3D Interactive Foot

Educating Allied Health Professionals in the Interdisciplinary Assessment of Diabetic Foot Pathology

Jodie Jenkinson, BA, MScBMC | Assistant Professor, Biomedical Communications,
University of Toronto Mississauga

Robert Sargeant, MD, PhD, FRCPC | Assistant Professor, Department of Medicine,
University of Toronto; Active Staff, General Internal Medicine, St. Michael's Hospital

James Mahoney, MD, FRCPC | Active Staff, Plastic Surgery,
St. Michael's Hospital

Anne Agur, BScOT, MSc, PhD | Course Director, Department of Anatomy, University of Toronto

Project Problem

Diabetes and its associated complications pose significant health and economic problems worldwide. The aging population, high obesity rates, and decreased levels of physical activity contribute to the 'epidemic' nature of this disease. By 2025, over a third of the world's population will have diabetes, 15-20% of which will have disease-related foot pathology. Diabetic foot ulcers (DFUs) and amputations are the most common and serious complications of diabetes and precede approximately 85% of all diabetes-related lower extremity amputations. Fortunately, over 80% of DFUs can be prevented with proper care and management of the diabetic foot.

Despite the vast impact of this disease, the prevention, assessment, and management of DFUs and associated complications remain low priorities to health care providers, patients, and funding sources. Moreover, clinical knowledge in this area is often developed locally within 'silos of excellence' and minimal collaboration exists between disciplines. Current web-based resources on diabetic feet reflect the lack of communication that dominates this field. Most available sites consist of collections of excerpts from review articles and clinical guidelines in textual format.

However, there are few sites containing photo references, and online videos depicting assessment, debriding, or dressing of wounds are virtually non-existent. Given the inherently visual nature of diabetic foot pathology, the lack of visual learning tools is a major limitation among existing web-based resources. Therefore, there is a great need for an innovative, evidence-based, comprehensible, visual tool that educates Allied Health Professionals in the basic assessment of the diabetic foot.

Project Goals & Objectives

In this project, I will collaborate with Drs. Robert Sargeant and James Mahoney at St. Michael's Hospital (a Toronto hospital specializing in diabetes care), in creating an online interactive module intended to be used as a teaching tool for Allied Health Professionals practicing and teaching in the fields of wound care, diabetes, and orthopedic surgery. The goal of the module is to address the lack of visuals in existing online resources through the visualization of an interactive three-dimensional (3D) anatomical model of the foot that the user can manipulate (rotate, label, hide/show structures) and use in order to supplement his or her knowledge and understanding of the anatomy. A secondary goal is to visualize diagnostic tests in one-minute-long animations, which will aid the user in successfully assessing and treating diabetic foot pathology in the clinical setting. The project objectives include:

1. Build a 3D foot model in Maxon Cinema 4D and add interactivity using JavaScript in the Unity 3D game development tool.

2. Animate two 1-minute-long diagnostic tests (monofilament & probe-to-bone test) using Maxon Cinema 4D and Adobe After Effects.

3. Design and code a graphical user interface (GUI) in HTML, CSS, and JavaScript and embed above content within it.

Metrics for Success

This project is an original contribution to an existing body of knowledge and is predicted to yield a considerable impact. The 3D foot model will be a very valuable tool in teaching medical assessment principles, whether in the clinic or in lectures. Moreover, it will enhance teaching in wound care and form the substrate for future educational modules intended to reach a wider audience. The module will be successful if:

1. Learners can understand and utilize the 3D model's interactivity.

2. Learners can effectively assess and treat diabetic foot pathology in an interdisciplinary manner.

3. Users can present the module and use it to teach during talks and lectures.

4. Future authors can use the module as a prototype for other diabetic pathologies.

Technical Requirements

Software: Maxon Cinema 4D, Adobe Photoshop CS5, Adobe Illustrator CS5, Adobe After Effects CS5, Unity 3D game development tool

Programming Languages: HTML, CSS, JavaScript


This project is funded by the Bickell Foundation, St. Michael's Hospital, and the Vesalius Trust Student Research Scholarship Program.