David G. Armstrong, DPM, MD, PhD
DISCLOSURES | April 23, 2024
Diabetes, a condition affecting millions globally, not only alters metabolic health but also affects a person’s gait, potentially leading to severe foot complications. An intriguing study presented at the European Society of Cardiology’s EHRA 2024 congress in Berlin, Germany, introduces an electronic sock designed to detect unhealthy walking styles associated with diabetes and poor circulation. This innovative approach may lead to new tools to prevent foot ulcers and the dire consequence of amputation.
Diabetes can wreak havoc on the body’s nerves and blood vessels, leading to numbness, tingling, and loss of sensation in the feet. These symptoms often go unnoticed in the early stages, allowing cuts and ulcers to develop and become infected. The combination of infection and poor blood flow complicates healing, increasing the risk for gangrene and amputation. With around 537 million people living with diabetes worldwide, the need for early detection and intervention is critical.
Assessing Gait and Heart Rate With a Smart Sock
Dr Ki Hong Lee of Chonnam National University Hospital, Gwangju, South Korea, led a study examining the potential of a ballistocardiography (BCG) sensor–equipped sock to differentiate between healthy individuals and those with diabetes. A BCG sensor detects movements in the body caused by heartbeat-induced body motions and pumped blood. In this study, it was evaluated for its ability to measure heart rate and assess foot pressure distribution while walking.
The study enrolled 40 participants: 20 with diabetes and 20 without. Each participant wore the BCG sock for a brief period while standing and walking. Concurrently, an ECG, the gold standard for heart rate measurement, was used for comparison. The BCG sock’s heart rate measurements closely matched those of the ECG, with a correlation coefficient of 0.99, indicating high accuracy.
Key Findings: Pressure Distribution and Circulatory Health
Pressure distribution measurements revealed that patients exerted more pressure on the ball of the foot below the little toe while walking. Furthermore, among people with diabetes, those with some degree of peripheral artery disease — indicated by an ankle-brachial index < 0.9 — placed significantly more pressure on the medial plantar area and less on the heel during walking. Interestingly and paradoxically, no significant difference was observed in foot pressure distribution between people with and those without nerve damage.
The BCG sock’s ability to accurately measure heart rate and identify patients with diabetes and poor circulation is promising. It suggests that this noninvasive tool may one day help to identify patients who would benefit from gait training to prevent foot complications — and potentially coax people into more activity, which may improve circulation. If an unhealthy walking style can be detected early, patients can be taught healthier walking patterns, possibly averting formation of ulcers that can lead to infection and amputation.
The Future of Remote Monitoring and Prevention
The concept of smart textiles in diabetic foot care is not entirely new. For example, the Siren Diabetic Sock (Siren Care) monitors local skin temperature to detect early signs of inflammation, a precursor to ulcers. These socks, embedded with microsensors, alert users to potential issues, allowing for prompt medical attention. Studies have shown high utilization and compliance rates with such remote patient monitoring devices, suggesting their potential for widespread adoption. Additionally, fiberoptic-based intelligent smart socks have shown promise to assess not only temperature but also pressure and even joint angle deviation.
The novel BCG sock represents a potential advancement in diabetic foot care. By providing accurate heart rate measurements and identifying unhealthy pressure distribution in the feet, it offers a simple and noninvasive method to detect and address gait issues in patients with diabetes. As the technology progresses, the approach could become an integral part of diabetes management, empowering patients to take proactive steps in preserving their foot health and overall quality of life.
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