greater success with Phits

3D printed insoles. Ice skates, particularly figures skates, are very narrow and many skaters wear them much smaller than their regular shoes. So getting a custom made insole to fit inside the skate and be supportive enough was always a challenge. I have found the Phits Nordic ski device suits my skaters perfectly as they are very narrow and the full foot style means they are easier to get into the skate. Skaters generally need a slightly different design of insole due to the positions the feet are getting into for the various skills. The Phits design software allows me to increase the flexibility in key areas and reduce bulk as much as possible, allowing the skater to achieve the edges that are required when ice skating, but still provide the correction and support needed.”

It’s been 12 years since Jo graduated as an Orthotist and she has seen a lot of innovation and improve-ment over the years: “I have seen so many changes in manufacturing techniques and materials and these have all been for the better. When I look at what we were giving out when I first started out in my career to what is available now, it doesn’t seem possible that it has happened in just 12 years. I am constantly searching for new techniques that will improve life for my clients, after all, the clients are why I do my job and it is them that I want to give the very best to.”

Will 3D printing become a game changer in her industry? “3D printing has been around for some time now but it is definitely building momentum and I wanted to be one of the first to offer it, particularly as the benefits they offer are things my clients have been requesting on a daily basis. I think there is still some resistance to the technology in the industry as clinicians have been treating patients successfully for many years, so why change.”

In the end, it’s a simple rationale: innovations have to offer better results at a reasonable price. If it is nothing more than a copy of any traditional manu-facturing method, it doesn’t make sense. It’s the

More info about The Lakes Orthotics? www.thelakesorthotics.co.uk

Interested in becoming a UK Phits Expert? Contact the UK Phits Distributor www.gaitandmotion.co.uk

Any other inquiries about Phits or RS Print: www.phits.com or sales@rsprint.be

PHITS IN O&P - JO LUCAS (THE LAKES ORTHOTICS, UK)ORTHOTICS, UK)

The benefits are huge - lightweight,

very slim, super strong and hard

wearing

Phits 3D printed insoles are the best

I’ve ever used

reason Jo Lucas puts her trust in Phits: “When I, and all other clinicians examine a patient, we make our decisions regarding orthotics prescription on the things we see and feel so some may say why do we need all the extra data and graphs? I say the more information we have, the better decisions we can make, and the better the orthotic device will be. As 3D printing is definitely making big strides in the orthotic world, there are lots of companies promoting their devices. As a clinician this can get a bit overwhelming as you don’t know where to go for the best. Having seen and used many different orthoses over the years, I can safely say that Phits 3D printed insoles are the best I have ever used and would recommend them to clinicians and clients alike.”

“After seeing so many changes within the orthotic industry I have no doubt that the direct milling of insoles will be replaced by 3D printing in the next 5-10 years within the private sector. Backed by companies like Phits and Materialise, there is no need to purchase and have the room to accom-modate huge printers, so for me, investing into the technology is cost effective and will add huge value to clinics and patients. I suspect the NHS will take a little longer to take on the technology, mainly due to the fact that most ‘NHS trusts’ produce their orthotics in-house. However, I feel that the long terms benefits of using 3D printed orthotics, in particular more successful outcomes and longer lasting orthotics, will mean that the value of utilizing 3D print technology will become clear and eventu-ally it will be available to all.”

© LJS PICTURES

The custom made 3D printed

Phits orthotics are much lighter,

more comfortable and more supportive.

PEYTON THOMPSONprofessional football player

jacksonville jaguars

21

INNOVATION IN PODIATRY EVA BOSTYN (POSTILLION, BELGIUM)

even in our shoe advice we will very often use the footscan to actually inform people, about which shoe fits them, about what we can do for them as a podiatrist. Ranging from a good shoe through a support insole to possible medical foot care.

Do the people understand what you show them on the analysis?I insist on showing the images from the analysis to people and explaining to them - in a good, naturally simple, way - how the pressure points are distrib-uted. I also try to briefly explain the center of pres-sure line. How this normally should be, how this goes wrong if people tend to pronate or supinate. And I do have the sense that people really get into the story of the footscan. Naturally, you have to be able to translate this in a human way. It isn ´ t my inten-tion to overwhelm people with all kinds of data and numbers, but I do want them to know why we are going to make orthotics. And that ´ s exactly why I like to show them the analytical image.

How did you learn about Phits?Well, I very clearly wanted to have a plantar pressure measurement system in order to inform people and to be able to offer more service. We quickly came to understand that we can actually make 3D-printed insoles based on footscan. Therefore the decision to work with Phits orthotics was easily made. I’m also a fan of 3D-printed insoles and I sought out information online as well and spotted good Phits reviews. After an additional visit to Phits and RS scan to gather even more information, we were fully convinced of the power of the footscan and Phits.

Were you initially sceptical with regard to 3D printing as a production technique?

Not really. If you open up magazines and newspa-pers these days, well… you see that 3D printing is making advances on every front. And that ´ s why I actually found it interesting to get further into it. We are above all familiar with the EVA support insoles from our podiatry education. I also worked with EVA insoles earlier. But to be entirely honest, if I put a Phits orthotics side by side with an EVA one, in terms of durability the Phits orthotic is far more superior compared to the EVA, and definitely when compared to cork and leather orthotics. That was an additional argument to opt for Phits.

Are you surprised that many of your fellow podia-trists are still so hesitant about 3D printing?Yes, but I think that is actually just a simple contin-uation of our training in college… Until now we haven´ t seen it in college. And then you´ re maybe hesitant to put this into practice. If we ´ d already been exposed to the technology in college, many colleagues maybe would have more quickly taken the step to 3D print technologies. We didn’t really experience this during our training and people remain close to what they know. But for me it was above all an inspiring innovation. People are also sincerely interested when we say that the Phits are 3D printed. I think that we, as podiatrists, really have to keep up with the latest technologies.

For you, what is the greatest added value of these Phits 3D-printed insoles?We use the footscan to do the analysis. People actively participate in their own gait analysis. I analyse and explain why we will proceed with orthotics if necessary. With the data that I have, on the basis of the Footscan, I can also immediately go and model the insoles. As a podiatrist, I really like the design tool within the system, it is really user friendly. It goes smoothly and the delivery of the orthotics is really consistent and reliable, that’s also a very interesting aspect. Certainly here in the store we want to be able to offer a really fast service. And that ´ s why we opted for the total package of footscan together with Phits. For our type of busi-ness, that ´ s definitely an added value.

Eva, can you explain to us how you built up Postillion? What is Postillion’s core business?My colleague Eveline is the owner of the building, and I got into contact with her when she was actu-ally still a bit in doubt about what she was going to do with it. Then we began reflecting and brain-storming, and I came up with the idea to do some-thing similar to where I had previously worked: an orthopaedic company that also at the same time has a store and makes orthopedic insoles.

I was confident that this concept would also work here. And now we´ re sitting here in our own store!

In short, Postillion is a medical specialty store for people with foot complaints or, more broadly, musculoskeletal complaints. We actually try to offer the people comfort shoes that go very well together with custom orthotics. Besides all that, we also offer our own orthotics on the basis of a gait analysis. Next to that, we also perform medical foot care in what we call our medical box.

Which insole solutions do you offer here?We work exclusively with Phits. We decide to include custom orthotics in the store because I ´ m a podi-atrist myself. I wanted to work with the RS scan footscan for gait analysis and they offer also the Phits orthotics, into which I can perfectly integrate my corrections. Hence my choice for Phits.

Why did you specifically choose footscan? Well, as a student at the Artevelde Hogeschool we received lessons on plantar pressure measurement and already back then we were able to work with footscan. Therefore the choice was actually quickly made: my knowledge was already there and I was also very satisfied about it. So we actually very quickly decided to buy the pressure plate in order to be able to actually begin with our insole therapy.

In your view, what’s the added value of footscan as an analytical tool?Well, here we note that the patients increasingly want to be well-informed. Even when they come purely for shoe advice, it sometimes happens that we just bring someone into our analysis room to do the footscan and make an analysis of the movement pattern. In this way people also get a picture of exactly what goes wrong during that gait pattern. That ´ s why we actually find it a very good tool to work with: people want to know what’s going wrong, and we can also provide them with this explanation, this background information. Thus

EVA BOSTYN - PODIATRIST AT POSTILLION

“AS PODIATRISTS, WE HAVE TO KEEP UP WITH THE LATEST TECHNOLOGIES”

Patients expect to be well-informed

23

Eva Bostyn graduated 3 years ago with a Bachelor´s degree in Podiatry from the Ar-tevelde Hogeschool in Ghent (Belgium). After her studies, Eva began working as a podia-trist at an orthopaedic company. Her work focused primarily on medical foot care and advising on semi-orthopaedic footwear. On a hot summer day we met Eva at ‘Postillion’ on The Market Square in Poperinge, a beau-tiful town in the middle of what is known as Flanders Fields. It is here that Eva works as a podiatrist. Postillion specialises in the com-bination of comfort footwear, medical foot care and custom orthotics.

INNOVATION IN PODIATRY EVA BOSTYN (POSTILLION, BELGIUM)

Phits are the official provider of 3D print orthotics to the Dallas Wings women’s basketball pro team.

Head Athletic Trainer Allison Russell shares her views on the benefits of Phits for her athletes.

“As an Athletic Trainer, finding good custom insoles for the people I work with has been an ongoing challenge.

We started using Phits Insoles last season and the occurrences of injuries in the lower body due to chronic stress, overuse and improper foot motion have noticeably decreased. Our athletes make their living playing at the highest level of basketball year-round, all over the world, so efficient movement and proper mechanics is imperative. Phits Insoles are a highly effective way to ensure athletes maintain correct alignment throughout the day, both on and off the court. This helps accelerate rehabilitation, prevent injury, as well as, improve performance and recovery.

I’ve sent athletes to numerous other companies for ‘custom’ insoles, purchased a variety of both profes-sionally sold and drugstore brand models. It has been difficult to find a product that addresses the athlete’s needs, lasts through more than a few weeks of in-season training, is comfortable and actually fits in a shoe is incredibly rare. Phits Insoles addresses all of these issues and they’re extremely affordable.

The scanning process takes just a few minutes and the information is saved in the cloud so if you want to order multiple pairs or adjust anything, it’s so simple.

We had our team scanned and the insoles arrived within about a week. Customer service is always top notch and we have not had to replace even 1 pair due to quality or durability for any of our athletes since we started using Phits. I would recom-mend for anyone, whether you are a high end athlete or weekend warrior.”

PHITS INSOLES ENSURE ATHLETES MAINTAIN CORRECT ALIGNMENT ON AND OFF THE COURT

Allison Russell Head Athletic TrainerDallas Wings Basketball

O F F I C I A L P R O V I D E R

3D PRINT CUSTOM ORTHOTICS

How do your customers react?We’ve had very good reactions about Phits! Many people are accustomed to the traditional orthopaedic orthotics, based on a footprint in a foam box, without much explanation. But here they find it fantastic that they are actually measured and analysed. People want to know what’s going wrong. We don’t consider people a number here, they get the feeling that they’re treated like a patient. When they fit the orthotics, they also see that they get much more support and that their gait is corrected really well. Next to the extra support for the feet, lots of functional corrections can be added to the orthotics.Patients also note that the Phits are high quality and very durable. For me as a podiatrist, that’s what matters most.

How is the combination with the comfort footwear that you offer?Well, the combination of our comfort footwear and Phits is excellent. People who ordered 3D-printed Phits here often immediately choose a good comfort shoe to go with it. Then together, we look for the perfect shoe. And actually we have never had problems to get the Phits into a comfort shoe, they are never too thick – which is something you often hear about traditional orthotics.

You describe Postillion as a foot specialist, not as a shoe store. Is that the true philosophy of Postillion?Yes, we use the term “medical specialty store” in our communication, specifically for feet. We always make clear that a podiatrist is present here: someone

who knows about feet! We really try to put together a nice comprehensive package of the three aspects - shoes, orthotics and foot care - in order to be able to offer the perfect solution for the patient.

You’re a very passionate podiatrist. Would you recommend this solution to your fellow podiatrists? Certainly! I’m convinced about footscan as an analytical tool for plantar pressure. I would imme-diately invite interested colleagues to drop by and work with the scan and model the insoles so they experience that you actually have a lot of tools in the program to make orthotics according to their preferences. So yes, I would certainly recommend to colleagues to try it out or to come test it sometime.

More info about Postillion? Visit www.postillion.be

Contact sales@phits.com to join the Phits Expert network.

Phits are an inspiring innovation

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BELGIUM - THE NETHERLANDSRS Print powered by Materialise NVwww.phits.comsales@phits.com+32 (0) 11 36 01 79

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