Background
The risk of developing a foot ulcer in people with diabetes is highest in those who have just healed from a foot ulcer. Many of these people are prescribed with custom-made footwear to help prevent ulcer recurrence, in particular when a foot deformity is present. This footwear is designed and manufactured based on the shape of the person’s foot, and more and more data-driven techniques such as barefoot and in-shoe plantar pressure measurement are used in the design and evaluation of such footwear. However, this is not yet done at a large scale. And despite custom-made footwear being available, ulcer recurrence incidence is still high, up to 40% within one year. Therefore, more needs to be done to identify knowledge gaps, design techniques, data-driven support systems and footwear evaluation methods that will deliver footwear that goes beyond the state-of-the-art, to help reduce the incidence of foot ulcer recurrence in diabetes.
In this DIALECT project we aim to develop and validate the best possible custom-made footwear for the high-risk person with diabetes, to pave the way for more personalised medicine in ulcer and amputation prevention.
Approach
The doctoral candidate will systematically review the medical-scientific and applied literature and survey clinicians, shoe technicians, podiatrists and footwear companies to identify knowledge gaps in design principles, material science and optimisation routines for custom-made footwear. Furthermore, the doctoral candidate will assess different currently used and newly identified materials for footwear manufacturing for mechanical properties, durability, and environmental impact, and in-vivo patient testing, in collaboration with other doctoral candidates. Using this knowledge, new, data-driven and beyond state-of-the-art footwear designs will be explored, developed and tested as prototype devices for effects on plantar pressure and shear and patient satisfaction. From this, the doctoral candidate will help update custom-made footwear design protocols and help implement these with footwear industry partners. These studies will advance our understanding of custom-made footwear design and manufacturing and material science and improve the quality of this footwear for the high-risk person with diabetes.
Secondments will take place at VIB to conduct essential industry-led footwear material design and testing with embedded training; at T3D for essential industrial-based training in footwear design automation; and at OIM to conduct clinical testing of custom-made footwear designs with additional training on footwear design and manufacturing.
Our Research Team
Amsterdam UMC is a leading institute in the world on clinical, biomechanical and footwear research on diabetic foot disease, in particular regarding the prevention of foot ulceration and amputation. The candidate will learn from, and collaborate with a multidisciplinary team of clinicians, scientists and health professionals, including footwear technicians from the participating footwear companies. The doctoral candidate will work together with two DIALECT doctoral candidates in Amsterdam UMC who focus in their projects on specific foot deformities in diabetes. and people with diabetes who are in remission.
The research group is embedded within the department of Rehabilitation Medicine that has high-class facilities for biomechanical research with a motion analysis laboratory, including plantar pressure measurement equipment, and hosts the outpatient diabetic foot clinic that includes a technical workshop for shoe modifications. The research group is also embedded in the Amsterdam Movement Sciences research institute, within which collaboration exists with partners in the field of movement sciences, tissue engineering, musculoskeletal disease, and sports, as part of the Faculty of Behavioural and Movement Sciences of the Vrije Universiteit
Amsterdam University Medical Centers
The Amsterdam UMC is the largest hospital and foremost medical research institution in the Netherlands with over 13,000 employees, combining what were previously the Academic Medical Center and Vrije Universiteit Medical Center. The location of Amsterdam UMC at Meibergdreef is part of the University of Amsterdam. Some 2500 staff members are fully or partially employed in medical research. Amsterdam Movement Sciences is one of the 8 research institutes of Amsterdam UMC that conducts world-class research on many different aspects of movement, both fundamental and clinical (see here for more info). Amsterdam UMC houses high quality core facilities including a movement analysis lab, advanced imaging techniques, medical physics department.
Doctoral Candidate
Isabella Gigante
Recruiting organisation: Amsterdam University Medical Centers, location University of Amsterdam, Department of Rehabilitation Medicine, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands.
Hosts: Prof. dr. Sicco A. Bus, dr. Jaap van Netten, drs. Tessa Busch-Westbroek
Duration: 42 months
Secondments: Vibram SpA, Milano, Italy (1 month); Taika3D, Espoo, Finland (1 month); OIM Voetzorg / Feeture, Amersfoort, the Netherlands (3 months)
Summary: The risk of developing a foot ulcer in people with diabetes is highest in those who have just healed from one. Many of these people are prescribed with custom-made footwear to help prevent ulcer recurrence. However, despite this treatment, ulcer recurrence incidence is high at 40% in one year. In this project, the doctoral candidate will identify knowledge gaps in design principles, material use and optimisation routines for custom-made footwear for the high-risk person with foot deformity. The doctoral candidate will explore, develop, test, and improve data-driven and science-based footwear design approaches through proof-of-concept and clinical validation studies, to go beyond the state-of-the-art in the design of such footwear and to better understand and help prevent foot ulcer recurrence.