Electronic Sock Detects Unhealthy Walking Patterns

A pioneering electronic sock capable of identifying an unhealthy walking pattern associated with diabetes and impaired circulation holds the potential to prevent foot ulcers and amputation. This innovative research aims to aid the numerous diabetes patients afflicted with blocked leg arteries and will be unveiled for the first time at EHRA 2024, a scientific conference hosted by the European Society of Cardiology (ESC).

Diabetes can affect the way people walk, also known as their gait. Patients with diabetes tend to put pressure on the metatarsal area of the foot rather than the heel. This way of walking encourages ulcers, which can become infected and lead to amputation. Identifying walking issues early using an electronic sock would enable patients to learn a healthy walking style and prevent serious foot problems.

Dr. Ki Hong Lee, Study Author, Chonnam National University Hospital

Worldwide, 537 million people, or 1 in 10 people, have diabetes. People with diabetes have a two to four times higher risk of peripheral artery disease, heart failure, atrial fibrillation, coronary artery disease, and stroke than people in the healthy population. Diabetes frequently results in foot issues.

High blood sugar causes numbness, tingling, pain, and loss of feeling in the blood vessels and nerves. In the early stages, it can be challenging to identify the symptoms, which increases the risk of cuts and ulcers developing and spreading infection. Together, infection and reduced blood flow impede healing and increase the risk of gangrene and, eventually, amputation.

The study aimed to determine whether a sock equipped with a ballistocardiogram (BCG) sensor could discriminate between diabetic patients and healthy individuals. A BCG monitors the body's movement while the heart pumps blood, and it may be utilized to gauge heart rate and the force applied to the feet during walking.

Twenty diabetic patients and twenty healthy controls were included in the study. Each participant wore the BCG sock for 40 seconds of standing and 40 seconds of walking to gauge heart rate and evaluate pressure distribution on the foot. In addition to donning the socks, subjects underwent an electrocardiogram (ECG) to measure their heart rates. A single electrode was affixed to the chest, and a tiny patch was fastened to the wrist. Regarding cardiology, the ECG is the gold standard for heart rate measurement.

The heart rate measurement was conducted to evaluate the BCG sock's accuracy compared to the gold-standard ECG method. Each research participant's ECG and BCG values—both patients and controls—were compared for this analysis. According to the researchers, the BCG sock and ECG heart rate measurements were nearly identical, who discovered a correlation coefficient of 0.99 (95 % confidence interval 0.99-1.00).

The purpose of the foot pressure distribution measurements was to ascertain whether the BCG sock could distinguish between diabetic patients and healthy controls and differentiate between diabetic patients based on the presence or absence of blood vessels or nerve damage. The Michigan Neuropathy Screening Instrument (MNSI) was used to categorize nerve damage, and the ankle-brachial index (ABI) was used to classify blood vessel damage.

According to the BCG comparison between the patients and healthy controls, the patients with diabetes put more pressure on their feet during walking than the non-diabetic participants did in the metatarsal area. In the BCG comparison between diabetic patients, the researchers discovered that patients with blood vessel damage (ABI score less than 0.9) placed noticeably more pressure on the metatarsal area of the foot during walking and less pressure on the heel when compared to patients without blood vessel damage (ABI score of 0.9 or higher). There was no discernible difference in the foot pressure distribution measurements between patients with and without nerve damage.

The novel BCG sock produced accurate measurements of heart rate, as indicated by the nearly identical values as ECG. The pressure measurements showed that the sock could identify patients with diabetes, and could also pinpoint patients with diabetes and poor circulation. Taken together, the results suggest that the electronic sock could be an easy, non-invasive way to find patients with diabetes who could benefit from gait training to prevent foot complications.

Dr. Ki Hong Lee, Study Author, Chonnam National University Hospital

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