Abbreviations: (CoP) center of pressure, (ICC) intraclass correlation coefficient, (GS-PSD) gold standard pressure-sensing device, (PMD) pressure measurement device, (PSRU) plantar sensory replacement unit Keywords: correlation, diabetes, insole, neuropathy, orthotic, pressure

Summary:Wounds of the foot challenge reconstructive surgeons to manage multiple factors: sensibility, stability, and durability. In this article, we focus on the insensate foot, which poses challenges to wound prevention with its propensity to develop pressure ulceration. The authors present the innovative use of a pressure-sensing smart insole system (SurroSense Rx, Orpyx Medical Technologies Inc., Calgary, Canada) in the management of the insensate foot in a patient following foot reconstruction. The pressure-sensing smart insole system provided unique feedback to both patient and provider in ways that contributed to the prevention of pressure ulcer recurrence, as well as highlight the importance of prescribed footwear in both the affected and unaffected foot. Wearable real-time monitoring and feedback faces the challenge of patient adherence. Future studies are indicated to examine the specific behaviors that are associated with favorable outcomes and long-term behavior changes.

Degloving injuries of the foot pose an important challenge to the reconstructive surgeon. Key features of reconstruction include sensibility, stability, and durability. Preservation of plantar sensibility is considered to be a critical factor in the evaluation of lower extremity trauma, with its absence once being considered an indication for amputation. However, recent studies show that outcomes following limb preservation are not as adversely affected by a lack of plantar sensation than was once thought. With the increasing practice pattern of attempting limb salvage in the face of impaired plantar sensation, methods and devices designed to provide patients with maximal protection for loss of protective sensation (LOPS) in the affected limb are critical. The authors present the innovative use of the SurroSense Rx smart insole system (Orpyx Medical Technologies Inc, Calgary, Canada) in the management of LOPS in a patient with a degloving injury of the foot that was reconstructed with a latissimus dorsi free flap and skin graft. To the authors’ knowledge, this is the first reported case of use of such a system following a traumatic injury to the lower extremity.

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