Ralph Hermanns Uses Print Farms to 3D Print Orthotic Insoles at Scale

Ralph Hermanns of Podotherapie Hermanns started his podiatry practice in a small village in the south of the Netherlands. Now, he has grown the business to over 260 locations. Inside hospitals, medical centers, or general practitioners’ offices, his team of podiatrists can be found close to where patients are and where they need to go. The entire business is based on a relentless search for quality and convenience in what was, at least in the Netherlands, a rather traditional and stiflingly stuffy business. Through innovation, Hermanns and his coworkers have shaken up this field. Their website and tools are very simple to use. Making an appointment online is easy, with the option to call or email if preferred. Simple workflows for customers and staff speed up and disrupt podiatry.

Traditionally, Hermanns used milling machines that cost around $55,000 to make his insoles. Plastic dust was always everywhere, especially when he had to finish lasts or insoles by hand on a shoe mill. Staff were hard to get and expensive in the Netherlands. In 2019, Ralph started looking for alternatives. He bought his first 3D printer, fine-tuned the output and processes, and then tested many more. He evaluated the Artillery X2 and 4Pro, the Prusa Research i3 MK3.5, PodoPrinter, Raise E2, Creality CR-30, iFactory One Pro, and more. Now, he uses a mix of machines to print tens of thousands of insoles a year. The team modifies the printers, and a big part of their success is in developing the right settings and post-processing for these parts. Subsequently, they’ve built a large 3D print farm at their headquarters that is currently bursting at the seams.

Hermanns has considered placing the 3D printers at patient locations, but he wants his medical professionals to focus on patients. He also wants to control QA, proprietary post-finishing steps, and the addition of the liner. He opted for centralized fabrication because this allows the care staff to focus on patient care while keeping manufacturing operations separate. Software connects the two. The initial data gathering about the patient can be done online. Then, a podiatrist evaluates the patient. If an insole is the right solution, a 3D scan is made with an iPad. That information is passed to an order form, design software, slicing software, and then to the print farm software.

In addition to his own software, Ralph uses FootPrint3D, which has fully automated the steps from scanning to uploading to the farm. He likes how this software reduces labor costs per part by minimizing the number of clicks his staff have to do. He also uses FootPrint3D filament, which is MDR and ISO 10993 compliant. Hermanns tested many filaments and finds this one offers the best value for money. Compliance-wise, the material is one of the few that he can actually use. It baffles him that, with so many vendors and types of filament, no one else is focusing on making filament that is safe and meets all the necessary standards.

Ralph’s switch to 3D printing has helped his practice grow to the third largest podiatry practice in the Netherlands. 3D printing saves time and money, and it makes clients happier.

Hermanns says that,

“I do not understand why podiatrists do not use 3D printing as the standard method of producing insoles. Everyone should. 3D printing has cachet, is cost-efficient, saves on manual labor, is faster, production is cleaner and safer, and uses less material. We did a study and looked at how many revisions we had to make to insoles. We compared traditionally manufactured insoles with those made using 3D printing, and we had more and happier customers with 3D printing than with traditional manufacturing. We also had to do fewer revisions with 3D printing than with milling. I really don’t get it; why doesn’t everyone do this?”

The initial level of investment is also lower; Hermanns had to invest significantly more in milling equipment to get started than he did in 3D printers. However, the company did have to develop many procedures and processes itself. Finishing processes are very important and something that Ralph is more guarded about than other parts of his operations. They’ve also had to develop see-through soles for the proper fitting of more complex orthoses. Additionally, they have different methods of adapting 3D prints and joining them to other materials.

Through 3D printing, new therapeutic possibilities have also emerged. For example, they have developed an insole for patients who perspire more. Despite these innovations, the driven entrepreneur remains surprised that more podiatrists are not starting with 3D printing.

What advice would Hermanns give to others looking to start large 3D print farms?

“First of all, the question is whether you are or want to be technically skilled or not. If you are not and do not want to be, you can make use of existing companies that can install the entire workflow for you. We are very satisfied with FootPrint3D’s solutions, which allow us to focus on care instead of peripheral issues.”

“If you are a bit technically skilled, find a simple machine to work with and understand it, or take a course in 3D printing. Get to know your printer and the materials, and pay attention to the MDR and settings. Look at things such as direct drive, different printers such as belt-driven printers, and different extruders as well. Only then should you evaluate other printers and start building your print farm. Simple machines are a great start, but you’re going to have to do a lot of modifications if you want to look at 24/7 3D printing, for example. It’s not just about placing larger spools on printers but about stability and repeatability. Yes, 3D printing is cost-efficient, but you will still have to hire people and equip a good space. Evaluating workflow and print farm software is also important.”

Ralph has taken particular care in examining how he and his team spend their time. Optimizing their workflow and file creation processes has been a priority. He is obsessed with reducing the number of clicks it takes to get a part made. Now, his problem is that he is running out of space. His current office is packed with 3D printers, and he’s looking for a new office to expand even further.

I personally believe that material extrusion and low-cost printers are the perfect solution for orthotics, insoles, and many orthoses. The low cost, durability, and dimensional accuracy of parts make the current solution cost-effective and scalable. Given the opportunity, we’re not seeing enough people forge ahead with extensive print farms using low-cost machines, and this is something that I hope to see more of going forward.