Three-dimensional Printing in the Foot and Ankle: A Do-it-yourself Guide

The adoption of three-dimensional (3D) printing in orthopedic surgery—particularly in the foot and ankle—has revolutionized preoperative planning, surgical execution, and education. This guide provides a practical and accessible workflow for clinicians to independently design and implement patient-specific surgical guides. By combining affordable digital tools with open-source software and additive manufacturing, complex deformity corrections can be approached with a new level of precision and personalization. The workflow is illustrated through a supramalleolar osteotomy (SMO) case in a 51-year-old female with medial tibiotalar arthrosis. Starting with a high-resolution computed tomography (CT) scan, segmentation of the tibia and fibula is performed to generate a 3D model. A virtual osteotomy and angular correction are planned, followed by simulated plate and screw placement to ensure fixation accuracy and avoid joint penetration. A custom surgical guide is then designed to fit the bone surface, incorporating features such as a saw slit, K-wire channels, and drill sleeves. The guide is printed using biocompatible materials, sterilized, and used intraoperatively to perform the osteotomy with improved accuracy and reduced fluoroscopy time. Patient-specific guides enhance the precision of bone cuts and implant positioning, reduce intraoperative variability, and support surgical reproducibility. The technique also serves as an effective educational and research platform. Key requirements include access to imaging, segmentation and design software, 3D printing capabilities, and an understanding of surgical and sterilization workflows. Despite challenges such as the learning curve and production time, standardized protocols and collaboration with biomedical engineers can make this approach widely adoptable. Beyond SMO, the same methodology applies to various foot and ankle procedures, including subtalar fusions, calcaneal osteotomies, and midfoot corrections. As technology becomes more democratized, 3D printing will continue to transform patient-specific surgical planning and execution in foot and ankle surgery. How to cite this article: Elibollar C, Karaismailoglu B. Three-dimensional Printing in the Foot and Ankle: A Do-it-yourself Guide. J Foot Ankle Surg (Asia-Pacific) 2025;12(4):189–193.