Development of an Original Biomechanical Model for Predicting Diabetic Foot Ulceration Risk in Nigerian Diabetic Patients

Diabetic foot ulceration is a leading cause of lower limb amputation in Nigeria, and biomechanical models predicting high-risk plantar pressure distribution could enable targeted preventive interventions, but existing models are parameterized from Western patient populations whose foot morphometry, footwear habits, walking surface characteristics, and diabetic neuropathy profiles differ substantially from Nigerian patients. This dissertation develops an original biomechanical model for predicting diabetic foot ulceration risk in Nigerian diabetic patients, making contributions to diabetic foot biomechanics and to evidence-based preventive footwear design for the Nigerian context. The model development encompasses four research phases. The first phase characterizes Nigerian diabetic patient foot morphometry, plantar tissue material properties, and neuropathy-related sensory threshold distributions through a clinical study of two hundred patients at University of Calabar Teaching Hospital and Lagos Island General Hospital, employing three-dimensional foot scanning, pedobarograph dynamic plantar pressure measurement, ultrasound tissue thickness measurement, and validated neuropathy assessment instruments. The second phase constructs patient-specific finite element models of the foot-ground interaction incorporating the measured Nigerian patient morphometric and material property distributions. The third phase develops a probabilistic ulceration risk prediction model using Bayesian inference to integrate biomechanical model outputs with clinical risk factor data, validated against longitudinal ulceration outcome data from a prospective three-year cohort of three hundred high-risk diabetic patients. The fourth phase applies the model to optimize offloading footwear insole topography for Nigerian patients, demonstrating thirty-one percent reduction in peak plantar pressure at high-risk sites for model-optimized insoles relative to standard flat insoles. Original contributions include the Nigerian patient biomechanical parameterization and the Bayesian ulceration risk prediction framework. Keywords: diabetic foot ulceration, biomechanical model, plantar pressure, Nigerian patients, preventive footwear.