Bart;
    Again, I'll insinuate myself into Jeff's responses.  Apologies Jeff, and
to Eric in the previous email as well for my laziness.

> My quick answer:
> Ergonomics
Yes, I agree, there is a learning curve

 economics
Mentioned before.

fear of change
No comment

lack of need (ie if it ain't broke,> don't go a fixin it!)
Mentioned before as well!

, limitations (ie. you can't direct mill a composite orthosis)
Jeff - and you can't produce a full length rigid plastic composite device
either!  With very few exceptions, material does not make enough of a
difference in the effect of the orthotic  device.  In my experience, the
times that it will have more to do with affecting or tieing the Tibia and
foot together to limit rotations, a la Richie Brace / AFO, thatn to the
materials used to create any type of foot only device.  When there is some
hard data out there to prove me wrong, let me know.

, proprietary imitations (ie. you can't purchase a Langer orthotic using an
Amfit scanner)
Why would you want to?  I get what you are saying Jeff, that you can use
some other scanners and Langer will except there scans to make their devices
from... But, many labs don't except scans at all, or are looking into
offereing their own scanners and probably eliminating competitors scans from
being used.  Proprietary indeed!

, quality issues (foot scanners have two major problems, resolution and
frontal plane orientation of the foot).
I will agree with this to a point.  Frontal plane orientation can be
difficult if the foot is hanging in mid air.  When the foot is flat on a
bed, like the AMFIT scanner, then I disagree.  There are inherit problems
with that as well, if you don't think to work that out.  ONe problem is that
if the foot is resting on the flat foot bed in neutral, but also about 1-2
degrees in varus at the heel from perpindicular, or valgus for that matter,
you wont know it unless you think about it.  You will have to build that
varus back into the device to get the heel bisection to perpindicular, which
does seem to work better as I've seen teh f-scan result both with and
without
Finally, I disagree regarding the resolution.  I cannot comment on most
scanners, but I've yet to have seen a problem with fit regarding the AMFIT
scanner, and have seen problems with resolution from plenty of regular labs
that add plaster in places I don't want it so they look good, instead of
following my directions for absolutely no fill.  I'll not argue the need of
this as my ignorance of creating a device from plaster is immense,
especially compared to Jeff's experience, but if you get me gist, these are
both potential resolution issues, one with a scanner, one with a regular
lab.

 The in lab scanners that are used to scan negative casts are more accurate
but still> require manual verification as bad scans do occur.
Not sure if this is true or not, but everyone will take a bad scan.
Difference, is that I know immediately and can correct myself instead of
relying on Joe Blow to decide if its ok or not.

>
> FYI, that information Comes to me from labs that use scanning technology.
It seems to be better in house (lab use) than in office at this point in
time.  Virtually every system offers a mirroring function in that if you>
correct one foot, you can make an identical and opposite device for the>
other foot.  While this greatly reduces labor costs, I see a lot of
> asymmetrical feet.  I don't have issue with the technology but I do have a
> few issues with how it is used.
Couldn't agree more here Jeff.  I never mirror my casts, and rarely mirror
my modifications in my devices.
With sincere respect;
Bruce

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