Short description projects

Expected start date: April-June 2023, or as soon as can be arranged in mutual agreement

All projects fall within the DIALECT European Union program: Diabetes Lower Extremity Complications Research and Training Network in Foot Ulcer and Amputation Prevention. For more information on DIALECT click here

DC1-project 1: Ulcer risk stratification in high-risk patients with diabetes – filled

DC2-project 2: Diabetes distress and health literacy in foot ulcer development and self-care and interventions to improve outcome

DC3-project 3: Biomechanical factors in Charcot neuro-osteoarthropathy and deformity – filled

DC4-project 4: From ulcer healing to remission: imaging and biomechanics of tissue properties in association with foot ulcer risk in diabetes – filled

DC5-project 5: Decreasing risk for developing diabetic foot ulceration with personalised feedback on daily physical activity. – filled

DC6-project 6: Smart wearable technology for long term pressure, adherence and activity monitoring – filled

DC7-project 7: A state of the art and clinically applicable shear force measuring system

DC8-project 8: From healing to remission: offloading in the transition phase to permanent footwear

DC9-project 9: The best factory-made shoe for the moderate to high-risk diabetic patient

DC10-project 10: Data-driven optimisation of custom-made footwear for the high-risk person with diabetes – filled

DC11-project 11: Offloading with additive manufactured insoles using optimally tested designs

DC1-project 1: Ulcer risk stratification in high-risk patients with diabetes

Recruiting organisation: Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730 Herlev, Denmark.

Hosts: A/Prof. Dorte Vistisen, Prof. Kirsten Lomborg

Duration: 36 months

Secondments: The Glasgow Caledonian University, Glasgow, Scotland (2 months); Maastricht University, Maastricht, The Netherlands (2 months)

Summary: The current understanding of diabetic foot disease is based on a biomedical model of predominantly non-modifiable risk factors. For that reason, current ulcer risk stratification systems only incorporate these traditional risk factors, not taking important, novel, and modifiable biomechanical and behavioural parameters, or any personalised, gender or cultural differences into account. Using data on a comprehensive set of disease-specific, biomedical, and behavioural parameters, as well as clinical outcomes from three existing, unique, and large datasets, this DIALECT project aims to assess groups of high-risk patients for modifiable biomechanical, behavioural, and other personalised outcomes to improve risk stratification and create starting points for personalised treatment approaches in ulcer and amputation prevention. Full project description

DC2-project 2: Diabetes distress and health literacy in foot ulcer development and self-care and interventions to improve outcome.

Recruiting organisation: Steno Diabetes Center Copenhagen, Borgmester Ib Juhls Vej 83, 2730 Herlev, Denmark.

Hosts:  Senior Researcher, Team Leader Nana Folmann Hempler, Head of Diabetes Management Research, Prof. Willaing, A/Prof. Dorte Vistisen, Mrs Anne Rasmussen

Secondments: Amsterdam University Medical Centers, The Netherlands (2 months); King’s College Hospital London, United Kingdom (2 months).

Duration: 36 months

Summary: This project addresses diabetes distress and health literacy among people with or at high risk of foot ulceration; two potentially influential components in terms of preventing foot ulcers and amputations. The project will investigate the role of diabetes distress and health literacy in foot ulcer development and self-care and how these components can be explored and addressed systematically in routine care. This way the project will explore possible initiatives improving equitable communication with and access to healthcare services for people with or at risk of diabetic foot ulcers with a particular focus on diabetes distress reduction and organizational health literacy responsiveness. The project will actively involve people with or at risk of foot ulceration and their health professionals in the exploration and development of methods and/or techniques to be pilot tested in clinical practice. Full project description

DC3-project 3: Biomechanical factors in Charcot neuro-osteoarthropathy and deformity

Recruiting organisation: Amsterdam University Medical Centers, location University of Amsterdam, Department of Rehabilitation Medicine, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands.

Hosts: Dr. Jaap J. van Netten, Prof. Dr. Sicco A. Bus, Tessa E. Busch-Westbroek, MD

Secondments: Glasgow Caledonian University, Glasgow, United Kingdom (2 months); King’s College Hospital London, United Kingdom (3 months).

Duration: 42 months

Summary: One of the most complex and devastating complications of foot disease in diabetes is Charcot neuro-osteoarthropathy (or Charcot foot). In this condition, inflammatory processes in persons with neuropathy result in damage to bones, joints, and soft tissues of the foot and ankle. While biomechanical factors are important in the cause and development of the Charcot foot, there are gaps in our knowledge concerning the extent and mechanisms through which biomechanical and other factors contribute to the development of foot deformity, ulceration and amputation. In this project, the Doctoral Candidate will retrospectively assess 3 unique clinical datasets on Charcot feet, to identify risk factors for Charcot. In addition, the doctoral candidate will perform in-depth prospective biomechanical and structural analyses in patients with Charcot neuro-osteoarthropathy. These analyses are expected to result in a comprehensive biomechanical model of the Charcot foot, to advance our understanding of this condition. Full project description

DC4-project 4: From ulcer healing to remission: imaging and biomechanics of tissue properties in association with foot ulcer risk in diabetes

Recruiting organisation: Amsterdam University Medical Centers, location University of Amsterdam, Departments of Rehabilitation Medicine and Radiology, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands.

Hosts: Prof. dr. Sicco A. Bus, Prof. dr. Mario Maas

Duration: 42 months

Secondments: Istituto Orthopedico Rizzoli, Bologna, Italy (2 months); Steno Diabetes Center, Copenhagen, Denmark (2 months)

Summary: The risk of developing a foot ulcer in people with diabetes is highest when people have just healed from an ulcer. In this project, the doctoral candidate will conduct analyses of histological, morphological and mechanical properties of skin and soft tissue (e.g. geometry, strength, and elasticity) at healing of plantar foot ulcers and prospectively during post-healing follow-up, using novel imaging techniques in combination with plantar pressure measurements. Such analysis of soft-tissue properties in association with biomechanical outcome represents an in-depth analysis at more microscopic level to help understand ulcer pathogenesis and high recurrence rates in people with diabetes. These analyses are expected to result in a comprehensive biomechanical model of foot ulcer recurrence to advance our understanding of diabetic foot disease. Full project description

DC5-project 5: Decreasing risk for developing diabetic foot ulceration with personalised feedback on daily physical activity.

Recruiting organisation: Maastricht University, Dept. of Nutrition and Movement Sciences, Universiteitssingel 50, 6229 GT Maastricht, The Netherlands.

Hosts: Prof. dr. Hans Savelberg, Dr. Annemarie Koster, Prof. dr. Nicolaas Schaper, Dr. Brenda Berendsen

Duration: 36 months

Secondments: Amsterdam UMC, Amsterdam, the Netherlands (2 months); Novel GmbH, Munich, Germany (2 months)

Summary: The risk of developing a foot ulcer in people with diabetes is largely increased when people already had an episode of ulceration. Physical activity and adherence may play a role in ulcer recurrence, but their effects are largely unknown. Profiling of physical activity and adherence is new to the field of diabetic foot disease and can now be explored with for example artificial intelligence. In this project, the doctoral candidate will assess profiles on quantity and quality of daily physical activity in a large population with or without foot ulcer risk, to personalize feedback on physical activity patterns. Using data from the “Maastricht Study” (https://www.demaastrichtstudie.nl/research) in combination with data from an observational study in patients with a history of a foot ulcer, machine learning will profile participants’ physical activity patterns with different foot ulcer risk. Using these outcomes, the doctoral candidate will develop communication strategies and technologies around these activity profiles to provide patients with personalised feedback. Full project description

DC6-project 6: Smart wearable technology for long term pressure, adherence and activity monitoring

Recruiting organisation:  novel GmbH, Ismaninger Str. 51, 81675 Munich, Germany

Hosts:  Dr. Axel Kalpen; Dipl. Ing. Peter Seitz; Dr. Ahmad Dahrouj

Duration: 36 months

Secondments: German Sports University, Cologne, Germany (2 months); Steno Diabetes Center Copenhagen, Denmark (2 months).

Summary: The risk of developing a foot ulcer in people with diabetes increases with the presence of loss of protective sensation, biomechanical abnormalities and peripheral vascular disease. In people at high risk of ulceration, we have incomplete understanding of the pathogenesis of ulcer recurrence. Biomechanical factors are important, but there are gaps in our knowledge concerning the extent and mechanisms through which biomechanical factors contribute to ulceration and amputation. A potential solution to increase this understanding is by continuous measurements of biomechanical factors in people’s daily life. However, such measurement systems are currently unavailable in clinical practice. The aim of this DIALECT project is to develop and validate the first of its kind advanced sensor system for continuous biomechanical monitoring of patients with diabetic foot disease in their real-life environments. Full project description

DC7-project 7: A state of the art and clinically applicable shear force measuring system

Recruiting organisation:  novel GmbH, Ismaninger Str. 51, 81675 Munich, Germany

Hosts: Dr. Axel Kalpen; Dipl. Ing. Peter Seitz; Dr. Ahmad Dahrouj

Duration: 36 months

Secondments: GSU, Cologne, Germany (2 months); Istituto Orthopedico Rizzoli, Bologna, Italy (2 months); OIM Voetzorg / Feeture, Amersfoort, Netherlands (1 month).

Summary: The risk of developing a foot ulcer in people with diabetes increases with the presence of loss of protective sensation, biomechanical abnormalities and peripheral vascular disease. In people at high risk of ulceration, we have incomplete understanding of the pathogenesis of ulcer recurrence. Biomechanical factors are important, but there are gaps in our knowledge concerning the extent and mechanisms through which biomechanical factors contribute to ulceration and amputation. One of those gaps is regarding the role of shear in the development of foot ulcers, where general consensus is that this factor plays a significant role, but we are not able to quantify it because a system or sensor that measures shear inside a patient’s shoe is currently not available. In this DIALECT project, we aim to develop the first of its kind sensor that can measures shear inside people’s footwear, to help improve our understanding of the role that shear plays in ulcer development and in evaluating footwear for people with diabetes for shear-reducing capacity. Full project description.

DC8-project 8: From healing to remission: offloading in the transition phase to permanent footwear

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. Full project description

DC9-project 9: The best factory-made shoe for the moderate to high-risk diabetic patient

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. These shoes may be factory-made, designed for people with diabetes who are at moderate-to-high risk of foot ulceration due to the loss of protective sensation, the presence of foot deformity or a history of foot ulceration. In current footwear practice we still lack essential knowledge and studies to provide these risk groups with the best factory-made footwear. In this project, the doctoral candidate will survey current use of factory-made shoes in different risk groups of patients and explore, develop and test beyond state-of-the-art designs and prototypes for factory-made shoes and materials used in these shoes, with the aim to providing the optimal factory-made footwear solution to the individual patient at the right time. Full project description

DC10-project 10: Data-driven optimisation of custom-made footwear for the high-risk person with diabetes

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. Full project description

DC11-project 11: Offloading with additive manufactured insoles using optimally tested designs

Recruiting organisation: Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA

Hosts: Dr. Patricia Munoz de Escalona, Dr. Ruth Barn

Duration: 36 months

Secondments: Istituto Orthopedico Rizzoli, Bologna, Italy (2 months); Firefly, Sligo, Ireland (2 months); Taika3D, Finland (1 month).

Summary: Diabetes-related foot ulceration is associated with biomechanical risk factors including foot deformity and increased plantar pressures. Management of these risk factors includes reducing elevated plantar pressures through customised footwear and insoles, but adherence and efficacy is variable. In this project, the doctoral candidate will explore, design, manufacture and experimentally test novel additive manufactured foot orthoses exploiting freeform design and manufacture capabilities and employing machine learning to optimise off-loading providing personalised interventions aimed at preventing foot ulceration. Full project description