Safe activity with less risk of foot ulcers

Background

Anyone working in diabetic foot care knows that physical activity is a difficult topic for people at high risk of foot ulceration. On the one hand, being active is important for general health and can help prevent many chronic diseases. On the other hand, in people with neuropathy and other foot problems, walking can also increase pressure on the foot and raise the risk of tissue damage and ulceration.

That tension is especially relevant in people who have had a foot ulcer before. In this group, the risk of a new ulcer is high. In daily care, special footwear is often prescribed to reduce pressure on the foot, but this does not always prevent recurrence. One reason is that people do not always wear their footwear as advised. Another is that the amount of loading over time, for example the number of steps taken each day, likely also plays an important role.

At the moment, it is still difficult to give people clear and personal advice on how to stay active safely. We often do not know enough about how daily physical activity, adherence to therapeutic footwear, and plantar pressure work together in relation to ulcer risk. Touria Ahaouari, PhD candidate at Maastricht University, focuses on that gap. By understanding better how physical activity, adherence to therapeutic footwear and plantar pressure interact, it aims to support more personalised advice on how people at risk of ulceration can stay active safely.

Approach

The DC5 project uses data from two main sources: The Maastricht Study and the DIALOAD project.

The Maastricht Study is a large population-based cohort study that includes many people with type 2 diabetes. It provides detailed information on health, complications of diabetes, and physical behaviour. In this project, data from The Maastricht Study have been used to examine links between diabetes, peripheral neuropathy, physical activity, sedentary behaviour and physical performance. Physical behaviour was measured with a thigh-worn accelerometer, making it possible to study activity patterns in detail.

The second source is DIALOAD, a 12-month prospective multicentre observational cohort study carried out by Amsterdam UMC. During the doctoral candidate’s secondment at Amsterdam UMC, data from DIALOAD were used to apply machine learning models for the prediction of recurrent diabetic foot ulceration.

The next step is to bring together key factors such as daily activity, adherence and in-shoe plantar pressure. Wearable technology and artificial intelligence are used to better understand how these factors interact, with the aim of translating that knowledge into more personalised advice on safe activity. The longer-term goal is to translate these insights into practical tools, such as digital support or communication strategies that can help people at risk of ulceration make safer choices in daily life.

From insight to care that fits better

The strength of this project lies in moving beyond general advice. In practice, people at risk of foot ulceration are often told to protect their feet, but that does not automatically answer the question of how they can remain physically active in a safe way. Better understanding of the balance between activity and foot loading may help healthcare professionals give more tailored advice.

That matters in daily care. Prevention is not only about reducing risk, but also about helping people stay mobile in a way that is realistic and safe. If we understand better how walking, footwear use and plantar pressure influence each other, advice on physical activity can become more specific and better matched to the individual.

In the longer term, the knowledge from this project may contribute to tools that support healthcare professionals in giving personalised advice on physical activity. In that way, the project aims to help prevent foot ulcers and amputations without unnecessarily discouraging people from being active.

Our Research Team

The project is being carried out at Maastricht University, where research is strongly multidisciplinary in nature. The supervisory team brings together expertise in movement sciences, epidemiology and clinical diabetic foot care. There is also strong expertise in measuring and analysing physical activity using accelerometers.

External supervision comes from DIALECT partners at Amsterdam UMC and Novel GmbH in Munich. Amsterdam UMC has leading expertise in clinical, biomechanical and radiological research on diabetic foot disease, especially in the prevention of foot ulcers and amputations. Novel GmbH is a global leader in systems for measuring load distribution and helps connect the project to smart technology being developed within DIALECT.

Maastricht University

Maastricht University is known for its problem-based and small-scale approach to education and research. The university has around 22,000 students and about 5,000 employees, many of whom come from outside the Netherlands. Research at Maastricht University is organised in a multidisciplinary and thematic way through research institutes and schools.

The Faculty of Health, Medicine and Life Sciences has a long-standing interest in mobility and diabetic foot disease and provides an important setting for this project. Within this environment, the project connects movement sciences, epidemiology and clinical care in order to improve prevention for people at risk of diabetic foot ulceration.