The challenge

The project addresses one of the societal challenges identified in Europe 2020(Europe’s growth strategy for the coming decade): “Health, demographic change and wellbeing” and specifically its activities: “Understanding the determinants of health, improving health promotion and disease prevention” and “Understanding disease”. It will entail an advance in the prevention and treatment of foot diseases of high social impact and of ever increasing prevalence, and deliver an improvement in the quality of life for the people concerned.

The common and often devastating foot diseases experienced by older people, those with diabetes and who are obese fall in to the so-called “civilization diseases”, are complex and often co-existing. To fully characterize these problems in depth and subsequently innovate from a position of deep insight into the consumer (or patient) problem, requires the creation of synergies between key stakeholders at all levels.

The 3 growing challenges: older people, diabetes, obesity.

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The population pyramid is inverting due to fewer number of births and higher life expectancy. The life expectancy in developed countries is 75 years, compared to 47 years in 1900. People aged 65 years or older account for 17.4% of the population in these countries, reaching 21% in 2025. By 2050 the number of people in the EU aged 65+ will grow by 70%. The 80+ group will grow by 170%. This tendency is seen in all countries in Africa (Tunisia, Egypt or Morocco), where demographic and epidemiological changes are being experienced, including the ageing of the population. An increasing proportion of older people, together with their physical, physiopathological and socioeconomical characteristics have very important repercussions, generating high social and public health demands.

The foot problems of older people are profound and yet common, including painful chronic skin problems (e.g. corns, callus, fissures) which require “protection” of specific areas of the foot, such as the toes and ball of foot. This protection involves use of pressure reducing materials over/under these areas and adapting footwear and insole shapes to ”off load” painful sites. The feet of older people also have a high rate of bone and soft tissue deformity which affects balance, gait and quality of life. This deformity can complicate the task of protecting the foot because foot geometries become very complex, are dynamic, and are often combined together.

Obesity is a dysfunction of the body’s weight control system that prevents the adjustment of the fat reserves to its optimum size. The most important cause is the adoption of unhealthy eating habits, in preference to saturated fats and simple carbohydrates, and inactive lifestyle. It is a complex reality where not only biological factors, but also social and cultural factors intervene.

The worldwide prevalence of obesity nearly doubled between 1980 and 2008. According to country estimates for 2008, over 50% of both men and women in the WHO European Region were overweight, and roughly 23% of women and 20% of men were obese. WHO warned about the need to establish the necessary measures to prevent what is considered the real health epidemic of the 21st century.

Obesity and diabetes are commonly coexisting diseases and pose a significant threat to quality and length of life. There are about 60 million people with diabetes in the European Region, or about 10.3% of men and 9.6% of women aged 25 years and over. In Morocco and Tunisia there were respectively 214 and 131 new diabetics per 100.000 population in 2008, and this tendency is increasing every year. Prevalence of diabetes is increasing among all ages in the EU-Med Region, mostly due to increases in overweight and obesity, unhealthy diet and physical inactivity. Worldwide, high blood glucose kills about 3.4 million people annually. Almost 80% of these deaths occur in low- and middle-income countries, and almost half are people aged under 70 years. WHO projects diabetes deaths will double between 2005 and 2030.

People with diabetes and obesity often suffer the same foot skin and soft tissue problems as older people, but the impact of their disease (vascular changes and neuropathy) mean the consequences of not using appropriate footwear can be devastating. 1 out of 20 people with diabetes develop a foot ulcer and 70% of people die within 5 years after amputation. In the UK diabetic foot disease accounts for more hospital bed days than all other diabetes complications. Trivial and avoidable diabetic foot lesions precede 85% of all leg amputations and the World Diabetes Federation highlight that amputation rates can be reduced by 49-85% if strategies for preventing and treating foot lesions are implemented – including footwear/insoles. In addition, foot deformity and biomechanics have been associated with increased risk of trips and falls in older people, and also diabetes. Movement strategies to prevent a fall are more difficult if you have deformed, less mobile, painful or perhaps insensitive feet.