Smart Technology for the Diabetic Foot in Remission

Najafi, Bijan; Armstrong, David G.

doi:10.1002/9781119445821.ch12

Cited by 8 publications

(11 citation statements)

References 84 publications

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“…Najafi et al found that neuropathic patients spent approximately three folds as much time weight‐bearing per day as walking, and that daily standing time may be predictive of worse DFU healing outcomes . In a recent exploratory study, they revealed that walking more than 3000 steps per day lowers the rate of wound healing irrespective of type of offloading (ie, removable and irremovable). These recent studies suggest the importance of understanding and managing the dosage of weight‐bearing activity for both prevention and healing of DFU.…”

Section: Technologies For Effective and Personalized Prescription Of mentioning

confidence: 99%

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

Najafi

Reeves

Armstrong

2020

Diabetes Metabolism Res

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The prevalent and long neglected diabetic foot ulcer (DFU) and its related complications rank among the most debilitating and costly sequelae of diabetes. Management of the DFU is multifaceted and requires constant monitoring from patients, caregivers, and healthcare providers. The alarmingly high rates of recurrence of ulcerations in the diabetic foot requires a change in our approach to care and to the vernacular in the medical literature. Our efforts should be directed not only on healing of open wounds, but also on maximizing ulcer‐free days for the patient in diabetic foot remission. The increasing development and use of technology within every aspect of our lives represents an opportunity for creative solutions to prevent or better manage this devastating condition. In particular, recent advances in wearable and mobile health technologies appear to show promise in measuring and modulating dangerous foot pressure and inflammation to extend remission and improve the quality of life for these most complex patients. This review article discusses how harnessing wearables and digital technologies may improve the management and optimize prevention of DFUs by identifying high‐risk patients for triage and timely intervention, personalizing prescription of offloading, and improving adherence to protective footwear. While still in their infancy, we envisage a future network of skin‐worn, jewellery‐worn, and implantable sensors that, if allowed to effectively communicate with one another and the patient, could dramatically impact measuring, personalizing, and managing how we and the patients we serve move through our collective world.

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Section: Technologies For Effective and Personalized Prescription Of mentioning

confidence: 99%

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

Najafi

Reeves

Armstrong

2020

Diabetes Metabolism Res

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View full text Add to dashboard Cite

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“…32 Hence, any weight-bearing activity even at low PP still has potential to add stress to the ulcer site and prolong healing. A recent review 33 found only six studies (in nine publications) 34-42 that have partially explored the effect of weight-bearing activity in offloading devices on ulcer-healing outcomes. One study 38,39 found that more daily steps were associated with slower ulcer healing; three studies 35,36,40,41 found no significant association (although two studies may have been underpowered); and in two studies, 34,37 the association was unclear.…”

Section: Ulcer-healing Mechanisms Of Nrkhdsmentioning

confidence: 99%

“…A recent review 33 found only six studies (in nine publications) 34-42 that have partially explored the effect of weight-bearing activity in offloading devices on ulcer-healing outcomes. One study 38,39 found that more daily steps were associated with slower ulcer healing; three studies 35,36,40,41 found no significant association (although two studies may have been underpowered); and in two studies, 34,37 the association was unclear. Thus, there may be a positive effect on ulcer healing by using devices that make gait and in turn weight-bearing activity more difficult, although the evidence for this conclusion is weak.…”

Section: Ulcer-healing Mechanisms Of Nrkhdsmentioning

confidence: 99%

Personalized Offloading Treatments for Healing Plantar Diabetic Foot Ulcers

Jarl

Rusaw

Terrill

et al. 2022

J Diabetes Sci Technol

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Background: Non-removable knee-high devices are the gold-standard offloading treatments to heal plantar diabetic foot ulcers (DFUs). These devices are underused in practice for a variety of reasons. Recommending these devices for all patients, regardless of their circumstances and preferences influencing their ability to tolerate the devices, does not seem a fruitful approach. Purpose: The aim of this article is to explore the potential implications of a more personalized approach to offloading DFUs and suggest avenues for future research and development. Methods: Non-removable knee-high devices effectively heal plantar DFUs by reducing plantar pressure and shear at the DFU, reducing weight-bearing activity and enforcing high adherence. We propose that future offloading devices should be developed that aim to optimize these mechanisms according to each individual’s needs. We suggest three different approaches may be developed to achieve such personalized offloading treatment. First, we suggest modular devices, where different mechanical features (rocker-bottom sole, knee-high cast walls/struts, etc.) can be added or removed from the device to accommodate different patients’ needs and the evolving needs of the patient throughout the treatment period. Second, advanced manufacturing techniques and novel materials could be used to personalize the design of their devices, thereby improving common hindrances to their use, such as devices being heavy, bulky, and hot. Third, sensors could be used to provide real-time feedback to patients and clinicians on plantar pressures, shear, weight-bearing activity, and adherence. Conclusions: By the use of these approaches, we could provide patients with personalized devices to optimize plantar tissue stress, thereby improving clinical outcomes.

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“…1,5,10 Recently several technologies from smart socks to smart insoles to smart mat to smart offloading to smart thermography imaging systems have been developed enable monitoring risk factors and have potential to scale up and transform the future of DFS management. 5,[11][12][13] Telemedicine and telehealth both describe the use of medical information exchanged from one site to another via electronic communications to improve the patents' health status. 14 Telehealth is already making a very positive contribution to healthcare during the pandemic, and is being used in a variety of ways.…”

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confidence: 99%

mentioning

confidence: 99%

Smart Technology for the Diabetic Foot in Remission

Cited by 8 publications

References 84 publications

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

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

Personalized Offloading Treatments for Healing Plantar Diabetic Foot Ulcers

Post the Pandemic: How will COVID-19 Transform Diabetic Foot Disease Management?

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