Project coordination
LEPRA Society, India

Partners
Sivananda Rehabilitation Home
Damien Foundation India Trust
Association of People Affected by Leprosy (APAL)
Office of Additional District Medical Health Officer
LEPRA

Aim: This study addressed the following question: Can a low-cost technology for measuring baropodometry, undertaken at the community / primary care levels, help design personalized MCR footwear that reduces the risk of new ulcers among people affected by leprosy with a history of plantar ulcers?

Full project title:
Personalised footwear for foot ulcers in leprosy by baropodometry through an innovative community engagement model

Final project summary:
Foot ulcers are one of the most common and disabling complications of leprosy. Because many people affected by leprosy lose sensation in their feet, they may not notice repeated pressure, injuries, or minor wounds. Over time, this can lead to chronic foot ulcers that affect mobility, independence, daily activities, and the ability to earn an income.

This study explored whether personalised footwear, designed using computer-assisted foot pressure measurements, could better prevent foot ulcers than standard protective footwear. The project also examined whether customised footwear would improve adherence to footwear use and increase awareness of the importance of foot care. In addition, the study sought to develop a tool capable of predicting an individual's risk of developing a foot ulcer within six months by considering factors such as foot pressure, lifestyle, and social circumstances.

The study was conducted across three sites, where participant information was collected using a mobile data collection system. Individuals in the intervention group received customised footwear designed to reduce pressure on specific areas of the foot. These designs were based on detailed pressure measurements taken using a Harris mat and specialised software. Participants in the control group received standard Microcellular Rubber (MCR) footwear, which was produced using conventional measurement techniques and adapted when necessary to accommodate existing ulcers.

All footwear was delivered within ten days of assessment. In addition, every participant received self-care training focused on preventing foot wounds, protecting insensitive feet, and understanding the importance of regularly wearing appropriate footwear. Self-care kits were provided, and participants practised foot care techniques during the training sessions.

Over the course of the study, participants experienced significant improvements in foot health and overall well-being. The proportion of participants with foot ulcers decreased from 41% at the start of the study to 11% by the end. As foot health improved, participants reported greater mobility and fewer limitations in their daily activities.

The benefits extended beyond physical health. Many participants described improvements in their emotional well-being, reporting increased confidence, greater independence, and reduced feelings of shame associated with their condition. The level of family and community support varied across study locations. Participants in Andhra Pradesh generally reported strong support from their families and communities, while those in Bihar and Odisha experienced higher levels of stigma and emotional distress.

Overall, the findings demonstrate that combining personalised footwear with self-care education can significantly reduce foot ulcers and improve both physical and emotional well-being among people affected by leprosy. The involvement and training of community health workers further enhance the sustainability of the approach and increase its potential for wider implementation.

The knowledge, training materials, and tools developed through this project provide a strong foundation for expanding similar programmes to other communities at risk of disability-related foot ulcers. By preventing wounds before they occur, such interventions have the potential to improve quality of life, maintain independence, and reduce the long-term burden of disability associated with leprosy.

Impact

A key achievement of the project was that all participants received footwear, self-care materials, and practical training. Community health workers and local support groups were also trained to provide ongoing assistance, helping to ensure that the benefits of the intervention could continue after the study ended. The research team successfully followed participants for a full year, generating valuable information on foot health, ulcer prevention, and quality of life.