Revolutionizing Diabetic Foot Care with Custom 3D-Printed Insoles

Breaking the Waiting Game

Diabetic foot ulcers can be a devastating consequence of diabetes, with 15-25% of patients developing foot ulcers and over 80% of lower limb amputations originating from these ulcers. Traditional pressure-relieving insoles, produced overseas, typically take up to two months to reach patients, with extended time needed for adjustments as it may involve shipping the insoles back and forth sometimes. In contrast, Sengkang General Hospital (SKH) has pioneered a game-changing approach to diabetic foot care through in-house production of custom 3D-printed insoles.

• SKH’s innovative approach transforms diabetic foot care from a manual craft into a precise science.
• The hospital’s podiatry team conducted comprehensive patient assessments, using detailed biomechanical examination and pressure mapping analysis to design precise digital models for each patient’s insoles.
• The Orthopaedic Surgery team played a crucial role in optimising the printing parameters, material selection, and creating various prototypes.

A New Era in Patient Care

The traditional insoles are created by hand or with the aid of CNC machines, using materials like EVA foam or other suitable materials. However, this manual process not only takes longer but can lead to variations in quality and fit. Any adjustments needed may mean shipping the insoles back overseas, further extending waiting times. In contrast, SKH’s new approach involves digitally scanning the foam box impressions before designing each insole with varying densities and precise topographical adjustments for different areas of the foot using specialised software.

Real-Life Examples

Patients like Mr Wong Sia Woon, 53, who had foot ulcers that resulted in three toe amputations in recent years, can now walk comfortably for longer periods with the new insoles specially shaped to fill in the gaps and provide better foot support. This has greatly improved his daily life, and the faster access to these insoles has enabled him to start his recovery earlier.

“The advancement in 3D printing technology has opened new possibilities in patient care,” says Dr Dickson Chau, Consultant, Department of Orthopaedic Surgery, SKH. “Through extensive testing of different materials and printing parameters, and valuable knowledge-sharing with SGH’s established 3D printing facility, we have developed a robust manufacturing process that ensures consistent quality of these insoles. This in-house production capability allows us to quickly refine the insoles based on patient feedback, which is important for optimal outcomes.”

A Cross-Institution Collaboration

The innovation was made possible by a cross-institution collaboration between SKH’s Department of Podiatry, SGH’s 3D printing centre, and the SKH Diabetic Limb Salvage (DLS) service. This multi-disciplinary approach demonstrates how different healthcare professionals can work together to achieve better patient outcomes.

• The podiatry team conducted comprehensive patient assessments, using detailed biomechanical examination and pressure mapping analysis to design precise digital models for each patient’s insoles.
• The Orthopaedic Surgery team played a crucial role in optimising the printing parameters, material selection, and creating various prototypes.
• The Plastic, Reconstructive & Aesthetic Surgery team complemented these efforts by bringing their expertise in wound healing and tissue reconstruction, ensuring the insoles would work in harmony with surgical interventions and support optimal healing conditions.

Implications for the Healthcare Industry

The impact of this innovation is evident in patients like Mr Wong Sia Woon, who can now walk comfortably for longer periods. The faster access to these insoles has enabled him to start his recovery earlier. This highlights the importance of early intervention in preventing diabetic foot ulcers and supporting wound healing.

1. Customised pressure-relieving insoles can reduce peak pressure by up to 28.5% and improve pressure distribution by 52.7%, compared to 23% reduction and 40% improved distribution with traditional insoles.
2. Early intervention can reduce ulcer formation and lower amputation risks.
3. This innovation represents a significant shift towards preventive care.

A Sustainable Future

The SKH podiatry team is currently conducting a comprehensive research study to further validate these initial results, with plans to expand the programme beyond diabetic care. The innovation brings multiple benefits, including faster access to customised care, enhanced pressure distribution for better wound healing and ulcer prevention, improved patient mobility, and supports environmental sustainability through the use of recyclable materials in local production. Key Takeaways:

* Custom 3D-printed insoles can revolutionise diabetic foot care by providing precise pressure relief and improved wound healing. * In-house production of custom insoles can reduce waiting times and enhance operational efficiency. * The innovation supports environmental sustainability through the use of recyclable materials in local production. * Early intervention is crucial in preventing diabetic foot ulcers and supporting wound healing.

About Sengkang General Hospital

Sengkang General Hospital (SKH) plays a vital role in providing quality and accessible care to better serve the healthcare needs in North-Eastern Singapore. Offering a wide spectrum of specialist clinics and co-located with Sengkang Community Hospital, we are a part of the integrated hospital campus delivering multi-disciplinary and patient-centric care covering all major healthcare disciplines.

• SKH’s team of doctors, nurses, and allied health professionals practise multi-disciplinary and team-based care.
• Patients who need longer-term rehabilitative care can be seamlessly transferred from the general hospital to the community hospital to receive the appropriate care during their recovery.
• SKH collaborates with other healthcare providers to ensure timely and appropriate access to specialist care for acute and complex cases.

About SKH Diabetic Limb Salvage Service

The SKH Diabetic Limb Salvage (DLS) service offers a comprehensive, one-stop solution for diabetic foot ulcer reconstruction and prevention. Since 2021, our multidisciplinary team—comprising healthcare professionals in Orthopaedic Surgery, Vascular Surgery Service, Radiology, Plastic, Reconstructive and Aesthetic Surgery Services, Population Health and Integrated Care, Allied Health (including Podiatry, Physiotherapy & Dietetics) and Nursing—has been dedicated to achieving optimal patient outcomes. To date, we have treated over 600 patients, significantly reducing limb amputations, improving wound healing, and lowering wound recurrence rates.

• SKH’s Diabetic Limb Salvage service has achieved significant results, reducing limb amputations and improving wound healing.
• The service offers a comprehensive, one-stop solution for diabetic foot ulcer reconstruction and prevention.
• SKH’s Diabetic Limb Salvage service is dedicated to achieving optimal patient outcomes.

Conclusion

The innovative approach to diabetic foot care through in-house production of custom 3D-printed insoles represents a significant advancement in both accessibility and quality of care for patients with diabetes. The collaboration between SKH’s Department of Podiatry, SGH’s 3D printing centre, and the SKH Diabetic Limb Salvage (DLS) service demonstrates how different healthcare professionals can work together to achieve better patient outcomes. The impact of this innovation is evident in patients like Mr Wong Sia Woon, who can now walk comfortably for longer periods. The faster access to these insoles has enabled him to start his recovery earlier. This highlights the importance of early intervention in preventing diabetic foot ulcers and supporting wound healing.