Background
Anyone working in diabetic foot care knows how vulnerable the period immediately after a foot ulcer has healed can be. The wound may be closed, but the skin and underlying tissue are often not yet fully recovered. In this transition phase, the foot therefore needs proper protection and offloading to prevent new damage. Yet it is still unclear which type of footwear is most suitable for this purpose.
Footwear, insoles and orthoses play a central role in this process. They need to reduce pressure under the foot, match the shape of the foot and be usable in daily life. However, for the phase immediately after healing, there is currently no footwear solution specifically designed for this situation.
This project addresses that knowledge gap. By developing and testing new designs for transitional footwear, Kamran Shakir, PhD candidate at the University of Bologna, aims to better understand what the foot needs in this phase and how footwear can support a safe and gradual increase in load.
Approach
Within this project, Shakir evaluates existing footwear designs in people with diabetes who have recently healed from a plantar foot ulcer. He examines factors such as in-shoe pressure and usability. In addition, the current standard of care for offloading during the remission phase is mapped, identifying key knowledge gaps.
At the same time, he is developing new footwear designs for the transition phase. These include modular shoe components and fixation methods such as rocker soles and wedges. 3D printing and casting techniques are also used to design and produce elements of this transitional footwear, in collaboration with Podartis, a partner specialized in orthopedic and therapeutic footwear development.
To determine the most suitable shapes and materials, material testing is conducted at Vibram, an industrial partner with expertise in sole materials and footwear technology. Newly developed footwear solutions are then tested in people with diabetes who have recently healed from a plantar foot ulcer. These tests assess in-shoe pressure, full-body movement patterns and usability.
This step-by-step approach provides increasing insight into the requirements for transitional footwear: it must effectively offload, be durable, and remain practical for everyday use.
From insight to better-aligned care
Better understanding of which footwear works best in this phase can help healthcare professionals guide patients more effectively after wound healing. It can clarify when and how to safely transition to increased load and permanent footwear.
In the longer term, this knowledge may contribute to footwear solutions that are both biomechanically sound and aligned with real-life use. In doing so, the project has the potential to improve the prevention of recurrent ulcers and amputations.
Research Team
The project is carried out within the Movement Analysis Laboratory of the Rizzoli Orthopedic Institute in Bologna. This laboratory has extensive experience in the instrumental analysis of human movement and works closely with clinical departments within Rizzoli. The team consists of engineers, rehabilitation physicians and surgeons working together on biomechanical and clinical research.
The laboratory is equipped with advanced systems for measuring movement, forces and pressure, including stereophotogrammetry, inertial measurement systems, force plates, EMG systems and plantar pressure measurement devices. These tools allow for precise analysis of foot loading and movement patterns.
The project also involves close collaboration with partners from the footwear industry, in particular Podartis and Vibram. Podartis contributes to footwear design and production, while Vibram performs material testing to optimize the properties of transitional footwear.
UniBo
The project is embedded within the research environment of the University of Bologna (UniBo), in close collaboration with the Rizzoli Orthopedic Institute. UniBo is one of the largest and most active universities in Italy in the field of research and technology transfer, offering a strong infrastructure for collaboration with clinical and industrial partners.
Within this environment, the project benefits from expertise in biomechanics, clinical research and innovation in footwear development. This combination enables the development of footwear solutions that are not only technically advanced, but also relevant to clinical practice.
Doctoral Candidate
Kamran Shakir
Recruiting organisation: University of Bologna, location Istituto Ortopedico Rizzoli, Movement Analysis Laboratory, via di Barbiano 1/10, 40136 Bologna, Italia.
Hosts: Prof. Lisa Berti, M.D., dr. Alberto Leardini, D.Phil., dr. Paolo Caravaggi, Ph.D., Giulia Rogati, M.Eng.
Duration: 36 months
Secondments: Podartis, Montebelluna, Italy (2 months); Vibram SpA, Milano, Italy (1 month); AMC, Amsterdam, the Netherlands (2 months)
Summary: To prevent foot ulcers and amputations, people with severe diabetes are required to wear protective footwear. This includes shoes, insoles, and orthotics designed to accommodate the shape of the individual’s foot, with proven plantar pressure-relieving properties and which fulfils the patient’s personal needs and preferences. In particular directly after healing of a foot ulcer, the risk of ulcer recurrence is high, likely because the skin and underlying tissues are still vulnerable. In current footwear practice we lack essential knowledge on what is the best footwear to use in this transition phase, from healing to prevention of a foot ulcer. Specific footwear to be worn in this critical phase currently not exists. In this project, the doctoral candidate will explore, develop and test beyond state-of-the-art designs and prototypes for transition offloading modalities, using additional insights in the interaction between footwear and tissue properties to assess the risk of ulceration in this transition phase, with the aim of providing the optimal footwear solution to the individual patient at the right time.