The best factory-made shoe for the moderate to high-risk diabetic patient

Background

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. For people who are at moderate to high risk of ulceration, this may include factory-made shoes designed specifically for people with diabetes who have lost protective sensation in their feet.

In current footwear practice we still lack essential knowledge and studies on the foot-shoe interaction, footwear design, material science, and person-centered factors to design the best factory-made footwear for the moderate-risk patient who may have some foot deformity and for the high-risk patient who has a history of foot ulceration with a foot shape that does not require custom-made shoes. In this DIALECT project we aim to explore, develop and test beyond state-of-the-art designs and prototypes of factory-made footwear for the moderate-to-high risk people with diabetes, and to pave the way for providing the optimal footwear solution for these risk groups, at the right time.

Approach

The doctoral candidate will survey hospitals and footwear companies in Europe for current use of preventive footwear in association with different risk levels of ulceration. The doctoral candidate will explore the use and application of 3D-designed (e.g. Creo, Rhino, SolidWorks) footwear modular components and fixation methods (e.g. rocker outsoles, wedges) and 3D printing (Dimension Elite, Stratasys) of modular components for preventive factory-made footwear. Footwear materials will be tested for mechanical properties, and via in-vivo pressure measurements, in collaboration with other doctoral candidates in DIALECT. The doctoral candidate will test current designs, modular components and new designs for preventive factory-made footwear in moderate-to-high risk people with diabetes for pressure relief, full-body kinematics via gait analysis, and footwear usability. These experimental data and analyses will advance our understanding of the specific requirements for factory-made footwear and its offloading properties and usability, to develop high-quality footwear for moderate-to-high-risk people with diabetic foot disease.

Secondments will take place at POD for training in footwear design and manufacturing; at VIB for footwear material training and testing; and AMC for biomechanical and clinical-based testing of new factory-made footwear designs.

Our Research Team

The Movement Analysis Laboratory was established in 1989 as an independent research unit of the Rizzoli Orthopedic Institute, with the purpose of performing quantitative instrumental analysis of human movement, in particular of the locomotor apparatus. The Laboratory, in close collaboration with the 1st Orthopedic and traumatology Clinic and other Rizzoli clinical units, is specialized in gait analysis both in normal and pathological subjects, mostly in patients before and after surgery or following special rehabilitations programs.

A team of engineers, physiatrists and surgeons, works with a high-level of integration in a large number of movement-science projects and clinical studies, also by assisting and supervising the research activities of residents from the Faculty of Engineering, Medicine and Surgery, Specialization Schools in Orthopedics, Physical Medicine and Rehabilitation, as well as students on the degree course for Podiatry, Orthopedic Technicians and Physiotherapists. For many of the past and current projects, strong international collaborations have been established with renowned institutions, universities, and companies.

The Laboratory takes advantage of state-of-the-art instrumentation for the objective measurement of human motion, via stereophotogrammetry or Inertial Measurement Units (IMU), and of the internal and external forces generated through human movement, via force- and pressure-plates and EMG systems, and plantar pressure measurement devices. These instruments allow accurate tracking of the kinematics and dynamics of the body segments, and of the relevant joints involved in the motor task under investigation.

UniBo

UNIBO is the second largest University in Italy and one of the most active in research and technology transfer. It stands among the most important institutions of higher education in the EU with 87,000 enrolled students, 2.857 Academic staff, 1.198 post-docs, 1.606 PhDs, 3.014 administrative and technicians staff units. The activities are unrolled in 5 Campuses based in the Emilia-Romagna Region (Bologna, Forlì, Cesena, Ravenna, Rimini) and a permanent headquarter in Buenos Aires, Argentina. UNIBO offers 51 PhD/Doctoral degree programs and 64 Master’s degree programs. At UNIBO, research activities are promoted, coordinated and supported by the 33 Scientific Departments and by the Research and Knowledge Transfer Division, with the support of the European Research & Innovation Office with more than 10 years of experience on European projects.