Real-Time Smart Textile-Based System to Monitor Pressure Offloading of Diabetic Foot Ulcers

Abstract

Background: The lifetime risk of developing a diabetic foot ulcer (DFU) is at least 25%. A DFU carries a 50% risk for infection and at least 20% of those receive some form of amputation. The most significant parameter that prevents or delays ulcer healing is high plantar pressure. To improve the patient's healing process, the DFU's plantar pressure should remain cumulatively low. Therefore, a tool that continuously measures the DFU loading, and provides real-time feedback can improve the healing outcome. Methods:We report the development of a system capable of continuously measuring the pressure, which could have applications to monitor DFU. The system contains a textile pressure sensor attached to a stretchable band, hardware that collects data and transmits them via Bluetooth to a phone, an app that gathers the data and stores them in the cloud, and a web dashboard that displays the data to the clinician. The sensor was characterized in vitro using the system, and the webdashboard was developed and tested on simulated patient data. Results:We demonstrate the feasibility of developing the system and characterize the pressure response of the device. As a result, we demonstrate a viable method for monitoring DFU off-loading in real time. Conclusions:The presented study demonstrates the feasibility to develop a simple, modular wearable system that opens up new possibilities for diabetic foot ulcer care by providing a way of monitoring the pressure under the ulcer in real time.

Five year mortality and direct costs of care for people with diabetic foot complications are comparable to cancer

“…Additionally, the emergence of remote patient monitoring technologies can allow us to predict and detect ulcers as or even before they form. Patients using a smart insole system, pressure‐monitoring insoles transmitting real‐time feedback to a smartwatch to cue offloading of sustained plantar pressure, in addition to the regular standard‐of‐care have been shown to have substantially lower rates of ulcer occurrence and approximately $15,000 less cost of care when ulcers do form, over a period of 18 months [39, 40]. In another study, a smart temperature‐monitoring bathmat was able to detect DFUs 5 weeks before clinical presentation [41].…”

Leveraging smart technologies to improve the management of diabetic foot ulcers and extend ulcer‐free days in remission

“…Smart flexible sensors implanted in insoles or socks combined with digital health apps have paved the way for monitoring PTS during activities of daily living. In 2017, Raviglione et al proposed the concept of daily monitoring of plantar pressure in people at risk of DFU using a smart textile (Sensoria socks, Sensoria Inc., Redmond, WA; Figure ). Their system contained a textile pressure sensor attached to a stretchable band, hardware that collects data and transmits them via Bluetooth to a smartphone, an app that gathers the data and stores them in the cloud, and a web dashboard that displays the data to the clinician.…”

Health Sensors, Smart Home Devices, and the Internet of Medical Things: An Opportunity for Dramatic Improvement in Care for the Lower Extremity Complications of Diabetes

“…In addition, most medical devices that connect to analytics dashboards can be developed into IoMT technology. 24 As sensors that can measure DFU predictive markers are being developed, there is a need to explore how these new devices can be integrated into an IoMT model for the DFU patient.…”