A Smart Insole in Rwanda Aims to Catch Diabetic Foot Problems Before They Become Amputations

The possibility of making an artificial limb for someone she loved was something Prisca Nikuze never expected to confront. As a high school student in Rwanda, Nikuze watched a family member live with diabetes. She initially imagined that studying medicine would give her a way to help treat the disease. She did not get the opportunity to enter medical school.

Instead, she enrolled in prosthetics and orthotics, learning to fabricate artificial limbs and assistive devices, including insoles designed to correct flat feet and other deformities.

At first, she struggled to understand how the course connected to the problem she had hoped to solve.

“I was like, how is this related to what I wanted to do? But I didn’t realise that that’s where my purpose was,” Nikuze told local newspaper New Times.

During her training, she learned that diabetes is a major cause of limb loss. The connection changed how she viewed her profession. “I was very scared at that moment and I couldn’t picture myself fabricating an artificial limb for a family member. So I was shocked,” she says.

Nikuze, now a licensed prosthetist and orthotist, had also developed an interest in technology. During university holidays, she taught herself about the Internet of Things, artificial intelligence and data analytics.

She began wondering whether those tools could help detect complications before they resulted in irreversible damage. That question became more urgent during her clinical internship in 2025 at the University Teaching Hospital of Kigali, known as CHUK.

Ten patients, six with diabetes

During the internship, Nikuze assessed patients and prescribed and fabricated artificial limbs.

Of the 10 patients she received, six had diabetes. “I don’t know why it happened to me personally, but from the 10 patients I received during that clinical internship, I fabricated artificial limbs for 10 patients and six of them had diabetes,” she says.

The experience made her question why patients were reaching the point of losing limbs when some complications might be detected earlier.

“That was so urgent, and I was like, I don’t want to see any more patients losing their limb from something that can be detected and that can be prevented,” Nikuze says.

That became the thinking behind NEEM, a health technology initiative she co-founded with other young innovators.

The team began exploring whether sensors embedded in an insole could identify warning signs of diabetic foot complications before they became severe.

Detecting what patients may not feel

Diabetes can cause peripheral neuropathy, a form of nerve damage that can reduce or eliminate sensation in the feet. A person can therefore develop an injury without experiencing the pain that might normally prompt medical attention. Poor circulation can further complicate healing.

Nikuze says the smart insole is designed to monitor some of the physiological changes associated with those risks.

It contains pressure and temperature sensors, as well as a sensor that measures blood oxygen saturation. “When you’re about to have an injury, the pressure changes. When there is inflammation, the temperature in the feet changes. When the blood flow doesn’t reach the lower extremity, the oxygen blood saturation changes,” she explains.

The sensors collect measurements and send them to a microcontroller, where the information is analyzed. The system can then send an alert to the patient and a health care provider, potentially allowing them to investigate a problem before it becomes more serious.

The technology remains under development and testing.

The team has worked with consenting patients who agreed to participate in testing, providing them with the insoles and monitoring the information they generate. Nikuze says some of the work has involved patients at Sayashika and Muhima Hospital.

She stresses that much more research is needed before the technology can be deployed widely. “This is a capital-intensive initiative because it needs a lot of research, a lot of trials, to be able to validate it, to be able to say that it really works,” she says.

Still, the early work has encouraged the team. “We have been able to at least work with some people and get to see the signs that this can be something that can really change,” she says.

The human cost of losing a limb

For Nikuze, the urgency extends beyond the technology itself. During her internship, she saw how diabetes could go undetected until complications had become life-changing.

She recalls interviewing a woman who did not know that she had diabetes.

The woman had experienced symptoms including dehydration, fatigue and weight loss. She eventually noticed wounds on her foot but did not feel pain.

When she sought medical attention, health workers discovered that she had diabetes. By then, the damage was severe. Her limb was amputated, while her other limb was also being affected.

“She didn’t know that she had diabetes. She lived with these signs and symptoms, having dehydration, being tired, losing weight, and one day she realised that she had some wounds on her feet. She didn’t feel the pain,” Nikuze says.

“She went to the clinic and that’s when they realised. They amputated that patient, and the other limb was also being affected. All of this happened before she could even realise that she had diabetes.”

The encounter stayed with her. Losing a limb can bring consequences that extend well beyond the operating room. Prosthetic limbs can cost millions of Rwandan francs, adding to the financial burden on families. They also cannot fully reproduce the function of a natural limb, potentially affecting mobility and the ability to perform certain tasks.

For people who support families financially, Nikuze says, an amputation can also threaten their ability to work.

“It is not a matter of diabetes only being urgent, but diabetes and NCDs as a whole are really urgent. We really need to put more effort in these diseases,” she says.

From rough prototype to wider solution

The smart insole has changed considerably since Nikuze and her colleagues first began developing it.

When they presented an early version at Hanga Pitch Fest, the device was still a rudimentary prototype assembled with locally sourced components.

“It was not something that you can wear in society. It was just a prototype that gives information,” she says.

The Hanga bootcamp helped the team refine the technology and think about how it could become a viable business. “They showed us how to really build and how we can turn a solution into business,” Nikuze says.

After winning Rwf20 million at Hanga Pitch Fest, the team began improving the prototype, sourcing higher-quality components, including some from China, as well as silicone materials.

They also began exploring research collaboration with the University of Rwanda.

The project has since expanded beyond the insole. Nikuze says the team is working with more patients and looking at other elements of diabetes management, including nutrition and education.

It has also developed an app for patients. “We moved into thinking not only about the product, but actually how we can influence the product but also help the people,” she says.

Young innovators need a chance

For Nikuze, developing a health technology is only one part of the challenge. Finding institutions and professionals willing to work with young innovators can be just as difficult.

She says potential partners can be hesitant when presented with solutions developed by young people, questioning their experience and expertise.

“I do believe in my solution, but people don’t believe in my solution,” she says. Her response is to seek collaboration rather than create a parallel system. “All I need is just to not start my own movement but to join the people who are already involved,” she says.

She recognizes that caution is necessary when new technologies involve patients. A device intended to identify health risks must be tested rigorously before patients can rely on it.

But she argues that caution should not become a reason to prevent young innovators from testing their ideas.

“There is a concern that maybe we need to be cautious about the solution that we’re bringing, but that doesn’t mean that we don’t need to give it a shot. We don’t need to be so hesitant about the solutions,” she says.

For Nikuze, credibility will ultimately come through evidence, collaboration and repeated testing. “Trust is built. We need a chance to build that trust,” she says.

That is also how she sees the future of NEEM and the broader effort to develop homegrown solutions to health problems in Rwanda. “You can’t win in isolation,” Nikuze says. “If we want to go far, we need to move together.”

Nkem Owoh (Nigeria)

Most Famous Movie: Osuofia in London (2003)

Short Bio: Nkem Owoh is a veteran Nigerian actor and comedian, widely regarded as one of Nollywood’s most influential and iconic figures. His role as Osuofia in the comedic film Osuofia in London brought him immense popularity across Africa.

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