About 415 million people around the world live with diabetes; chances are, everybody knows someone whose life has been affected by this deadly disease. One of the challenges that people with diabetes face is painful ulcers that develop on their feet due to poor blood circulation and a lack of feeling in their limbs. A significant portion of those who develop diabetes-related ulcers have to get their limbs amputated. In fact, 68 percent of all amputations are attributable to diabetes.
With the help and direction of exercise science professor Dustin Bruening, Andrew Hillier (‘22), a public health student, and Seth Huber (‘20), a manufacturing engineering student, teamed up to research different offloading braces that help people heal from diabetes-related ulcers.
GETTING A FOOT IN THE DOOR
Hillier currently works with a foot and ankle surgeon in Utah County and helps many diabetic patients. “I thought it was fascinating that [the surgeons] could take someone who was suffering and help them get going again,” Hillier says. His goal is to become a podiatrist because “I love seeing people be able to walk again. It really can make or break someone’s life.”
Foot ulcers can start with something as simple as a rock in a shoe. Due to limited blood flow, diabetics usually can’t feel the pressure of a pebble tumbling around; so, at the end of the day, they may find an injury when taking off their shoes. Decreased circulation also means fewer nutrients can reach the sore, slowing or disrupting the healing process.
The current healing method for diabetics with foot ulcers is to immediately put them in a rigid, high calf, controlled ankle motion (CAM) boot in order to reduce pressure around the ulcer area. The boot allows individuals to walk around during the healing process, but Hillier was skeptical of its effects.
“Clinically, they showed success, but I didn’t understand how they were able to offload the lower limbs as claimed. The physics just didn’t make sense because you cannot dissipate force or pressure into thin air,” Hillier explains. “I was really curious as to whether these boots actually do this, and how. Do they actually offload onto the shank?”
Before Hillier initiated the research, Seth Huber (‘20), a manufacturing engineering technology student, created a unique foot brace prototype that eventually developed into the SpringEase Boot. It is designed to offload using a cushioned gap between the foot and sole of the brace. Springs at the ankle decrease foot strain and help soften the blow of each step. He originally got the idea when one of his friends was in a climbing accident and broke both of his feet.
“I was watching him go through the recovery process, and even after going through surgery, he still had a lot of pain in his feet and ankles,” Huber says. “It got me thinking, why don’t you just transfer the weight from your foot and ankle to your lower leg? It seemed like an obvious thing to do.”
After investigating, it turned out there weren’t many great options for a boot that would transfer the weight effectively. So, the idea was born, and Huber began designing an offloading brace himself.
“As I showed [the boot] to podiatrists, one thing that continued to come up is that they thought it would be useful for patients with diabetic foot ulcers,” Huber says. “There is a niche of people that are pretty healthy otherwise, but that have diabetes and have developed foot ulcers. This would be a good fit for them.”
The prototype boot could enable ulcers to heal much faster by decreasing the amount of stress on the foot throughout the day. Huber wanted to test his new invention to see if it worked better than the traditional boots.
RESEARCH STEPS FORWARD
Hillier and Huber’s interest in footcare led them to Bruening’s office. Huber provided the specialized brace, and Hillier provided the legwork to start the project. Hillier applied for a College Undergraduate Research Award (CURA) and received a grant to fund the research.
Along with Bruening’s mentorship, Hillier enlisted the aid of exercise science students Dylan Parry (‘22) to help lead the research, Amy Hayward (‘22) to help write the paper, and Jordan Grover (‘22) to help gather and analyze the data. They spent the school year testing the effectiveness of various braces.
“We wanted to figure out what the boots are doing to the foot and what they are doing to walking patterns,” Bruening says. “In order to do the study in a reasonable timeframe, we did it on healthy subjects . . . to try and understand just what the boot does to people in general.”
Hillier and Huber compared three different biomechanical offloading braces: a traditional CAM boot, a hinged boot, and Huber’s SpringEase Boot. They tracked the ground reaction force (GRF) by inserting a special insole underneath the foot and using a plate on the ground, similar to a scale. Then, they measured the force as the test subjects walked in the different boots.
Hillier and Hubert recorded the data and graphed it out to visualize the effectiveness of each kind of boot. According to their findings, the spring-loaded boot has the potential to decrease the amount of healing time, therefore leading to better patient outcomes.
“The spring-loaded boot helps spread that force over time,” Hillier says. “It has a hefty amount of offloading as well.”
The spring-loaded boot works by taking pressure off the heel and slowing the impact of the foot as it hits the ground. This improved model could significantly impact individuals trying to get back on their feet without having to wait so long for the sores to heal.
IMPACT ON PUBLIC HEALTH
Innovations like the spring-loaded boot are essential in helping people stay healthy. Hillier chose to study public health because he loves seeing the bigger picture. With his future plans to become a podiatrist, he anticipates discovering new ways to help people get back on their feet—literally.
“Not only will [this brace] help avoid amputation, but it will also help speed up the healing process,” Hillier says. “It will save money on the medication and healthcare, making the overall public health healthier.”
Hillier believes that improvements in healthcare will have the greatest impact on the overall population.
“Not all of our projects have such a direct connection with something that people can grab onto and see the application of,” Bruening says. “Everybody knows someone who’s had something to do with diabetes and how devastating it is, so it’s really easy to catch the vision.”
GIVING A LEG UP
Hillier and Huber agree that even though the research was challenging, it was worth it when everything came together at the end of the day. Their efforts will significantly impact the healing process of those who use the spring-loaded invention.
“When we get people in the right places, it really helps give them experience as they launch themselves into their own careers,” says Bruening of the students involved in mentored research.
As Huber prepares to partner with a company in New York to produce the SpringEase Boot, he hopes to continue testing the boot to measure the improvements on actual patients.
“The main value in [doing research] is validating its efficacy,” Huber says. “It’s irresponsible to put something out there and say it’s helpful without doing the testing and showing that it actually does what you say it does. This is the first step towards that.”
For Hillier, research is where the rubber meets the road. His passion for research provided a new perspective on his education at BYU, more confidence in his ability to face challenges, and an opportunity to see how learning is applied outside the classroom.
“The point of science is to better the lives of those around us,” Hillier says. "Even by just starting small, we are taking another step in helping those around us: our neighbors, our parents, and our grandparents.”