Sustainable prevention of foot ulceration secondary to diabetic and leprotic neuropathy in Nepal

Diabetes and Leprosy can both lead to neuropathy, a complication that results in a loss of the protective pain sensation in the foot, an underlying cause of foot ulceration. The incidence of diabetes is rising exponentially in Nepal whilst Leprosy is still associated with significant stigma and discrimination leading to delays in seeking treatment and non-compliance. This project is funded by the Global Challenges Healthcare Fund. The project has two overarching aims. It firstly aims to undertake research to inform the design and evaluation of sustainable, cost effective footwear for people with diabetes and leprosy to prevent the onset of foot ulceration. Secondly, the project aims to build research capacity in Nepal through workshops to promote research methods and design and training and engaging Nepalese healthcare professionals to deliver the research arm of the study.

Research Aims:

The overall aim of this 4-phased project is to gain an increased understanding of the extent and impact of foot ulceration, secondary to diabetic and leprotic neuropathy, in Nepal, and to explore the effect of potential base shoe designs on plantar foot pressures.

Specific Objectives 

The specific objectives are:

1. To undertake an audit of in-patient and out-patient hospital notes of people with diabetes or leprosy to estimate

• the incidence of diabetic and leprotic foot ulcers and amputations.
• the anatomical location and how this varies with patient characteristics.
• the current management of ulcers and how this varies with geographical location in Nepal.

2. To measure using clinical tests the foot and ankle health of a sample of people with diabetes or leprosy and to compare the results to age and gender matched healthy controls.

3. To measure the effects of two different shoe bases on plantar pressures while walking, comparing people with diabetes and leprosy with healthy controls.

4. In people with diabetes and leprosy to explore

• beliefs, views and experiences about living with a foot ulceration. In particular its impact, barriers and enablers to foot ulcer treatment adherence and management
• views and preferences regarding shoe and orthotic design (cosmesis and functionality)