Computer-aided design and manufacturing (CAD/CAM) has been part of orthotics and prosthetics (O&P) for more than three decades. What began as an experimental approach to socket design has evolved into a powerful digital workflow used in clinics around the world.

Today, technologies such as 3D scanning, digital modification software, CNC carving and additive manufacturing are transforming how clinicians design and produce prosthetic and orthotic devices.

The Origins of CAD/CAM in Prosthetics

One of the earliest reports of CAD/CAM in prosthetics appeared in 1985. The research described a software system used to design transtibial prosthetic sockets digitally.

This early work helped inspire the development of dedicated O&P digital tools. One of the pioneers in this space was Vorum, which became one of the first companies focused exclusively on digital prosthetic fabrication systems.

Early CAD/CAM systems used 3D carving machines. These machines carved foam models based on a digital design. Technicians then laminated or vacuum-formed plastic over the carved model using traditional fabrication techniques.

Early Experiments with 3D Printing

The first attempts to use 3D printing in prosthetics appeared in the early 1990s. Researchers experimented with technologies such as stereolithography (SLA) and fused deposition modelling (FDM).

These early projects explored whether transtibial sockets could be produced directly from digital files.

The technology was still limited at that time. Printers were slow and materials were basic. However, these experiments demonstrated the potential of additive manufacturing for personalised prosthetic devices.

Growth of Digital Technology in O&P

Over the past two decades, digital tools have become increasingly common in prosthetic and orthotic practice.

Clinics now use a range of technologies, including:

• handheld 3D scanners

• digital rectification software

• foam carving machines

• 3D printers

• advanced printing materials

Despite this progress, digital workflows have not replaced traditional fabrication methods. Most clinics operate hybrid workflows that combine digital design with conventional manufacturing techniques.

Applications of CAD/CAM in Orthotics and Prosthetics

Today, CAD/CAM technologies are used to produce a wide range of devices.

These include:

• lower limb prostheses

• upper limb prostheses

• custom prosthetic covers

• ankle-foot orthoses (AFOs)

• upper limb orthoses

• scoliosis braces

• spinal orthoses

• cranial remoulding orthoses

Digital design allows clinicians to create more customised solutions while maintaining consistent manufacturing quality.

The Digital Workflow Explained

The CAD/CAM workflow typically involves three main stages.

Shape Capture

The first step is capturing the patient’s anatomy using a digital scanner.

Two common technologies used in O&P include:

• structured light scanners

• laser-based scanners (LiDAR)

Modern scanners can be handheld or connected to mobile devices such as tablets and smartphones.

Digital scanning removes the need for plaster casting and improves patient comfort.

Digital Rectification

Once the limb shape is captured, clinicians modify the model using CAD software.

This process allows practitioners to:

• adjust pressure areas

• add relief zones

• optimise device geometry

Specialised O&P software is commonly used for this stage. Some clinicians also use engineering programs such as Autodesk Fusion 360 or SolidWorks.

The modified design is then exported as a file format such as STL before manufacturing.

Fabrication

The final stage is fabrication. This may involve either traditional or digital manufacturing methods.

Common fabrication options include:

• CNC foam carving

• vacuum forming

• direct 3D printing

Three additive manufacturing technologies are widely used in O&P:

• fused deposition modelling (FDM)

• selective laser sintering (SLS)

• powder bed printing

The choice of printer and material determines the final strength, flexibility and durability of the device.

Clinical Impact of CAD/CAM

Surveys of O&P clinicians show strong support for digital workflows. In one international survey, 97 percent of practitioners reported that CAD/CAM improved patient care.

However, many clinicians also believe that digital technology is still poorly understood within the profession. Training and standardisation remain important challenges.

Digital workflows can improve efficiency in several ways.

For example:

• limb scans can be stored digitally

• devices can be reproduced quickly

• limb changes can be tracked over time

This digital record allows clinicians to compare limb volume changes months or years after amputation.

Lower Limb Prostheses

The use of 3D printing for prosthetic sockets is growing. However, some clinicians remain cautious.

A common concern is whether printed sockets can match the strength of carbon-laminated sockets.

Current research suggests that printed sockets show strong potential for definitive use. Reinforcing high-stress areas or using composite materials can improve durability.

Some studies also suggest that digitally designed sockets may improve patient comfort and quality of life.

Orthotic Applications

CAD/CAM is also gaining popularity in orthotic fabrication.

3D printed orthoses can offer several advantages:

• improved ventilation

• lighter structures

• adjustable stiffness

• enhanced aesthetics

Digital workflows are particularly common in the production of foot orthoses.

Studies show that digitally manufactured orthoses can provide similar biomechanical benefits to traditionally manufactured devices.

Spinal Orthoses and Scoliosis Bracing

Digital scanning has been used in scoliosis brace fabrication for more than twenty years.

Scanning provides several advantages compared with plaster casting:

• faster measurements

• reduced mess in clinics

• improved design accuracy

• faster manufacturing turnaround

More recently, 3D printed scoliosis braces have entered clinical trials. Early research shows similar correction outcomes compared with conventional braces.

The Future of Digital Prosthetics and Orthotics

The next stage of CAD/CAM development will likely focus on smarter design and stronger materials.

Emerging technologies include:

• carbon-reinforced printing filaments

• textured socket surfaces for better suspension

• parametric prosthetic design systems

• finite element modelling for mechanical optimisation

These technologies could allow prosthetic and orthotic devices to be fully customised to each patient’s anatomy and activity level.

Digital Manufacturing in the IMEA Region

Digital fabrication may also transform the O&P supply chain in emerging regions.

As scanners, printers and software become more accessible, clinics can produce more devices locally.

This shift could improve access to prosthetic care across Africa, the Middle East and South Asia.

For suppliers and distributors, supporting digital manufacturing will become an increasingly important part of the O&P ecosystem.