COMMENTARY

Be 'Smart' With New Technology for Diabetic Foot Monitoring

Neil D. Reeves, BSc, MSc, PhD

Disclosures

October 11, 2018

Diabetic foot ulcers are a major health and economic global burden, but ultimately, at least in theory, they're preventable. The re-ulceration rate is as high as 65% within 5 years,[1] and among persons who initially present with a diabetic foot ulcer, up to 25% may require amputation.[2]

One of the most important risk factors for diabetic foot ulceration is diabetic peripheral neuropathy. This involves loss of sensory perception, haptic feedback, and pain perception, so patients can't self-regulate their foot pressures. It's thought that these high foot pressures over time cumulatively contribute to the development of diabetic foot ulcers.

We've just finished a clinical trial[3] investigating how we can reduce the occurrence of diabetic foot ulcers in high-risk patients, which are those who have a history of plantar foot ulcers.

We used new technology in the form of smart pressure-sensing insoles that measure the plantar pressures under the feet and feed this information back to patients via a smart watch to let them know if and when they develop high pressure, and where on the foot the high pressure is located. The idea is that patients can get this feedback that they've lost many years ago through diabetic peripheral neuropathy, and they can take action to offload the foot and thereby reduce the risk for ulceration.

We found some beneficial effects of this intervention. When compared with the control group, ulcer recurrence was reduced in those who used the insoles by [71%]. We also found a reduced estimated time to ulceration. Informing patients on their pressures via smart watch really empowered them to take control of their foot health in a way that they perhaps haven't been able to do since the onset of significant diabetic neuropathy.

This technological solution is based on measuring pressure, because pressure is important in the development of diabetic foot ulceration. Another important measurement is temperature. Before someone develops a diabetic foot ulcer, the area of the foot will likely heat up before the skin breaks down.

Many people have used temperature as a potential early indicator of a diabetic foot ulcer.[4,5] Some devices can detect temperature—differences in temperature between the feet and between different areas of the feet—to indicate whether a diabetic foot ulcer is imminent. This type of technology can really help patients and clinicians monitor foot health.

There is probably no substitute for directly having a look at a patient's foot. However, we need to embrace the technologies that can help us prevent the occurrence of diabetic foot ulcers and hopefully make an impact on this global problem.

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