SMART DIABETIC SOCKS: Embedded Device for Diabetic Foot Prevention

Diabetic Footis the consequence of the long-term chronic complications of diabetes affecting the lower limbs, namely peripheral neuropathy and angiopathy. When both complications are associated to an external trivial trauma, they determine the progression of the pathology from a non-ulcerated condition of a foot at risk, to an acute syndrome characterized by the classic diabetic foot ulcer, followed by a chronic condition in the post-ulcerative phase, which can lead to amputation [1]. If the same external trauma occurred in a person with intact somatosensory function, the person would experience pain and avoid the offending pressures. However, in a person with loss of protective somato-sensation (diabetic neuropathy), there is no warning of excessive pressures or tissue damage and persistent localized pressures could lead to skin breakdown or ulceration. It has been estimated that a limb is lost every 30 seconds in the world because of diabetes. In addition to causing pain and morbidity, foot lesions in diabetic patients have substantial economic consequences, with huge direct and indirect costs [2-3]. As concerns prevention, previous studies have suggested that an efficient Care could reduce foot ulcer and amputation [4]. This monitoring strategy is largely based on renewed vigilance of the diabetic patient which mainly consists in making a daily inspection of his feet. Unfortunately, studies have shown that patient vigilance decreases over time. Complications which appear after some time are directly correlated with the increasing lack of vigilance. Unfortunately in the case of diabetic patients, it is precisely when the first foot ulcers appear that serious complications begin. This is mainly due to recurrent disease in the diabetic angiopathy, which severely limits the powers of healing. It becomes therefore essential to propose new technologies and services dedicated to the monitoring and assistance of the diabetic patient to help maintain alertness and by extension its autonomy in society. The external trauma that causes tissue breakdown could be intrinsic, such as repetitive stresses from high pressure and/or callus, or extrinsic such as from ill-fitting footwear rubbing on the skin or an object inside the shoe. It hence appears very suitable to be able (1) to monitor the external pressure applied all around the foot and (2) if possible, to estimate the corresponding internal stresses and strains. Dr Paul Brand (1914–2003) was the pioneer advising the measurement of the pressures between foot and shoe, trying to observe the causes and not the consequences of foot high pressures .

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