Unveiling the Biomechanics of Diabetic Foot Ulcers: Identifying Critical Foot Load Profiles for Prevention and Treatment MRC GW4 BioMed DTP PhD studentship 2025/26

About the GW4 BioMed2 Doctoral Training Partnership

The partnership brings together the Universities of Bath, Bristol, Cardiff (lead) and Exeter to develop the next generation of biomedical researchers. Students will have access to the combined research strengths, training expertise and resources of the four research-intensive universities, with opportunities to participate in interdisciplinary and ‘team science’. The DTP already has over 90 studentships over 6 cohorts in its first phase, along with 58 students over 3 cohorts in its second phase.

Project Information

Research Theme: Population Health Sciences

Summary

Diabetic foot issues pose significant challenges for patients and healthcare providers. Current evaluation methods are costly, invasive, and subjective. This study aims to address these problems by analysing gait patterns in diabetic patients compared to healthy individuals. By examining how foot ulcers affect movement and using computational and experimental biomechanics simulations, we aim to understand changes in load distribution within the foot. This will enhance our knowledge of heel pad deformities, which contribute to diabetic foot ulcers.

Project description

Approximately 10% of the NHS budget for England and Wales is allocated to diabetes care, costing the healthcare system more than £1.5 million every hour. This expenditure amounts to an estimated £14 billion

annually, primarily spent on managing complications rather than providing direct diabetic care. The cost of diabetes medications alone has surged by nearly £500 million since 2015, underscoring the escalating financial burden on the NHS. Diabetes mellitus, a chronic illness affecting millions globally, leads to numerous complications, including diabetic foot ulcers (DFUs). DFUs result from peripheral artery disease and neuropathy, increasing the risk of infection and amputation. Preventing these catastrophic outcomes necessitates early detection andeffective management of foot health issues.

Traditionally, changes in diabetic foot biomechanics have been attributed to polyneuropathy, which weakens the intrinsic muscles of the foot, leading to limited joint mobility (LJM) and deformities, particularly in the forefoot. Certain deformities (i.e., small muscle wasting, hammer or claw toes, prominent metatarsal heads, and Charcotarthropathy) are associated with increased plantar pressure. These conditions can cause the displacement of the plantar fat pad and prolapse of the metatarsal heads on the plantar surface and, subsequently, are precursors of foot ulceration. A UK population study of 15,692 diabetic patients found that foot deformity, along with other risk factors such as peripheral arterial disease (PAD), peripheral neuropathy, and insulin usage, accounts for the higher number of foot ulcerations in Europeans compared with two other ethnic groups. Diabetes often impairs the body’s ability to heal wounds. When combined with deformities that cause repeated pressure and friction, even minor injuries can become chronic ulcers that are difficult to treat.Early detection and management of foot deformities can prevent complications. By closely monitoring and managing foot deformities, healthcare providers can improve outcomes and quality of life for diabetic patients while reducing the risk of serious complications and associated healthcare costs.

Diabetic foot problems are a significant concern for both patients and healthcare organisations. Current methods for evaluating foot health often rely on costly procedures or subjective assessments, which can be resource-intensive, time-consuming, and uncomfortable for patients. This study aims to address these challenges by analysing gait patterns in diabetic patients to identify differences compared to healthy subjects. This analysis will help observe how the progression of ulcers on the plantar surface of the feet impacts human locomotion patterns.

Additionally, by developing computational simulations such as Finite Element Analysis (FEA), we can investigate changes in load patterns within the human foot. This will enhance our understanding of the initiation and progression of deformities and their severity within the heel pad, which contribute to the development of diabetic foot ulcers. Through such studies, different footwear and/or insoles can be prescribed to alleviate the load on diabetic feet, thereby reducing the likelihood of DFU progression. By leveraging these insights, we aim to

develop a model that evaluates foot load profiles using data gathered from pressure sensors and other non-invasive devices. This approach will facilitate the early identification of abnormal pressure distributions that precede ulcer formation.

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