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Under Pressure: Smart insoles – a way to prevent diabetic foot ulcers

Project summary

Diabetic foot ulcers are a common complication of all types of diabetes. Professor Reeves has found that a new type of ‘smart’ shoe insole technology, which raises an alarm when levels of pressure on the feet are too high, can reduce the risk of foot ulcers. To build more evidence on the technology’s effectiveness he will compare different types of smart insoles to find which is best at reducing high pressure. This research could help people with diabetes get the best possible care to protect their foot health.

Background to research

Having diabetes means you’re at a greater risk of developing foot problems, such as diabetes-related foot ulcers. This is because high blood sugar levels can damage nerves in the feet, preventing people from sensing when they’re experiencing higher than normal pressure. Too much pressure can damage skin on the soles of the feet. If left untreated this can lead to foot ulcers, infections and, in serious cases, amputations.  If we can find ways to stop these areas of high pressure, we can help to stop foot ulcers and amputations too. 

With our funding, Professor Reeves and his team previously showed that smart shoe insoles could help reduce foot ulcers by 70%. This technology measures pressure under the feet and alerts the wearer when it goes too high, via a smart watch. This replaces the ‘natural’ feedback that has been lost through nerve damage, so people can make adjustments to offload pressure. Smart insoles are already available to the NHS, but we need more evidence on their effectiveness to ensure people with diabetes get access to them.  

Research aims

Professor Reeves and his team will invite 30 people with diabetes and at risk of ulcers to use one of three different smart insole technologies for two weeks. Participants will be interviewed and asked to fill out questionnaires during this time, so the researchers can understand their experiences. The team will also test out different psychological approaches to see which are the most helpful in encouraging people to take action when they receive an alert telling them that their foot pressure is too high. 

The team will then study a further 60 people with diabetes, who will use each of the three different systems for a period of three weeks. This will help the researchers find out if people are better at responding to high-pressure alerts when they can choose from different systems, and which of the three smart technologies is the best at reducing high-pressure.   

Potential benefit to people with diabetes

The evidence from these studies will help to gradually remove barriers to technology like this by giving us more information on its effectiveness and strategies that can help people with diabetes to make best use of the systems.  

Smart insole technology has the potential to transform day-to-day monitoring of diabetic foot ulcers, empowering people with diabetes to better understand and reduce their risk and enabling health care professionals to provide more personalised footcare.  

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