Abstract:
The present invention relates to a process for determining the magnitude and distribution of forces on a foot during ambulation and utilizing this data in combination with a plurality of other factors to create an orthotic inlay with an automated inlay fabricating machine.

Description:
[0001]    This application claims priority of U.S. provisional patent application Ser. No. 60/188,791, having a filing date of Mar. 13, 2000, and is incorporated herein in its entirety by reference.  
         FIELD OF THE INVENTION  
         [0002]    The present invention relates to an apparatus and method for measuring the forces and distribution of forces on a user&#39;s foot and utilizing this data in combination with other factors to manufacture a custom designed orthotic inlay with an automated fabrication machine.  
         BACKGROUND OF THE INVENTION  
         [0003]    Footwear has been utilized by mankind for thousands of years for protection from rough terrain, thermal extremes, and other hazards. Although primarily utilitarian in nature, footwear construction and design are often influenced by custom and aesthetics. In recent times, the design of footwear has focused more on achieving maximum comfort in general and specialized construction for athletic uses.  
           [0004]    Regardless of the protection and other benefits of footwear, they also are frequently a source of discomfort and, sometimes, trauma. Although footwear manufacturers often attempt to produce comfortable footwear, manufacturing practice and distribution methods effectively limit the range of sizes and shapes available to the purchaser. Women&#39;s high heeled shoes, for example, are frequently uncomfortable and can lead to acquired problems of the foot. Even regular Oxford style footwear with a standard heel and adequate room for the foot is frequently uncomfortable. This is due to the limited size and shape of footwear available for a limitless variety of human foot sizes and shapes. There are frequently size differences between the feet of the same individual and even the same foot between the heel and forefoot. For example, the right foot may require a size 10-medium shoe while the left requires a size nine. Furthermore, the individual&#39;s right heel may be smaller than the predicated standard forefoot to heel width for the size  10 -medium shoe. Since footwear is sold in pairs of the same size (length and width), the general rule is to obtain the largest size that will fit both feet and hope for the best. Since neither foot, in the above example, is properly fitted, abnormal loads and movement within the footwear during ambulation can be anticipated.  
           [0005]    Another issue not addressed by footwear manufacturers and not readily appreciated by the consumer but which has a direct bearing on comfort is the concept of body weight to foot size ratio. For example, an inlay specification for a person weighing 140 pounds and wearing a size 10 shoe compared to another individual who weighs 200 pounds with the same size footwear is significantly different.  
           [0006]    Producing comfortable footwear is made more difficult by the fact that the structure and shape of both the foot and footwear changes during movement which can generate complex plantar pressures. Local areas of high plantar pressure frequently causes pain forcing an individual to adopt unusual ambulation patterns which may, in turn, cause secondary problems in the foot, leg or back. Prolonged areas of high local pressure can result in painful blisters and skin thickening or callus formation. When this is coupled with loss of protective sensation, such as in diabetics, prolonged abnormal pressures can result in ulceration, bone infection and ultimately, amputation. The measurement of the magnitude and distribution of forces present on the plantar surface of the patient&#39;s foot during ambulation is described in detail in the Applicants&#39; U.S. Pat. Nos. 5,678,448 and 5,323,650, which are incorporated herein in their entirety by reference.  
           [0007]    Foot problems increase with age and may include gradual destruction, over time, of the protective fat pads located under the bony heel and under each of the toe bases. This coupled with arthritic changes in the foot results in a less adaptable foot during ambulation subject to increasing discomfort and secondary changes to include limited joint motion and muscle imbalance.  
           [0008]    Footwear manufacturers, depending on intended use, vary sole rigidity which tends to disperse high local pressures generated by sharp objects. They generally provide a thin, inadequate, generic pad for the plantar foot for esthetics. From the above discussion, it should be obvious that a specifically designed interface (inlay) between the plantar foot and footwear is needed to match the unique foot to the generic footwear which objectively address the above issues.  
           [0009]    Recognizing the need for an interface between the plantar foot and footwear is, of course, not new. In 1865, Everett H. Dunbar designed the leather lift. In 1905, Dr. Royal Whitman developed the first medical inlay referred to as the Whittman plate. In 1910, Dr. William Scholl commercialized the first arch support, the Foot Eazer. Custom inlays (orthotics) began to be developed during the 1930&#39;s but it wasn&#39;t until the 1980&#39;s that semi-automated fabrication systems began to appear. These systems generally automate the process of making the positive mold then resort to traditional inlay fabrication techniques.  
           [0010]    Current custom inlay design is based on the shape of the bottom of the foot and to a lessor extent, the inside shape of footwear. Traditionally, a cast mold is made by pouring plaster into a foam impression of the planter foot. Various moldable materials are pressure and/or heat fitted to the cast mold. Highly skilled inlay fabricators (podiatrist, orthotist or pedorthist) then fit the molded inlay product to the foot and shoe. Depending on the skill of the fabricator, an inlay can be fitted to achieve a fairly high degree of comfort based on trial and error methods. Unfortunately, these custom inlays or orthotics require 3 to 4 hours of labor over several days and multiple return visits by the wearer to make the necessary adjustments. Custom inlays are, therefore, time intensive to fabricate, expensive and are at best only an educated estimate of the ideal fit. The effects of changes in the foot and footwear shape during ambulation are ignored, as well as the actual forces which are being exerted on the foot.  
           [0011]    An automated method as taught by Schartz (U.S. Pat. No. 4,517,696) and Rolloff (U.S. Pat. Nos. 4,876,758 and 5,640,779) uses a device which generates a numeric foot shape description by use of closely spaced pins pushing against the plantar surface of the foot while the individual is standing or seated. The foot being measured rests on a firm flat platform, and the pins are pushed against the foot with varying pressure, distorting the foot in the process. The displacement of each pin is separately expressed as a number. Thus, this group of numbers represents the shape of the foot. This numeric information is then suitably processed and used as input to a numeric controlled machine to produce inlays. This method is flawed in several respects. First, it modifies the actual shape of the foot during measurement. Second, the process only accumulates data on a stationary foot as opposed to measurements on a foot in motion. These methods do not provide true pressure mapping of the plantar foot. The fabrication component of this method uses pre-formed blanks and only mills the top side. The tool path is a first traverse of the perimeter of the milled area with subsequent traverses offset to the center of the work piece. This is a traditional fabrication process used for milling a rigid work piece. However, it is an inferior process for use with soft materials due to problems associated with holding the work piece and debris collection issues. Further, the use of preformed blanks creates an inventory problem because each shoe brand, style, and size is a separate stock item.  
           [0012]    Another process requires that an individual take several steps while barefoot on a capacitive matrix force plate, as taught by U.S. Pat. No. 5,088,503 to Serts. A digital pressure map of the plantar foot is developed and augmented by fabricator input. The resultant prescription file is sent by modem to a central facility where a semi-rigid orthotic inlay is manually fabricated. This process has several significant limitations. There is no in-shoe pressure data obtained, the entire ambulation cycle is not studied, the sample size is limited to just a few steps on a force plate and the very process of stepping on a force plate at a specific location affects the measurements and renders them invalid for use in developing an inlay specification.  
           [0013]    A non-automated method has further been utilized by inserting a pre-heated (softened) thermoplastic material between the footwear and the user&#39;s plantar foot. When the individual stands, the soft material migrates from any high pressure area to a low pressure area. After cooling, the insert retains the new shape. This inlay functions to hold the plantar foot in a pre-set neutral position but achieves very little plantar pressure re-distribution. Again, only the non-dynamic stance phase of foot pressure is addressed, i.e. non ambulatory, and represents, at best, a holding form for the foot.  
           [0014]    There is thus a significant need for an orthotic inlay which reduces excessive differential plantar pressures, provides a significant reduction in fabrication time, can be designed to match the foot to specific footwear not only while standing but also while engaged in any form of ambulation, and can be produced in a manner to reduce fabrication error and provide a means to objectively document the post-fit plantar pressures. An apparatus and method describing such a system is described hereinbelow.  
         SUMMARY OF THE INVENTION  
         [0015]    It is thus one object of the present invention to provide an improved method for creating an orthotic inlay by utilizing force distribution measurements and generating an optimal force distribution profile. These force distribution measurements are obtained during the ambulatory functions of a foot, which is used herein describe the non-static positioning and movement of a foot during walking, running, jumping, etc.  
           [0016]    To avoid any misunderstanding, the word “pressure” as used herein is pressure in the mechanical sense meaning “force per unit area”. Generally, the human body only perceives and is affected by pressure differences. An example of a pressure differential is a barefooted person bringing a heel down on a pebble or a hard flat surface. In this event, a substantial portion of the person&#39;s weight will be concentrated at the contact area between the pebble and the foot, and the resultant extreme pressure differential will cause pain and potential trauma. Thus, the shape and mechanical nature of objects forced together determines the pressure distribution between the objects. In the instance of two rigid objects, computation of the pressure is simple because the contact areas are constant. In the instance of two resilient objects, the issue is much more complex due to increased force causing an increase in the contact area. The human foot is a resilient object, and so is most footwear. Yet, the shapes of both when loaded determine the distribution of pressure between the two. If the shape of either is changed, then the pressure distribution changes. Hence, there is a direct, but complex, correlation between loaded shoe and foot shapes and pressure distribution.  
           [0017]    The method of the present invention deals directly with the pressure distribution pattern on the plantar surface of the foot during ambulation to generate an inlay shape which redistributes pressures to a more advantageous pattern. The inlay shape is a mathematical function of the measured pressure distribution during ambulation, the desired pressure distribution, and the shape of the footwear.  
           [0018]    Generation of a desired pressure distribution pattern is thus a necessary prerequisite to inlay shape generation. Although usually unexpressed, redistribution of pressure is the goal of any inlay fabrication method. With the method of the present invention, development of a desired pressure distribution follows receipt and analysis of all aspects of the measurement data by use of analysis tools which are essential parts of the system. These analysis tools may include, but are not limited to, displays of, a frame by frame view of the direct measurement data, a force versus time plot for each foot fall, a centroid of forces track for each foot fall, and composites, averages, and derivatives of each and all of the above. However, the fundamental element of the method of the present invention is pressure redistribution to reduce peak pressures through modification of the inlay shape, and underlying this is a computer routine to achieve pressure leveling within user-defined areas of the plantar surface of the foot.  
           [0019]    Pressure leveling is achieved by increasing the inlay thickness in areas of low measured pressure. Conversely, the inlay is thinner in areas of greater measured pressure. At peak measured pressure areas, the inlay has a minimum thickness. The bottom shape of the inlay must reasonably fit, or match, the footwear. The top shape, or elevation (S T )at any single point is:  
             S   T   =S   B   +D−C×T    1.0  
           [0020]    where:  
           [0021]    S B  is the elevation of the bottom of the inlay  
           [0022]    D is the desired pressure  
           [0023]    C is the composite pressure pattern  
           [0024]    T is the translation factor  
           [0025]    Note that elevation is a vertical distance from a datum plane. “T” is empirically derived. The above may only be applied to local areas having uniform load bearing capability. Different areas of the foot have different capabilities. For example, the instep cannot tolerate as much pressure as the heel. Consequently, the total plantar surface area of the foot must be subdivided into appropriate local areas and 1.0 above must be applied with different “T” factors for each area.  
           [0026]    Because the above can change the relative position of the skeletal elements of the foot, an additional elevation factor is necessary.  
             S   T   =S   B   +D−C×T+P    1.1  
           [0027]    where:  
           [0028]    P is an added, or subtracted, depth  
           [0029]    Note that the “P” factor varies between local areas.  
           [0030]    The “P” factor can serve another important function in defining the shape of the inlay. It is an appropriate variable to accomplish adjustments to the foot&#39;s posture when a review of the measurement data as described above indicates such to be necessary. An example of this is a fallen metatarsal arch. In this instance, a high pressure is seen proximal to the second through fourth metatarsal heads. Without an appropriate “P” factor adjustment to this local area, an inappropriate inlay shape could result.  
           [0031]    Once the inlay shape is determined, the numeric specification can be used to control automated equipment to fabricate the inlay. The ideal material for inlay fabrication must be resilient to some degree. If the inlay is to be fabricated by machining, it is preferably machined on all sides. Consequently, the present invention includes a means to support all inlay material blank pieces on all six sides and a sequence of milling to assure maximum stability of the work piece, maximize efficiency of debris removal, and achieve adequate precision.  
           [0032]    The advantages of the method of the present invention include but are not limited to reduced space requirements for data collection and fabrication, objective measurement capability to minimize guesswork, increased speed of fabrication, and the elimination of most of the hand work mess, and clutter of traditional custom inlay fabrication. Further, manipulation of the inlay shape prior to fabrication, evaluation of shape and data files either locally or at a remote location, the capability to collect data for research purposes, and post-fit pressure analysis is provided. Additionally another significant advantage is that it allows the Fabricator to directly observe, manage, adjust, and work with a desired pressure distribution as a means of creating an inlay shape prior to actual fabrication.  
           [0033]    Thus, in one aspect of the present invention, a method for fabricating an orthotic inlay for insertion into footwear is provided, comprising:  
           [0034]    obtaining force data which is indicative of the magnitude and distribution of forces present on the plantar surface of a foot during ambulatory functions;  
           [0035]    generating optimum orthotic shape inlay data based on said force data; and  
           [0036]    fabricating said orthotic inlay using said orthotic inlay shape data.  
       
    
    
     DETAILED DESCRIPTION OF THE DRAWINGS  
       [0037]    [0037]FIG. 1 is a flowchart of a process used to size and fabricate an orthotic inlay;  
         [0038]    [0038]FIG. 2 is a flowchart of an inlay shape generation program;  
         [0039]    [0039]FIG. 3 is a view of a computer monitor display showing an interactive user display;  
         [0040]    [0040]FIG. 4 is a view of the computer monitor of FIG. 3 with illustrative example data;  
         [0041]    [0041]FIG. 5 is a plot of pressure v. time;  
         [0042]    [0042]FIG. 6 is a depiction of the pressure distribution on the bottom of a foot, and indicating a particular frame of measurement;  
         [0043]    [0043]FIG. 7 is a wire frame isometric view showing the distribution of pressure on a user&#39;s foot;  
         [0044]    [0044]FIG. 8 is an isometric view of a desired pressure pattern;  
         [0045]    [0045]FIG. 9 is an isometric view of the top and bottom of the inlay shape generated from the two patterns shown in FIG. 7 and FIG. 8;  
         [0046]    [0046]FIG. 10 is a front elevation view of an inlay fabrication machine;  
         [0047]    [0047]FIG. 11 is a side elevation view of the inlay fabrication machine shown in FIG. 10;  
         [0048]    [0048]FIG. 12 is a detailed side view of a debris removal cowling;  
         [0049]    [0049]FIG. 13 is a is a front view of the cowling shown in of FIG. 12;  
         [0050]    [0050]FIG. 14 is a detailed side elevation view of a holding frame;  
         [0051]    [0051]FIG. 15 is a detailed front elevation view of the holding frame shown in FIG. 14; and  
         [0052]    [0052]FIG. 16 is a front elevation view of plates used to hold the work piece, the slot representing a location where a cutting instrument extends therethrough.  
     
    
     DETAILED DESCRIPTION OF THE INVENTION  
       [0053]    A method for fabricating a custom designed orthotic inlay using force and measure data present on a user&#39;s foot is provided herein. In general, the process includes three major steps. These include data collection, inlay shape generation, and inlay fabrication. All of these activities are performed and/or supervised by an inlay fabrication machine through the use of an inlay software package as described herein.  
         [0054]    In general, the process is first used to measure the distribution of pressure on the foot when the subject individual is standing, walking, running, etc. This is done using an intra-footwear pressure distribution measurement system or device which interferes as little as possible with the subject&#39;s movements. This body of data is then converted to digital form and transferred to a computer system or other form of central processing unit (CPU). The computer system then functions as an analysis tool for operator review of the body of data. The computer system also functions to generate an inlay shape through software routines controlled by user input. The result of this is an inlay shape defined by a digital shape file. This shape information is then the basis for other software to control an inlay fabrication machine.  
         [0055]    Referring now to FIG. 1, a flow chart of the main inlay program is shown. This program serves only as a user entry point to the fabrication system. Step  102  is a routine necessary to any software program for the allocation of memory, opening of files, computer screen displays, etc. Step  104  allows the user to select one of the three aforementioned steps as well as other programs not shown on the flow chart of FIG. 1. Step  110  is a test for user selection of the function of step  112 , step  120  is a test for user selection of the function of step  122 , step  130  is a test for user selection of the function of step  132 , and step  140  is a test for user selection to exit the program. If all of the tests of steps  110 ,  120 ,  130 , and  140  are false, program activity continues with step  104 . If any of steps  112 ,  122 , or  132  are executed, program activity continues with step  104  upon return from any of these programs.  
         [0056]    The first major process step is a means for obtaining measurement data. This is necessary component, but not a required step of the present invention since different methods and apparatus can be utilized to obtain the force and pressure distribution data necessary to operate the orthotic inlay fabrication machine. Preferably, a means is provided for receiving this measurement data, collecting essential non measurement data pertainment to the fabrication technician&#39;s analysis, and to link the measurement data with the individual. Such non-measurement data may include but is not limited to a subject&#39;s name, age, general health, date of measurement, and type of footwear. The essential criteria for this body of pressure measurement data is that a) it must be reasonably accurate; b) it must consist of individual pressure values taken at known locations across the entire plantar foot surface closely spaced with respect to the size of the parts of the human foot anatomy; c) it must include multiple measurements of the total of all locations taken at a rate to assure multiple measurements of all locations for each foot fall; d) it must represent pressures between the plantar foot surface and the inside surface of the subject&#39;s footwear; and e) must be taken while the subject is engaged in unrestrained ambulation. Although not a specific part of any major activity, coordination between the various programs to capture and convey aspects of size and shape of the preferred footwear and the location with respect to the footwear of each of the pressure measurement points is also essential for the accuracy of the present system.  
         [0057]    Although the forces typically measured in the present invention are forces acting vertically on the sensor arrays, it is possible to also measure “translational forces” which act in a non-vertical direction. Pressure distribution measurements are generally made with sensor arrays having individual sensors which cannot distinguish force vectors. In fact, it is often advantageous to construct sensors which do not respond to horizontal components. However, inferences can be drawn with respect to horizontal forces when the entirety of the vertical forces acting on the foot are considered as a whole and in conjunction with the mechanical characteristics of the foot anatomy and the footwear.  
         [0058]    The second critical process is shape generation. Referring now to FIG. 2, a flow chart is provided of the shape generation program. Step  202  is a routine necessary to any software program for the allocation of memory, opening of files, computer screen displays, etc. User settings are stored in permanent data storage files for consistency between program runs. A file which can optionally contain a comprehensive history of the program activity is also maintained. This file is rewritten for each program invocation. At a minimum, it will include a text message giving the reason for the last program termination. This step  202  also includes all data storage specifications. Significant data storage specifications include a series of two vector short integer arrays, sized 54 by 120, to receive and manipulate pressure measurement data and another series of short integer arrays, sized 120 by 112, are used in the process of generating the inlay shape.  
         [0059]    Step  204  is a simple menu routine to receive user input.  
         [0060]    Step  210  tests for a user command to select an existing measurement data file. If Step  210  is true, step  212  is executed to allow the user to review a list of available measurement data files. Upon exit from step  212 , step  214  is executed to test for user selection of a measurement data file. If step  214  is true, step  216  is executed, else step  204  is executed. Step  216  loads the selected measurement data file. Upon exit from step  216 , the program returns to step  204 . Note that until step  216  is successfully executed, steps  222 ,  232 ,  242 ,  252 , and  262  will always test false. FIG. 3 shows the appearance of the screen on initial entry into step  216 .  
         [0061]    Step  216  functions to first open the selected measurement data file and read the entire file into a buffer. In addition to the actual measurement data, this buffer then contains additional pertainment information including the subject&#39;s name and address, date of measurement, identification of footwear, etc. The “load” function of step  216  also calls other routines to load a footwear shape file and a file containing a list of coordinate locations for each pressure measurement point. This is followed by calling another routine (savg) to repetitively search through the measurement data buffer and extract all reads of a single sensor, load these into each eighth element of another buffer, and then apply an interpolation routine to logically generate values for the intermediate points. Each point intermediate to these eighth points is set equal to seven times the sum of the two adjacent eighth data points less the sum of the two next adjacent eighth data points divided by 12. This procedure is repeated twice more to evaluate the intermediate points to the fourth points and the intermediate points to the second points. Any resultant value less than zero is set to zero. The result of this procedure is a pressure versus time plot typified by FIG. 5. Each measurement point is then evaluated as a factored average of its peak values and stored in its respective location in the “commap” 54 by 120 vector data array. The “load” routine next calls “dfil” routine which functions to evaluate intermediate locations in the “commap” array by using a similar interpolation routine. On completion, a composite numeric pressure distribution pattern representative of all foot falls is complete. FIG. 4 shows the appearance of the computer display at the completion of step  216 , and depicting the force and pressure distribution present on the planar surface of the subject&#39;s foot who is identified as Jane A. Doe.  
         [0062]    Step  220  tests for a user command to do a detailed frame by frame review of the pressure distribution measurement data. If true, and if step  222  is also true, step  224  is executed and “plbk” routine is called. A typical computer display during this activity is shown by FIG. 6., and which identifies the pressure distribution pattern for the pattern of FIG. 4.  
         [0063]    Step  230  tests for a user command for a wire frame review of the composite pressure distribution pattern. If true, and if step  232  is also true, step  234  is executed and a “wfrm” routine is called. A typical computer display is shown in FIG. 7 which shows a wire frame review of the force and pressure distribution.  
         [0064]    Step  240  tests for a user command for pressure modification routine. If true, and if step  242  is also true, step  244  is executed and a “pmod” routine is called. A typical computer display is shown in FIG. 8, which identifies an isometric view of the desired pressure pattern. In FIG. 8, the cursor remains at the same coordinates as in FIG. 7.  
         [0065]    Step  250  tests for a user command for a review of the inlay shape. If true, and if step  252  is also true, step  254  is executed and the “ishp” routine is called. A typical computer display is shown by FIG. 9. In FIG. 9, which more clearly depicts an isometric view of the top and bottom of the inlay shape generated from the two previous patterns of FIG. 7 and FIG. 8. The Y axis cursor remains at the same location.  
         [0066]    Step  260  tests for a user command for to save the inlay shape created by step  254 . If true, and if step  262  is also true, step  264  is called and the “sisi” routine is called. The sisi routine (Save Inlay Shape Information) first creates a unique file name for the inlay shape information file, saves this information, and then records the file name in the pressure measurement data file to link the two files. Step  270  tests for a user command to exit the shape generation program. If true, activity continues within the calling routine.  
         [0067]    Referring now to FIG. 3, the upper left box contains the menu for the shape generation routine. The “OPEN ACCOUNT” option is highlighted. The user can change the highlighted option by pressing the “up” or “down” keys, and when the “enter” key is pressed, the highlighted option is executed.  
         [0068]    Referring now to FIG. 4, the box at the bottom of this screen contains the subject&#39;s name and other incidental information. The box at the right is a 12 color representation of the composite pressure distribution pattern. The background is preferably black, while minimum pressure is represented by dark blue, maximum pressure is in bright red, and intermediate pressures are green shades. Of course, any variety or combination of colors may be used to show the pressure distribution pattern. There are preferably 12 pressure ranges represented by the various colors.  
         [0069]    Referring now to FIG. 5, this is a screen for technical analysis only, and is not ordinarily seen by the user. Color of each line of the traces is different to facilitate review when overlapping occurs. The top three lines show repeated footfalls on a single sensor identified by the first line of text at the top. The right half of the fourth line shows the subject attempting to stand still on one foot. The remaining flat lines indicate only the buffer in the pressure measurement device which was not completely filled. Time is constant throughout the trace. Note that during the walking portion, this sensor is loaded slightly more than half of the time. For this sensor, the highest peak measured is 65 (PSI). There are 26 instances of peak pressures above the threshold value of 32. The total of these peak pressures is 1167 and the average pressure value is 44. This is the pressure used in the composite pressure distribution pattern. It should be kept in mind that, although the pressure distribution can be changed, the total force on the foot due to body weight and ambulation dynamics cannot be changed by any aspect of footwear. Also, the composite pressure distribution pattern represents a total force greater than any actual force imposed by the subject. This is because the person&#39;s total weight is typically supported first by the heel area and then by the forefoot area while the composite pressure pattern generation algorithm necessarily focuses on peak pressures at each measurement point. In order to generate the inlay shape, a conservation of force concept can be applied to sub-areas of the plantar surface of the foot once the total force to be, or is being, supported by the sub-area is determined.  
         [0070]    Referring now to FIG. 5, this is a screen for technical analysis only, and is not ordinarily seen by the user. The color of each line of the traces is different to facilitate review when overlapping occurs. The top three lines show repeated footfalls on a single sensor identified by numbers in the first line of text at the top. The right half of the fourth trace line shows the subject attempting to stand still on one foot. The remaining flat lines indicate only that the buffer in the pressure measurement device was not completely filled. Time is constant throughout the trace. Note that during the walking portion, this sensor is loaded slightly more than half of the time. For this sensor, the highest peak measured is 27 psi. There are 30 instances of peak pressures above the threshold value of 13. The total of these peak pressures is 641 and the average pressure value is 21. Thus 21 psig is the pressure used in the composite pressure distribution pattern. It should be kept in mind that, although the pressure distribution can be changed, the total force on the foot due to body weight and ambulation dynamics cannot be changed by any aspect of footwear. Also, the composite pressure distribution pattern represents a total force greater than any actual force imposed by the subject. This is because the person&#39;s total weight is typically supported first by the heel area and then by the forefoot area while the composite pressure pattern generation algorithm necessarily focuses on peak pressures at each measurement point. In order to generate the inlay shape, a conservation of force concept can be applied to sub-areas of the plantar surface of the foot once the total force to be, or is being, supported by the sub-area is determined.  
         [0071]    Referring now to FIG. 6, the “001” at the right of the bottom box indicates this is the first frame. The right box shows the same color coded pressure distribution pattern as for the composite pattern of FIG. 4. In this instance, the subject&#39;s foot is just coming into contact with the ground. There is light pressure at the heel, and less at the forefoot area. Some of the pressure evident in this display, particularly in the mid-foot area, is residual and results only from the footwear being held snugly to the foot. The user moves from frame to frame by use of the arrow keys on the keyboard. The result is essentially a motion picture of the measured pressure distribution patterns on a users&#39; foot.  
         [0072]    Referring now to FIG. 7, the image in the center of the screen is an isometric view of the composite pressure distribution pattern. All edge pressures are zero, and upward displacements indicate increasing (positive) pressure. There are no negative pressures. The dark lines crossing at the first metatarsal head are a cursor. The cursor can be moved in four directions by use of the arrow keys. Below and to the right of the wire frame are three text lines indicating the location of the cursor and the pressure at the cursor. These are in standard medical terms of centimeters and kilopascals with the coordinate origin at the lateral posterior edge of the pattern. This particular individual has an extremely high arch. Note the absence of pressure at the medial mid-foot. The elongated pressure area at the fifth metatarsal is probably due indirectly to poorly fitting footwear. Note that the pressure at the cursor is 301 kilopascals as shown in the lower right hand portion of the FIG. 7. It is important to remember that this image depicts the pressure on the bottom of a foot, and regardless of the similarity, does not depict the shape of the foot.  
         [0073]    Referring now to FIG. 8, the image at the center of the screen is an isometric view of the desired pressure pattern. As in FIG. 7, all edge pressures are zero, but rise abruptly to constant peak pressure. Initially, each cross section is equal in area to its counterpart in the composite pressure distribution pattern of FIG. 7. The desired pressure distribution pattern of FIG. 8 is derived from these initial cross sections in a manner that the total cross sectional area of all sections in the pattern of FIG. 8 is equal to the total cross sectional area of all sections in the pattern of FIG. 7. Note that the cursor position is the same in FIG. 8 as it is in FIG. 7, but the pressure at the cursor position is now 109 kilopascals. This is a significant reduction from the pressure at this point in the composite pressure distribution pattern of FIG. 7.  
         [0074]    Referring now to FIG. 9, the image at the center of the screen is an isometric view of the top and bottom of the inlay shape generated from the two previous patterns of FIG. 7 and FIG. 8. The moire effect is due to the superimposition of the two patterns. The bottom pattern depicts the inside shape of the footwear. This shape information is the output of a separate procedure and can be in any of a number of currently available methods to digitize, or express as numbers, the footwear shape. At the center bottom of FIG. 9 is a series of cross sectional lines depicting, from highest to lowest, the measured pressure, the desired pressure, the top of the inlay shape, and the bottom of the inlay shape. The vertical scale of the pressures is arbitrary. The vertical scale of the inlay shape is one to one with the actual inlay shape being developed. The thickness of the inlay at each point is computed by subtracting the measured pressure from the desired pressure and multiplying the result by a factor. The user input settings for global depth factor, mid-foot depth factor, and lift factor are shown at the upper left of FIG. 9. The Global depth factor affects the entire foot area and the mid-foot depth factor affects only the mid-foot area. The lift factor does not affect cross sectional inlay thickness. A positive lift factor increases the total depth of the inlay at the heel and may reduce it at the toe. A negative lift factor does the opposite. Lift is used when deemed appropriate by the user.  
         [0075]    The third major process step in the present invention is to fabricate the inlay using the numeric shape information generated by the second activity. In summary, the method of the present invention is to mill or machine all inlays from a standard size blank piece of suitable material. This involves cutting a pliant material on all six sides. Preferably the pliant inlay material is comprised of plastic, forms, (open and closed cell), ethyl vinyl acetate (EVA) or other similar materials known in the art. This pliant material can be any material having the preferred mechanical characteristics. The preferred mechanical characteristics are flexibility similar to that of a shoe sole, a small amount of compressibility, and light weight. The most obvious material is a closed cell, high weight, polymer foam.  
         [0076]    The milling equipment and disclosed method of use is designed to support the work piece on all six sides. Referring now more specifically to FIGS.  10 - 16 , the work piece is held in opening  356  and formed by holding frame  350  and on the two remaining sides by each of the plates  450 . Plates  450  are stationary, holding frame  350  moves up and down to form an “X” motion, carrier  400  moves left and right to form a “Y” motion, and mill heads  430  each move forward and backward to form “Z 1 ” and “Z 2 ” motions. The long slot  452  in plates  450  is for access to the work piece by the cutting bits  438 .  
         [0077]    Referring now to FIG. 10, which is a frontal view of the assembled machine, Chassis  302  is not shown in its entirety, but is a single element necessary to support all other parts. Motor  310  drives the “X” motion, motor  312  drives the “Y” motion, and motors  440  drive the “Z” motions. Guide rails  304  support the “X” motion, guide rails  306  support the “Y” motion, and guide rails  408  support both “Z” motions. Motors for all motions turn drive screws  308 ,  314 , and both of  406 .  
         [0078]    Referring now to FIG. 11, a side view of the assembled machine is provided herein. The asymmetry or offset of frame  350  is necessary to preclude interference with carrier  400 . Part  400  extends around the bottom of fixed plates  450  and the lowest position of frame edge  362 . Position  318  is the highest position of frame edge  354  which is used for material insertion and removal. Position  320  is the highest position of frame edge  354  during milling. Mill head motors  432  are identical, and have one direction of rotation. Thus if cutting bits  438  were to meet when running, damage would occur. This situation is prevented by arms attached to both sides of mounting brackets  434  and extending under position  316  to prevent contact between cutting bits  438 .  
         [0079]    Referring now to FIG. 12, which is a detailed side view of carrier  400  and FIG. 4 which is a detailed front view of the same carrier  400 . Drive nut  416  transfers drive force from motor  312  to carrier  400 . Bearings  422  slide along guide rails  306  and prevent undesired movement of carrier  400 . Seals  403  contact and slide against plates  450 . Parts  414  and  410  receive “Z” motion guides  408  and drive screws  406 . Parts  410  also receive drive motors  440 . Parts  412  are stiffeners. Holes  404  allow cutting bits  438  access to the work piece. Parts  424  and  426  are tightly connected to parts  428  to form air tight vacuum debris removal channel  418 . Channel  418  communicates with flexible vacuum hose  420  leading to a vacuum debris collection system which is not shown.  
         [0080]    Referring now to FIG. 13, a front view of the cowling shown in FIG. 12 is provided herein and includes the components discussed above.  
         [0081]    Referring now to FIG. 14, which is a detailed side view of holding frame  350  and FIG. 15 which is a detailed front view of the same holding frame  350 . Drive nut  360  transfers drive force from motor  310  to holding frame  350 . Bearings  358  slide along guide rails  304  and prevent undesired movement of holding frame  350 . Latch  352  holds frame edge  354  in place during milling and can be released by hand to swing up frame edge  354  for insertion or removal the work piece.  
         [0082]    Referring now to FIG. 15, a detailed front elevation view of the holding frame shown in FIG. 14, and including the various components described therein.  
         [0083]    Referring now to FIG. 16, a front elevation view of one of the plates  450  is shown. These plates  450  are fixed directly to chassis  302 . The plates  450  are separated by the thickness of the work piece. Different thicknesses of work pieces can be accommodated by repositioning plates  350  and using thinner or thicker seals  402 . Note that this machine can easily be adapted for automated work piece feeding, and all dimensions, materials, thicknesses, etc. are subject to engineering analysis and modifications. The particular arrangement described herein is optimized for compactness. Other optimizations may be advantageous depending on circumstances.  
         [0084]    The necessary components of wiring, limit switches, encoders, motor driver units, indexer facility, etc. are not necessarily part of the present invention and are not described herein. However, as appreciated by one skilled in the art, most of these components are off-the-shelf items used frequently in the mechanical and electrical arts. In a similar manner, tool path generation software is necessary, but it is not part of the present invention and is not described herein.  
         [0085]    The foregoing description of the present invention has been presented for purposes of illustration and description. Furthermore, the description is not intended to limit the invention form disclosed herein. Consequently, variations and modification is commensurate with the above teachings, and the skill or knowledge of the relevant art, or within the scope of the present invention. The embodiments described hereinabove are further intended to explain best modes known for practicing the invention and to enable others skilled in the art to utilize the invention as such, or other embodiments and various modifications required by the particular application or use of the present invention. It is intended that the appended claims be construed to include alternative embodiments to the extend permitted by the prior art.