Abstract Body

Diabetic foot syndrome is a complication of diabetes mellitus and is defined as the infection, ulceration, or destruction of the deep tissues of the foot. Diabetic neuropathy and/or peripheral vascular disease in the lower extremities are factors that contribute to the occurrence of diabetic foot syndrome. To diagnose diabetic neuropathy other causes of neuropathy have to be ruled out; neuropathies not associated with diabetes mellitus may be present in patients with diabetes and may be treatable. In up to 50% diabetic peripheral neuropathy can be asymptomatic. If diabetic peripheral neuropathy is not recognized and preventive foot care thus is not implemented, patients are at risk to develop diabetic foot syndrome due to their insensate feet. Loss of protective sensation (LOPS) is a sign of distal sensorimotor polyneuropathy and is a risk factor to develop foot syndrome. The following diagnostic tests are useful to assess small- and large fiber function and protective sensation:

pinprick and temperature sensation for small-fiber function, vibration perception and 10-g monofilament for large-fiber function and 10-g monofilament for assessment of protective sensation.

The incidence of diabetic foot syndrome lies between 15 and 25%. Diabetic foot syndrome is a frequent cause of hospitalization and could lead to major complications, like lower limb amputations, sepsis and death. In up to 80-85% of cases with diabetes who have to undergo lower limb amputations have previously had a foot ulcer. The mortality rate in patients with diabetic foot syndrome is more than double than in the general population.

As diabetic neuropathy with loss of protective sensation is associated with a high risk to develop (recurrent) ulcerations, different methods to (continuously) monitor diabetic feet and diabetic foot disease are in development.

(Remote) monitoring of diabetic foot syndrome can be applied in three domains using technologies to support triaging high-risk patients, technologies to support care at the site of the care provider, and technologies an enabling self-management. These technologies include digital health solutions, smart wearables, telehealth technologies, and “hospital-at-home” care delivery model.

Minor injuries are often unnoticed and may result in subsequent infection and ulceration may end in a foot amputation. Some studies have shown an association between increased skin temperature and asymmetries between the same regions of both feet. A smart device to assess the temperature patterns might indicate the risk to develop diabetic foot syndrome. Pressure sensors could compensate for the loss of pain sensation and enable the early detection of inadequate pressure patterns and thus prevent diabetic foot syndrome. These sensors can be incorporated in socks or insoles. Apps to recognize infections and wounds, and to empower self-care might also be useful in the management of diabetic foot syndrome.

Most of these innovative technologies are still in early phases of development and have not been widely adopted in routine care. However, they do have the potential to revolutionize management of diabetic foot syndrome in the near future.