A quarter of diabetic patients in Switzerland are prone to foot sores. This is one of the major complications of this disease. In 85% of cases, according to epidemiological studies, it is the precursor of all amputations in diabetics.
The existence of a foot sore represents a turning point in the evolution of the disease and is the result of two factors: arteriosclerosis (lack of oxygen supply to the feet due to an accumulation of fatty plaques and other substances in the arteries) and neuropathies (nerve degeneration that involves a loss of sensation in the foot).
Complications of the diabetic foot, which are largely preventable, are associated with a significant reduction in the quality of life and independence of the patient.
What are the different solutions on the market?
Various therapeutic approaches are now available to reduce diabetic foot complications and the risk of amputations. These approaches target two distinct objectives: prevention and offloading for rapid wound healing to avoid infection.
Detection of areas at risk of foot pressure
New connected devices have emerged in recent years to detect areas of the foot at risk and help diabetic patient to maintain vigilance against foot pressure in real-time and daily use.
- Smart mats
The connected mats are used to detect small temperature differences between the two feet that predict the short-term occurrence of a foot sore within 40 days.
Ex: SmartMat™ from Podimetrics, Bluedrop Medical - Connected socks
The Siren socks (USA) feature a smart textile woven with temperature micro sensors that monitor changes in foot temperature and send a signal via Bluetooth to a dedicated mobile app. The increase in foot temperature indicates that inflammation is developing, which may be a sign of injury - Connected insoles
Sensory insoles provide advanced analysis using pressure, temperature and motion sensors to measure the pressure distribution of the foot
Ex. Orpyx SI® Sensory Insoles de Orpyx Medical Technologies, Pedar from Novel GmbH
In parallel, traditional preventive measures such as pedicure and proper footwear are still required.
Innovative therapeutic approach
The 3CPatch® from Reapplix are obtained from centrifuged blood and applied directly to the wound at the foot of the patient’s bed. According to Dr Olivier Bourron, endocrinologist-diabetologist at the Pitié-Salpêtrière Hospital in Paris, “there are very significant results in terms of improving healing time or achieving complete healing”. The International Working Group on the Diabetic Foot (IWGDF) now even recommends the use of the Reapplix technology. Indeed, data from their cohort study gave an average healing time of 11 weeks.
Discharge devices for risk areas of the foot
When the wound occurs despite preventive measures, it may take several weeks to months to heal, which puts the patient at risk of infection and amputation.
There is a range of orthotics available to protect the areas of friction apart from the Total Contact Cast (TCC) which remains the current reference for the relief of the diabetic foot:
- Removable connected boots
The removable boots are an off-loading device equipped with sensors to better monitor patient compliance. The design, created by a former Nike designer, combines the benefits of a conventional offloading boot with the comfort and aesthetics of a sports shoe. The Foot Defender won the award at the Symposium on Advanced Wound Care where it was presented this year. The device is the result of a collaboration with Sensoria Health (Redmond, USA), a leader in embedded sensors and mobile applications for remote monitoring. - Smart shoes to measure and adapt the flexibility of soles
A close collaboration between the HUG and the EPFL has led to the development of intelligent shoes that continuously detect the distribution of plantar pressures in the foot and dynamically adapt the shape of the soles to redistribute the stresses and relieve the at-risk areas of the foot. The device is designed to be worn daily by the patient. After the development and prototyping stage, clinical studies are planned to test the effectiveness of the device in a medical context. - Customised insoles using 3D printing
A team from the Lyon-Sud University Hospital is developing a 3D-printed insole to prevent wounds by reducing hyper pressure points.
The POC 3D PEDIAB project, developed in conjunction with a Lyon-based startup, 3D Fab, aims to standardise the production of foot orthoses to reduce treatment costs and ensure better prevention of wound risks.