From carpenter's eye to digital precision

Operating based on experience with the help of data that predicts the outcome - that is the ambition of the team of researchers developing the Twente foot model. A unique collaboration between ZGT, MST and the University of Twente (research groups BMPI and BDDP) that aims to give patients with severe foot deformities a new life.

"The foot is very complex. There is so much involved," says trauma surgeon Wouter ten Cate of ZGT. For years, he has been treating patients whose nerves in their feet have been damaged by diabetes. "They can walk around all day with a pebble in their shoe without noticing. Or not feel a sprain and continue to walk with it."

The result? A diabetic foot and, in the worst case, a Charcot foot (a foot that becomes deformed due to nerve damage). The foot can become so severely deformed that patients can no longer walk. A disadvantage is that these patients often only come to the attention of the hospital when wounds or bone infections have already occurred. In many hospitals, amputation follows. But the diabetic foot team at ZGT, of which Ten Cate is a member, prefers to opt for reconstructive surgeries, which succeed in preserving the foot in 85% of the cases. But preservation is not the same as problem-free: complications occur regularly and, in many cases, the result is not as good as hoped.

"The problem is that the procedure is often performed with the surgeon’s carpenter's eye rather than precise measurements," explains Ten Cate. "You straighten the foot and then occasionally you see that the postoperative result looks slightly different than you had envisioned."

Impact for the patient

For the patient, it comes down to quality of life. "A foot is a very important factor in our happiness," says Kappert. "Socially, but also physically. Your health depends on it. If you can no longer walk, you have a higher chance of developing all kinds of other complaints, such as cardiovascular disease. You won't die from that Charcot foot, but you can die from its consequences."

Ten Cate also emphasizes the economic impact: "There are many patients with diabetic foot problems and our techniques are well-suited for them. They are expensive patients: the healthcare costs are very high for this group."

Better planning means fewer surprises in the operating room and more control over recovery. The goal: a stable, shoeable foot so the patients can walk again and regain their independence. "We know that more than half of people with diabetes who undergo a lower leg amputation die within five years," says Ten Cate. "So looking ahead before operating can make the difference for this vulnerable group between continuing to walk and the path to amputation, which is associated with a reduced life expectancy."

And although the project is now focusing on a relatively small group of patients, the potential is much greater. "The idea is to create a model that we can use for all types of foot surgery," Kappert explains. The researchers are already looking further ahead: "By identifying problems at an earlier stage, we can intervene more quickly," says Kappert. " Think of shoe adjustments, minor surgeries, or specifically designed insoles and braces."

The PIHC voucher as a catalyst

The Pioneers in Health Care voucher made a breakthrough possible. "It allowed us to hire a researcher for six months who laid the foundation for our model," says Kappert. "But it has also led to surprising side projects, such as collecting data from healthy feet as a reference. We collaborate with master’s students from various programs who are doing internships at ZGT, MST, and the UT. This cross-pollination between engineers and doctors not only provides fresh insights but also practical benefits such as access to the 3D lab of MST."

And that is exactly the intention of the Pioneers in Health Care fund: bringing technology and clinical practice together so that a good idea can grow into applicable research. Nevertheless, there are still considerable financial and organisational hurdles to overcome to structurally continue the project, Ten Cate acknowledges. Fortunately, the project recently received a major boost: a Reggeborgh fellowship makes it possible for technical physician Sam Kroezen to work full-time on the project for the next three years.

The first experiences

The basis is up and running: the preoperative 3D model is in use. The next step is hard evidence: comparing post-operative pressure predictions with pressure measurements before and after. Goal: to strive for clinically relevant accuracy and a preparation time of minutes instead of hours.

A few operations have now been performed with the support of the 3D model. "During the most recent operation, the measurements showed that there was too much bone on one side of the foot, and too little on the other," says Ten Cate. "We put the excess back on the other side. That worked out well, without the model, we would have solved it differently."

Nevertheless, common sense remains important, Ten Cate emphasises. "It's a tool, not the truth. Compare it to a car navigation: you can easily drive to France with Google Maps, but you shouldn't rely on it 100%."

And the wish for the future?

"My wish is simple," says Ten Cate. "A satisfied patient who benefits from the surgery and regains the joy in his life." Kappert adds: "And that our approach works so well that it ends up in the guidelines."

About PIHC

The Pioneers in Health Care (PIHC) Innovation Fund is a collaboration between the University of Twente (TechMed Centre), Saxion University of Applied Sciences, and the hospitals MST, ZGT, and Deventer Hospital. Each year, the Fund provides €600,000 for 10 innovative projects that make smart use of technology for the healthcare of tomorrow. PIHC brings doctors and researchers together to develop new technology for better patient care, or by using existing technology for new medical applications.

Picture of dr. K.D.R. Kappert (Kilian)

dr. K.D.R. Kappert (Kilian)
Assistant Professor & Technical Physician

Picture of drs. M.M.J. van Hillegersberg - Hofmans (Martine)

drs. M.M.J. van Hillegersberg - Hofmans (Martine)
Communications advisor TechMed Centre

drs. J.G.M. van den Elshout (Janneke)

Press relations (available Mon-Fri)

+31 53 489 6007

j.g.m.vandenelshout@utwente.nl

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