University of Twente and Regional Hospitals Advance Predictive 3D Foot Model to Improve Surgical Outcomes for Diabetic Patients

University of Twente and Regional Hospitals Advance Predictive 3D Foot Model to Improve Surgical Outcomes for Diabetic Patients

(IN BRIEF) Researchers from the University of Twente, ZGT, and MST are developing the Twente foot model, a predictive 3D tool designed to improve surgical outcomes for patients with severe diabetic foot deformities. By combining imaging data and pressure measurements, the model allows surgeons to better plan procedures and anticipate results, reducing complications and improving mobility. Early applications have shown promising results, while funding from the PIHC Innovation Fund and a Reggeborgh fellowship has accelerated progress. The long-term aim is to expand the model’s use across various types of foot surgery and integrate it into clinical practice, ultimately enhancing patient quality of life and reducing the need for amputations.

(PRESS RELEASE) ENSCHEDE, 13-Apr-2026 — /EuropaWire/ — A collaborative effort between University of Twente, regional hospitals ZGT and MST, and research groups BMPI and BDDP is advancing a new data-driven approach to foot surgery through the development of the Twente foot model. This initiative seeks to transform how severe foot deformities, particularly those linked to diabetes, are treated—shifting from experience-based decisions to predictive, data-informed surgical planning.

Trauma surgeon Wouter ten Cate from ZGT highlights the complexity of the human foot, especially in patients with diabetic nerve damage. These individuals often lose sensation, which can result in unnoticed injuries such as sprains or pressure points. Over time, this may lead to severe complications, including Charcot foot, a condition that causes significant deformity. Many patients only seek medical care when serious infections or wounds develop, often leaving amputation as the standard treatment option. However, ZGT’s specialized diabetic foot team has prioritized reconstructive surgery, successfully preserving the foot in approximately 85% of cases, though outcomes are not always optimal and complications remain common.

One of the key challenges lies in the traditional surgical approach, which relies heavily on a surgeon’s visual judgment. Ten Cate explains that outcomes can differ from expectations due to the lack of precise measurement tools during procedures. The Twente foot model is designed to address this gap by offering predictive insights into how surgical corrections will affect pressure distribution across the foot.

Technical physician Kilian Kappert explains that the process begins with detailed imaging using CT or MRI scans, combined with pressure measurements taken while patients stand and walk. This data is used to construct a digital 3D model of the foot, broken down into smaller components using mechanical engineering techniques. The model calculates forces acting on the skin and underlying tissues, enabling surgeons to better anticipate surgical outcomes.

The University of Twente contributes specialized expertise in biomechanical modeling and force analysis. A notable innovation includes access to an MRI system that allows patients to be scanned while standing, providing more realistic representations of foot structure under load. Researchers are also working on an algorithm capable of translating images taken in a lying position into standing equivalents, making the technology more accessible to hospitals without specialized equipment.

The implications for patients are significant. Improved surgical planning can lead to better functional outcomes, enabling individuals to walk again and regain independence. Kappert emphasizes that mobility plays a crucial role in overall health, as reduced movement increases the risk of additional conditions such as cardiovascular disease. Ten Cate further notes the economic burden of diabetic foot complications, which often require extensive and costly care.

By enhancing preoperative planning, the model aims to reduce intraoperative uncertainty and improve recovery outcomes. The ultimate objective is to achieve a stable, functional foot that allows patients to resume daily activities. With more than half of diabetic patients who undergo lower leg amputation not surviving beyond five years, the ability to predict and prevent such outcomes is critical.

While the current focus is on complex deformities, the long-term vision extends to broader applications across various types of foot surgery. The model could also support earlier interventions, including customized footwear, orthotics, and minor surgical procedures, potentially preventing severe complications before they arise.

The project has benefited significantly from funding through the Pioneers in Health Care (PIHC) Innovation Fund. This support enabled the hiring of a dedicated researcher who established the foundation of the model and contributed to additional initiatives, such as gathering reference data from healthy individuals. The collaboration has also fostered interdisciplinary engagement, with students and professionals from engineering and medical backgrounds working together across institutions.

Further momentum has been gained through a Reggeborgh fellowship, which allows technical physician Sam Kroezen to dedicate the next three years to advancing the project. Initial clinical use of the preoperative 3D model has already begun, with early surgical cases demonstrating its practical value. In one instance, the model identified imbalances in bone distribution, enabling surgeons to make adjustments that improved the outcome compared to traditional methods.

Despite these advances, Ten Cate stresses that the model is intended to complement, not replace, clinical expertise. Like navigation tools, it provides guidance but must be used alongside professional judgment.

Looking ahead, the team aims to refine the model’s accuracy and reduce preparation time, ultimately integrating it into clinical guidelines. The overarching goal remains clear: to improve patient outcomes and restore quality of life for individuals affected by debilitating foot conditions.

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.

Media Contacts:

Dr. K.D.R. Kappert (Kilian)
Assistant Professor & Technical Physician
+31534899990

Drs. M.M.J. van Hillegersberg – Hofmans (Martine)Communications advisor TechMed Centre
+31534896949
m.vanhillegersberg@utwente.nl

Drs. J.G.M. van den Elshout (Janneke)
Press relations (available Mon-Fri)
+31 53 489 6007
j.g.m.vandenelshout@utwente.nl

SOURCE: University of Twente