Happier feet - Disrupting the vicious cycle of healthcare decline in Diabetic Foot Ulceration through active prevention: The Future of self-managed care

Diabetic foot ulcers (DFUs) are common, chronic and cost the NHS £1Billion annually. Up to 25% of patients with diabetes develop a DFU within their lifetime. Healing is slow and 40% of patients re-ulcerate within 12 months. DFUs frequently recur and lead to amputation and/or death, with a 40% mortality rate at 5 years. DFUs are more common in people who are socially and economically disadvantaged. The physical and emotional burden of ulceration is considerable: 32% are depressed and this is related to a 3-fold greater risk of mortality. Gait is often maladaptive in this group, overloading parts of the foot, making movement painful/unsafe, and they are scared of movement. They often feel hopeless about the future, as it's not currently possible to prevent DFUs. A consequence is a downward vicious cycle of reduced movement, self-efficacy and mood, which is thought to negatively impact patient ability to engage in preventative behaviours for DFUs and increase chances of re-ulceration, but also has significant potential to increase other disorders which are influenced by lack of physical activity/low mood, e.g. pain, cardio-metabolic disorders, and cancer.

This project proposes to build and expand on current smart insole technologies for the detection of Diabetic Foot Ulcers, utilising a multiple sensor-based approach for their identification. A smart insole with integrated pressure, temperature, acoustic and sensors which measure how someone walks will identify early indicators of ulceration and when movement is appropriate/ inappropriate. The smart insole will respond to these inputs and adjust the foot, and hence the way someone walks, through embedded actuators, to support better, safe and comfortable movement. The smart insole will alert the user to potential problems, through a smartphone, enabling self-management; promoting users to check their foot and seek medical attention as required. Although data sharing with the cloud to facilitate community self-management and to inform clinical decision-making is beyond the scope of this project, this research will lay the foundations for future proofing the security and privacy of highly sensitive information against advancements in quantum computing. This project will seek to understand and overcome the barriers of technology adaptability, acceptability and adoption for users and their social networks (friends, family etc). This smart insole can break the vicious cycle by increasing self-efficacy to self-manage Diabetic Foot Ulcers and to be more active, thus impacting across multiple illnesses which respond to physical activity.