What If The Best Prosthetic Innovation Is Repeatability with Rob Gabourie

We welcome  prosthetist and Niagara Foot inventor Rob Gabourie for a fascinating conversation spanning more than five decades of prosthetic innovation. Rob shares how his career began after his brother's industrial accident, reflects on hand-carving wooden sockets for World War II veterans, and explains how the demands of Vietnam veterans helped accelerate advances in prosthetic technology. Throughout the discussion, he emphasizes a philosophy of practical problem-solving—continually "fiddling" with designs to make them simpler, more durable, and more effective for the people who depend on them every day. 

The conversation also explores the development of the Niagara Foot, lessons learned from decades of fitting transfemoral patients, and the importance of balancing engineering with clinical experience. Brent and Rob discuss how additive manufacturing is transforming prosthetics, where 3D printing fits into the future of patient care, and why repeatable, data-driven socket design may be the next major leap forward. It's an episode filled with history, wisdom, and practical insights for clinicians, engineers, and anyone passionate about improving mobility through thoughtful innovation. 

Special thanks to Advanced 3D for sponsoring this episode.

Transcript

Welcome Season 14 And Mission

SPEAKER_01 0:02

Welcome to season 14 of the Prosthetic and orthotics podcast. This is where we connect with experts in the field, agents who use these devices, physical therapists, doctors, and defenders to help bring it all together. Our mission remains the same: to share stories, tips, and insights that help improve patient outcomes. Tune in and join the conversation. We're glad you're here and hope it's the highlight of your day.

Guatemala Trip Patient Wins

SPEAKER_02 0:32

Hi everyone, my name is Yoris Peels, and this is another episode of the Prosthetics and Athletics podcast with Brent Wright.

SPEAKER_01 0:37

How are you doing, Brent? Hey Yoris, I'm doing well. Just got back from a trip to Guatemala, and that was uh entertaining. This is the first time we've been in July, and the w the way that I say it is so hot. Like I started pre-applying Gold Bond, you know, about a week beforehand, you know, that along with the malaria medicine kind of goes hand in hand.

SPEAKER_02 0:55

Do you have the good stuff, the malaria stuff, or not? No, no.

SPEAKER_01 0:58

No, so actually, uh, believe it or not, we and it's a obviously a person's so we don't we don't take malaria medicine. There's not a lot of malaria up where we're at. There is dengue, though, and there's just nothing that you can do with dengue. So uh a lot of bug spray, and then it's just you don't stay out at night. So we and we in our sleeping quarters, we do have air conditioning, the windows are closed, there's not mosquitoes coming in, so we don't have to do the mosquito net thing. It's not quite luxury, but uh it it we get enough rest to keep on working. Okay, okay. All right, definitely. And was it you was it productive this time? Yeah, we saw about 25, I would say, patients or so. Some of them were follow-up patients. And I always love seeing that. We had a guest recently, and it really stuck with me. It's it's not the first day that you fit the prosthesis that's important. It's that it's in that they're still wearing it six months later. And I think that is very important to us at Life Enabled. And so seeing these people come back that are wearing their prostheses and they're, you know, they're we're having to maybe make some adjustments or what have you. It's just a a real joy. And then on the other side of things, giving hope to people that didn't have hope. We had had three patients that doctors said, there's nothing that you we can do for you. You're never going to walk. And uh uh two of them took their first steps, this clinic. Then the third one, he was a little kiddo, probably 18 months, two years old, very rare, like weird thing. I've never seen anything like it before. And I made him some 3D printed prostheses. He was crying the whole time, hated it. Probably like a white coat syndrome sort of thing, even though I don't wear a white coat. And so we're like, okay, we're just gonna send them on. They fit, looks like okay. And then two days later, we get to a video of him walking behind like a little push toy in the dirt, and he'd never done that before. So that's awesome. I think I think the cool thing is about this is you never want to write anybody off. You know, if they have a will to to do stuff and walk, I'm not gonna be the one that doesn't give them something because who knows, they may surprise you and do it.

SPEAKER_02 3:04

That's awesome, dude. That's awesome. Okay, and and how's that the what uh uh did you take an E3D printer? What printer did you take? And how did that go?

SPEAKER_01 3:10

So yeah, I have a uh two bamboo A1s down there. So, you know, we only have it's uh essentially 10 by 10 by 10 build volume, so it's pretty much only for pediatrics, and we do our partial feet and uh, you know, potentially oh, I I used Raven AI. I know you did a ray uh an article recently about AI, and it actually created a really cool tool that I was able to use in the lab that helped me do some organization of stuff. And so that was another thing that I printed. So it was, you know, not only stuff that people wore, but tools that allowed me to get organized. That's awesome,

Guest Intro Rob Gabori

SPEAKER_01 3:45

man. So who's our guest today? Well, I'm really excited to have uh Rob Gabori on today. And so Rob is a pretty humble dude, but uh I'm just gonna get to brag on him a little bit. He is the inventor of the Niagara Foot, and I've been a Niagara Foot user since 2006, starting with the Model One and then to the Model Two. Rob has also been a great friend over the many years that I've known him and uh definitely encouraging me along the way. So, Rob, I know that we we we don't talk, you know, a ton. We'll text back and forth, but uh, I mean, Rob, as far as an influence on my life and practice and the way that I practice and help patients, I would say would be in my top three prosthetic friend group and and just a friend in general. He's always encouraging. And I love the some of the philosophy behind what he does as well. And that is sometimes simple products take a lot of a lot of thought for our patients, but do work the best. And so, not only with the foot stuff, I'm still working on the knee stuff that's closer than it's ever been. And and then we also talk uh shop and socket design and uh salesion belts and how to make patients' lives better. So that's that's Rob in a nutshell. He's in Canada. He is semi-retired, but chasing grandkids around now. And uh, so yeah, I'm really excited to hear probably some stories that I haven't heard before. Welcome to the show, Rob.

SPEAKER_00 5:09

Thank you. And you what you're what you're doing is actually it's not evolutionary, it's revolutionary in in in PO and prosthetics and orthotics. It's it really does open up much more downstream creativity. Like you we were really stuck with what we had. Slow, Librous, blah, blah, blah. And if you make a mistake, oh my God, it's all that over. Now you I'm really admire you guys from charging ahead. Well, on behalf of Brent, thank you.

SPEAKER_02 5:33

I'm not really charging ahead. I just talk to people. No, um so so Rob, tell us how did you when did you get start uh started with OMP?

From Wooden Sockets To Modular Systems

SPEAKER_02 5:40

Before you were born. Really? Okay, okay. And and so so was it like it was a black and white OMP or what was it before it was was it uh like back then?

SPEAKER_00 5:48

It was okay, I'm probably one of the few people alive who has made, and I would do this from my World War II vest, I have made wooden sockets. And how you start a wooden socket is you get a large block and about 25 centimeters by 25 centimeters by 70 centimeters of basswood and you hand carve it. Because these guys wanted that, and they're all of them were heroes in my own eyes, and I would do whatever the hell they wanted, and then slowly progress them over years into the newer technology. But how I got started, my brother lost some fingers in an industrial accident. I went in to look at the field, and this was probably 50 plus years ago, and I thought that the most sophisticated device 50 years ago, I thought, oh, I could do that in my garage. So that's what got me started.

SPEAKER_02 6:31

And and and so that that that's a that's an amazing story. And what were for you when when did it really start to shift? What was the technology or the insight, or when would it really change from this kind of older state to something much more modern or much more, you know, better for the patient?

SPEAKER_00 6:47

You know, it's the past for me is is blended, and I sort of forget the exact moment. I I was working at McMaster, so that was 40 years ago. And I would say it started the shift, and I would say post-initial Autobach. Now, Autobach and Brent Brent knows that company, they had stainless steel modular devices that that instead of us making exoscalesis, they allowed us to sort of quickly fit across the device. And I think that was that was the initial start of the rapid progress and driven by this really is important. It was driven by Vietnam vets. And why why just because there was an influx of a lot of people all of a sudden? Are there younger people? A lot of younger people, a lot of very the World War II guys was they were happy and it was a different generation. They were happy with or satisfied or or tolerative of what they got, which was so crude you wouldn't believe it. These men were tough men just to wear them. The Vietnam guys were not happy with what they got. And that that to me drove some money into this field and drove some consumerism into the field. So I can see a definite shift from when the Vietnam bet started getting prosthesis to the five years later. So that to me was driven by those young injured men. Aaron Powell Okay.

SPEAKER_02 8:06

And and and technologically, I mean, was it carbon fiber? We always talk about like things like carbon fiber and liners, but was there a moment before you said the autoblock, the kind of modular units?

SPEAKER_00 8:15

Was there also other steps that you it was fitting fitting techniques that went to more intimate, better biologically designed, more anatomically designed devices. That doesn't mean the whole field did this. They were it was mainly stragglers, but there were a few people ahead of their time, and and and Brent's doing that now in a different way, but there were a few people ahead of their time who were willing to spend the time, try it, and if it didn't work, then do it again. And that's that really is in at that time in this particular business. That really was important because you really did, the people who did make the advances sometimes were a little bit radical and sometimes they wasted a lot of time. So that it's it's a long, not precise answer, but that that's all there is.

SPEAKER_02 8:57

No, exactly. It's difficult to see. Also in retrospect, it's it's it's easy, you know, the people who are innovating often fail. I mean, that's you know, I think I think that's something you have to accept if you do that. Yep. So and and and you yourself, uh, you know, did you change much as a practitioner? Are you always kind of the same guy, do you think, or did you change a lot in personality or in the way you operated as well?

SPEAKER_00 9:17

I attempted to no, I didn't not really. I was I was always a fiddler. But I attempted to be slightly more compassionate and space, but not quite so mechanical at the end. Now and have you said that, I could never do pediatrics, period. I just couldn't. No, my brain just would not let me separate that poor little kid from the job at hand. I found myself not being very good at it, not very not being very efficient at it. So Okay, okay.

SPEAKER_02 9:44

You're like the the the the people on the TV show ER, like always worrying about the patient and then you know, I don't I don't know about that.

SPEAKER_00 9:50

I just could not separate that you and you when you're into the middle of a of a mechanical job, I had to be a mechanic and not sort of thinking about the emotions.

SPEAKER_02 9:58

So Okay, okay, okay, that's cool. And then and uh so at one point you started kind of more commercializing your own devices, right? No, I don't think commercialized.

SPEAKER_00 10:07

I never thought about I never thought about that. Never never ever. Inventing things. Yeah. It wasn't even inventing, it was just I'm not I have not got an imaginary bone in my body. I know it it it's it's just take something, look at it, and say, Well, this this could be made better, or this could be made different, and let's see how it works out. So I'm not I'm not an inventor person. I I don't, again, I don't have that creativity. So it was it was just I'm a fiddler and then seeing how it works out.

SPEAKER_02 10:31

And does that mean well uh when you when you when I Okay, let's think about this this fiddler process, let's say. So imagine I have something like what Brent had, like uh somebody with a completely unique kind of thing. How would you start with that? Would you start with the problem? Would you start with the patient? Would you start with the mechanics of it? Well, how does the fiddling start?

SPEAKER_00 10:46

It's almost straight. You know, I have to go back to this. It's almost in my tiny brain, it's almost straight. I call it Newtonian physics. It's, you know, you do this and something else happens, and that's it. And if you see a certain gait pattern and you don't like that gate pattern, you work your way from where it starts to the ground and then see how we can influence it. Trevor

Why The Niagara Foot Exists

SPEAKER_00 11:05

Burrus, Jr.

SPEAKER_01 11:05

So one of the things that I'd love to dive into is the kind of the evolution of the Niagara foot. Uh I I know you've told me multiple times that, you know, yes, it was a it's a great foot. I st I mean I and I still use it, but there are some things that you um, you know, would have liked to seen different, but I don't really want to focus on that part, but I wanted to focus on the part of why go down the the road of the the Niagara foot the way that you did. Like what was the inspiration there? And then tell us some of the the journey to finally get there because it's not obviously you have your prototypes and that sort of thing, and then you've got to cut a mold, and then you've got to inject that mold, and that all that stuff has to be precise that you can send out. And so there's there's a lot more than just coming up with an idea for the foot.

SPEAKER_00 11:53

It was also back to that back to that fiddling. The initial reason I did this is because some of the times we would get at at McMaster, Tiroak rehab center, which is McMaster, we we'd get the clients from underdeveloped countries, and they had either the autobox sash foot, the you know, you know that, or an imitation or a bad imitation of that. And these people who who they were already fighting for their like they their lives were very, very physical, and they had these end-of-the-vices, it doesn't matter how good the sockets were, and sometimes they came with surprisingly good sockets. Because some people in underdeveloped countries are as smart or smarter than me. They came with decent sockets, but just these terrible feet that were literally nothing left to the wood core. So the people who had to use expend calories, the most calories, just to survive, had a part of their processes that was just sucking up energy and calories and making it bad. So I just started fiddling with stuff. And I saw that I think you need a little bit of quote unquote, if not energy storage, at least don't suck up the energy. And that that might involve cushioning, but that's also an energy, an energy drag. And I just started working from there. It's some of the initial veterans' foots that we feet that we would hand make had rubber bumper controlled planter flexion and rubber bumper controlled dorsiflexion, but they were just a a nightmare of parts. And I wanted to reproduce that in a one-piece mold. And back then, my my initial goal was to make it that this was back, keep in mind it's 40 plus years ago. The cheapest way to reproduce an accurate device back then was after the initial cost, by far injection molding was the cheapest way to go. So that was my my initial goal was to work toward a foot that gave some plant reflection, a bit of dorsiflexion stabilization, and I could injection mold it. So that was an initial, and I I my goal from the get-go was that. So what was that? An injection molded in a in a place that would do it for a reasonable cost, and then just ship it out.

SPEAKER_01 13:56

Yeah, I mean, I think one of the neat things that I I found with the foot, one is you can grind it to length. So it's one model, you can grind to length, you can also independently adjust the heel and the keel. So I thought that was uh a really great option. But I tell you what, the transphemoral people, my transphemoral patients, they walk amazing. For whatever reason, having having that dynamic heel, probably more to the softish side, these people walk great. And they they last a long time. I mean, it's always one of those things where uh just like what you were saying, I used to use satch feet before the before the Niagara, and they would come in on just the wood block because the all the other stuff, you know, in the jungle of Guatemala, that was it. Now, now we're replacing like shoe tread because they're wearing through the and we're and that's all we're doing. We're not even replacing the whole foot because the foot's fine. So I think that's uh a really neat benefit of that.

Socket Fail Safes And Energy Use

SPEAKER_01 14:54

I I do want to jump into just a little bit about some some of the philosophy that you had around some of your adult patients. I know you said, you know, you've got your World War II guys, the Vietnam, and that sort of thing. What were some of your thoughts around, let's just say the transphemoral side? Like what are some things that you were looking at for the fitting you had success with? And just kind of like your philosophy, not necessarily socket style, but how did you want that socket to to operate?

SPEAKER_00 15:23

Brent, I I'm I'm I'm old-fashioned everybody. I I wanted, because I'm just straight mechanic, okay. I don't understand anyway, Newtonian mechanic, which is also important. I I wanted a fail-safe so that this person would almost impossible to quote unquote sink too far into that socket and give themselves the Terry Fox fit. And you guys know who Terry Fox was. I I don't know the name. He ran he's a guy who ran across Canada on one leg, and he ended up dying of cancer before he stuck his foot in the Atlantic in the in the Paso. Oh no. Okay. But I repaired his foot for his leg when I was at McMaster, and that guy was so tough. And this was uh after I developed my don't want this to happen to any of my clients, he was riding on his pubic remous because as soon as your sockets don't fit, yeah, blah, blah, blah. So I always wanted, even with some of my sort of quote unquote narrower sockets, I wanted a fail-safe. I never wanted that to happen to my clients because I did it to myself a couple times, let myself ride on that, just walking around the shop. I got a decent paint class, but man, I didn't think that was fun at all. You know, that was a really evil feeling. So I always wanted something so that wouldn't happen. And I know that's not according to new, new and modern fitting techniques, but I wanted something to stop it, and I I picked the ischial tuberosity. So, but I also saw the clients who were walking with a tremendous, a lot of them would come in with just an absolute tremendous lateral shift. And even though the the leg was aligned medial lateral properly, they would still get on the middle of that leg, and then if they weren't totally paying attention, they'd flop over two, three, four centimeters to the, to the, to the to that side, the prosthetic side. Energy consumption wears away the groin and so on and so forth. So whatever socket I used, and all I end up doing, I told you this before, Brant, was modifying those quad brims to make them fit less, more distance, anterior, posterior, and the smaller distance, medial lateral, but I would severely modify that for pubic ramus room and the little knots for the viscal tuberosity and and a bunch of different flares. So that that was my answer. And I could consistently do that. I could fit that socket the same one six times in a row, where if I was hand casting, yeah, I could never get the same circumference within, I don't know, 5% in three three hand casts in the same client. So Yeah.

SPEAKER_01 17:41

Well, and I think that's uh interesting. I mean, and I would say you're definitely before your time on on that sort of thing. I do think that there is there are recipes to be had for being successful in the prosthetic side of things. I think that um, yes, it is a blend of art and science. Yeah. But the reason why people say art and science is because they can't explain the science part. And so one of the trends that I'm seeing is the more data that you have around the fitting and what works, the more that you can create a system of a socket. And that art really now becomes the art of the fitting rather than the art of making the socket. Absolutely.

SPEAKER_00 18:23

Absolutely. Good, good, good way of putting it. It's the more info you have, the more repeatable info you have, is the the better for the final result.

Designing For The Developing World

SPEAKER_02 18:31

And and do you have any advice for people? Like because I we see a lot of people that are trying to make stuff for the developing world and stuff, but sometimes it feels a bit finicky and kind of, you know, a bit robot-y what they're doing, and a lot of stuff that is actually working is very robust. Do you have any advice specific for people who would want to make things that are very low cost with a very low plus philosophy?

SPEAKER_00 18:49

No, I you know what, though, the more people trying it, I think the and I hate to say this, the better off it is because somebody's gonna come up with something that is better than anything else. It's uh I I tend to think though, with with with the knee and the foot, I think there are a couple of rules. And with the foot, the rules to me are you have to have a a little bit of allowable plantar flexion without sucking up too much energy. And you have to have a little bit of mid stance or post-midstance stabilization without making it too rough. So that's what that's the rule for the foot. And I think the rule for the knee is that patient should not have to lift that body a centimeter higher to do a swing through. So that really is important because they're both all three of them are giant energy consumers when they're not done.

SPEAKER_01 19:35

I think that's interesting that you say that. I mean, so it yes, you've got the knee and the foot. They're both mechanical. But the one part that people overlook is yeah, what happens during swing phase? What happens to the socket? Do you does that thing swing all the way through, or do you have to hike your hip to get it all the way through because your socket feels like it might be dropping away or what have you? So I think that's that's super, super good advice.

SPEAKER_00 19:59

I Brent, one of the things that I did to a couple of Queen students, you you know more my shop was on top of that hill. Remember that? Yep. Well, they would start talking about how unimportant that little bit of a height difference made. So I would force the yappiest one there and I'd glue up I'd gotten I'd glue a one centimeter piece of rubber on the bottom of one of their shoes and send them to run up and down the hill. Yeah. Yeah. And I sure shut them up.

SPEAKER_01 20:22

You know what's interesting about the about that, especially when you have the blending of the engineering side of things. So because I know you worked closely with uh Queen's University there, is I I always say engineers always have all the answers until it comes time to fit a patient. And so can you just explain a little bit because we do have a lot of engineers that do listen to the podcast, because that is a great way to take care of patients using the talents that you have. But in orthotics and prosthetics, that that blend of the engineering to the actual clinical side of things is very important. And a lot of times what I've seen is engineers with less experience don't value the clinician feedback as much. But you know, they get a little bit of years under their belt, one or two, and then all of a sudden it's like, oh, this clinician. We need to, we need to figure out how to work with this clinician. So it's it is a it is a blend or a balance for a good outcome because the reality is we need both. Yes. Um, but you can't go pure engineer and you can't go pure clinician.

SPEAKER_00 21:33

No, you're ex you're a hundred percent right on that observation. And and the the the smartest engineers, the ones that were almost genius level that I worked with recognize that. How's that? There you go. So the the the ones that weren't quite that smart, that thought they had all the answers weren't that smart. So well, you're 100% right. We definitely, definitely need this profession, but the engineering brain in that profession. So um anyway, the the the the the one both the chaps that are running my business now are uh are uh Biomedical engineers before they became my process.

SPEAKER_01 22:03

On this podcast, we do talk some about additive manufacturing.

3D Printing Reality Materials And Customs

SPEAKER_01 22:07

I know you didn't get to use a lot of that while you were practicing, but I mean, what do you think about the technology? What are some what are some holes or limitations that you know of? And then where does it excite you about where it's potentially going?

SPEAKER_00 22:21

Aaron Powell Well, with with the quote unquote, as soon as everybody initially used PLA and they were always making these brags about it, about it could do this and it could do that, and it couldn't because it was just convenient and what was available. But with the some of the new materials, you can make f fairly subtle changes and then see how it works. And I I'm not sure of the cost because I know Brent, this is the one thing that shocked me about the Niagara Foot is that the material cost of the Model One, the of the good Delrin, it was too much, just the material cost was too high for a lot of the third world traders to even think about. Just the material cost. I mean, that really is backward thinking. And yeah, positions without borders and one other one both gave me a hard time about that. But I can't, you can't use crappy material like nylon to do the same job as as a Delrin. So it it's I don't know. I don't I don't know how you're gonna cross that border because printing, printing is still going to be on a per unit basis, more expensive than a handmade sash foot in India that costs you $1.50. So that that that's a that's a uh a bump you have to overcome somehow. Get that $3 foot out of the charity's brains. Yeah.

SPEAKER_01 23:31

Yeah. What about like materials and socket stuff with the 3D printing? Do you where do you think about the role of additive for that?

SPEAKER_00 23:37

I think it's a hundred percent more than that. Better focus on that now rather than the foot, because it's there's there's no no real cyclic stress in there. So no, I think that's a definite way to go. That's just absolutely and especially if you're gonna go with a modular socket. And Mary, I I she's got some stuff. Even with the with the below knee, we did some surveys and seven or eight or nine sizes of below knee would fit about 90% of the below knee. So you know, Brand, you could the initial the initial socket is a shaping slash healing device, and you know darn well it's not going to last, et cetera, et cetera. So that's that that would be perfect. Yeah.

SPEAKER_01 24:14

Yeah, I think I think you're right on the so anytime you're looking at large production run, I think injection mold goes a long way. And then for the socket stuff, the 3D printing side, the materials have definitely come a long way where modular is more more possible. One of the things that excites me about 3D printing is not having to deal with customs. So if you and you're only bringing raw material in that they don't throw anything about.

SPEAKER_00 24:40

I never thought about that.

SPEAKER_01 24:41

So being able to, hey, have a small, medium, large brim with a flexible medial panel, and you just bring it in, and they and when the machine is not not doing something, you can be adding stock to your machine. And so that's that to me, that's what's exciting is not necessarily the production side of things, but just the just the governmental hassle of getting stuff in. You don't have to you don't have to worry about it with 3D printing. And uh I and I and I really like that.

SPEAKER_00 25:11

The only time we ever had to deal with that, believe it or not, we did, and this sounds very bad. Our manager at the rehab center way back when arranged a quote unquote charity mission to Barbados. Yeah, I know. I was I was against it, but they made me go. And it was political. Uh and Barbados is so poor. I the uh as soon as you get off the ocean, it's poor. There's no question. There was uh type two diabetic amputees everywhere. But anyway, it took us threats and bribes to get through their customs. Yeah. We're from Canada, we're from the same play sort of Commonwealth. So yeah, I never and I don't think about that. You're going into even more tense situations than that. So that's actually a good a very important thought. Yeah.

Closing Thoughts

SPEAKER_01 25:50

Well, Rob, but this has been really great. I know our listeners are gonna get a lot about it. I I bet the Niagara Foot's gonna get some uh more views and that sort of thing. And and I think that's always great. And I love your perspective on, you know, not only socket design, but hey, let's try to keep it simple, get these patients walking, and control, really control the things that need to be controlled, which is socket, and then you just it's mechanical from there on out. So yes, it is. Thank you so much for coming on today.

SPEAKER_00 26:19

Yeah, thank you, son. Nice hearing from you, and thank you for the uplifting video you just sent me. And nice meeting, George, if he's still there.

SPEAKER_02 26:25

It was super nice, it was super nice to meet you. And uh, and thank you so much for being with us today. Yeah, you're welcome. Have a good day, buddy. Ciao, ciao. Bye bye. Thank you for listening to another episode of the Presthetics and Athletics Podcast.