Diabetes, a widespread condition impacting millions worldwide, not only disrupts metabolic health but also alters a person’s gait, potentially leading to severe foot complications. A fascinating study presented at the European Society of Cardiology’s EHRA 2024 congress in Berlin, Germany, introduces an electronic sock aimed at detecting unhealthy walking patterns associated with diabetes and poor circulation. This innovative device could pave the way for new tools to prevent foot ulcers and the dire consequence of amputation.

Diabetes can have profound effects on the nerves and blood vessels of the body, resulting in 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, significantly increasing the risk of gangrene and the need for amputation. With approximately 537 million people living with diabetes worldwide, the imperative for early detection and intervention cannot be overstated.

Evaluating Gait and Heart Rate with an Innovative Sock Dr. Ki Hong Lee of Chonnam National University Hospital in Gwangju, South Korea, spearheaded a study investigating the potential of a ballistocardiography (BCG) sensor-equipped sock to differentiate between healthy individuals and those with diabetes. A BCG sensor detects body movements induced by the heartbeat and blood flow. In this study, it was assessed for its capability to measure heart rate and evaluate foot pressure distribution during walking.

The study enlisted 40 participants: 20 with diabetes and 20 without. Each participant wore the BCG sock for a short duration while standing and walking. Simultaneously, an electrocardiogram (ECG), considered the gold standard for heart rate measurement, was used for comparison. The BCG sock demonstrated heart rate measurements that closely mirrored those of the ECG, boasting a correlation coefficient of 0.99, indicative of high accuracy.

Key Insights: Pressure Distribution and Vascular Health Pressure distribution measurements unveiled that diabetic patients exerted more pressure on the ball of the foot beneath the little toe while walking. Moreover, among individuals with diabetes, those exhibiting signs of peripheral artery disease—identified by an ankle-brachial index < 0.9—applied significantly more pressure on the medial plantar area and less on the heel during walking. Interestingly, no significant difference was observed in foot pressure distribution between individuals with and without nerve damage.

The BCG sock’s precision in measuring heart rate and identifying patients with diabetes and compromised circulation holds promise. It suggests that this noninvasive tool may one day aid in identifying patients who would benefit from gait training to mitigate foot complications—and potentially encourage individuals to engage in more physical activity, which could enhance circulation. Detecting unhealthy walking patterns early on could enable patients to learn healthier gait habits, potentially preventing the formation of ulcers that could lead to infection and amputation.

The Future of Remote Monitoring and Preventive Care The idea of smart textiles in diabetic foot care is not entirely novel. For instance, 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, facilitating prompt medical intervention. Studies have indicated high utilization and compliance rates with such remote patient monitoring devices, indicating their potential for widespread adoption. Additionally, fiberoptic-based intelligent smart socks have shown promise in assessing not only temperature but also pressure and joint angle deviation.

The innovative BCG sock represents a significant 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 means to detect and address gait abnormalities in patients with diabetes. As the technology continues to evolve, this approach could become an integral component of diabetes management, empowering patients to take proactive measures to preserve their foot health and overall quality of life.