Diabetic foot ulcers are a major health and economic global burden, but ultimately, at least in theory, they're preventable.

The re-ulceration rate is as high as 65% within 5 years and among persons who initially present with a diabetic foot ulcer, up to 25% may require amputation. One of the most important risk factors for diabetic foot ulceration is diabetic peripheral neuropathy. This involves loss of sensory perception, haptic feedback, and pain perception, so patients can't self-regulate their foot pressures. It's thought that these high foot pressures over time cumulatively contribute to the development of diabetic foot ulcers.  

The usage of new technology in the form of smart pressure-sensing insoles that measure the plantar pressures under the feet and feed this information back to patients via a smart watch to let them know if and when they develop high pressure, and where on the foot the high pressure is located. The idea is that patients can get this feedback that they've lost many years ago through diabetic peripheral neuropathy, and they can take action to offload the foot and thereby reduce the risk for ulceration.

When compared with the control group, ulcer recurrence was reduced in those who used the insoles by 71% and found a reduced estimated time to ulceration. Informing patients on their pressures via smart watch really empowered them to take control of their foot health in a way that they perhaps haven't been able to do since the onset of significant diabetic neuropathy. This technology is based on measuring pressure, because pressure is important in the development of diabetic foot ulceration. If someone develops a diabetic foot ulcer, the area of the foot will likely heat up before the skin breaks down. Many people have used temperature as a potential early indicator of a diabetic foot ulcer. Some devices can detect temperature between the feet and different areas of the feet to indicate a diabetic foot ulcer is imminent. This type of technology can really help patients and clinicians monitor foot health.

There is probably no substitute for directly having a look at a patient's foot. However, we need to embrace the technologies that can help us prevent the occurrence of diabetic foot ulcers and hopefully make an impact on this global problem.

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