Diabetic feet and temperature biofeedback

Introduction

Diabetes Type 1 and Type 2 are among the prevalent diseases in the world with Type 2 diabetes accounting for the majority of cases (Sun et al., 2022). Diabetes can lead to complications in the foot area, commonly known as diabetic foot disease. This condition includes foot ulceration, infection, and tissue destruction. The worldwide prevalence of diabetic foot disease is 6.3%, and it presents a major challenge to patients and healthcare systems, with increased rates of hospitalization and mortality (Craus, Mula, & Coppini, 2023).

Diabetic foot complications include polyneuropathy, infection, ulcers, and skin health issues  and are one of the leading causes for foot amputation (Matijević et al., 2023; Dewi & Hinchliffe, 2020; Maitra & Ray, 2023) and a significant predictor for mortality (Edmonds, Manu, & Vas, 2021).

One, maybe underestimated factor are the psychological aspects of the complications like Depression (Neeru et al., 2015)

Blood Circulation One of the issues stemming from diabetic feet is a weakened blood circulation in the foot. (Hile & Veves, 2003; Dinh & Veves, 2005).

Enhancing the blood flow in this are could be a crucial aspect of treating and preventing complications in diabetic feet. Enhanced circulation can be beneficial for a variety of issues, including the healing of foot ulcers, prevention of infections, reduction of swelling, improvement of skin health, reduction of amputation risks, pain relief, prevention of foot deformities, and improvement of overall foot functionality (source).

Temperature Biofeedback A long known way of raising blood circulation is trough the use of temperature biofeedback. In this technique the client uses his mind to control the blood flow of differeant areas by means of relaxation. A biofeedback device monitors this and gives feedback to the client regarding their success. The device itself is not doing anything, its merely a way of showing succes and allow the client to adjust strategies. While usually done on the finger, studies have shown that other areas of the body such as the foot can be controlled as well. (Khazan, 2013). 

Besides that biofeedback is in a way a kind of gamification and is known to boost compliance (Pinheiro, Figueiredo, Magalhães, & Santos, 2020; Pinheiro, Figueiredo, & Santos, 2022). 

Another huge benefit of the biofeedback training could be the feeling of control that biofeedback brings for the client which brings psychological benefits (Chen, 1995).

Methods and Apparatus

While incorporating temperature sensors into orthopedic soles involves challenges such as the stability of the sensors, a huge benefit of this approach is, that there are already insoles with sensors on the market. At the moment these mostly use pressure sensors to monitor sensible areas, but the fact that these technology already is in use makes it a prime candidate for the rather easy implementation of a temperature sensor and a lightweight app for training purposes. The company sendance GmbH already has proven that implementing both temperature and pressure sensors is possible.

Image 1 one shows a preliminary design for such an insole.

The insole incorporates a readout electronics, which will send the data to a smartphone device, where an app is providing the biofeedback. The feedback will be given in easy to understand ways (numbers or colors) and can be done while sitting.

Expected Outcomes

Clients able to warm their feet via temperature biofeedback, and attain better blood flow

enhanced blood circulation leading to less ulcers, amputation, pain skin health issues and increased sensation and psychological improvements due to the feeling of control via biofeedback (Park, Son, Kim, Kim, & Oh, 2011; Rosales-Velderrain, Padilla, Choe, & Hargens, 2013).

Challenges

One of the most crucial uncertainties is the aspect of how the present symptoms of the current diabetic feet will hinder the progress of the temperature biofeedback. The lack of feeling due to polyneuropathy could be a problem, if it makes controlling the blood flow at the feet harder. 

Another problem is, that while the implementation of the sensor in an existing device is comparably easy, there is still the challenge of finding one and developing the app.

Summary

This exposé emphasizes the need to explore and develop innovative treatment approaches that address both the physical and psychosocial aspects of diabetic foot problems. Blood circulation enhancement via temperature biofeedback could represent a significant advancement in treatment. The challenges in technological development and the necessity for further research are key factors that must be considered.

References:

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