For Chris Aldred in England, it all began with a blister. He was 20 years into his type 1 diagnosis, and had experienced nerve damage in his feet for a number of years prior, but nothing life-impacting so far. Chris looked over the blister briefly and it soon healed over. What he didn't realize was that an infection underneath was developing into an ulcer.
Even after a podiatrist's treatment with antibiotics helped treat the ulcer initially, the infection worsened and spread into the bone -- to the point where oral medications weren't working. Chris was forced to self administer intravenous (IV) antibiotics via a needle in the skin for 15 whole weeks, after which all seemed OK.
But then, six months later, Chris noticed his foot was red and swollen. Another ulcer, he wondered? Yes, it was. That meant another round of IV treatments. After a full 54 weeks (more than a year!) of that and a long stint wearing a protective boot, the issues finally seemed resolved. But the risk remains. So Chris now walks with insoles designed specifically for his shoes to reduce the risk of injury and infection.
Chris has shared details of his foot complications at his blog The Grumpy Pumper, but his story unfortunately isn't unique; foot-related issues are one of the most commonly experienced diabetes complications out there.
At this time of year, the American Diabetes Association (ADA) is prepping for its huge annual Scientific Sessions conference, which will include a slew of sessions focused on the latest research around foot complications -- at least a dozen on this topic alone.
While those clinically-focused sessions are important, Chris wishes the ADA would include more perspective from people actually living with diabetic foot issues.
"They could do with having PWD (person with diabetes) who’s lived it up there on stage," says this advocate who has attended the conference in the past and even done on-site reporting for the pharma company Ascensia.
"Explaining what it’s really like is so important... How these problems occur not because we didn’t look after ourselves or neglect our diabetes, which is too often the message. Practical real-life tips on foot checks -- that's what we need."
"Time in Range" for Diabetes-Related Foot Stress?
One of the most interesting new studies that will be showcased at the ADA conference is outlined in an article recently published in the Journal of Diabetes Science and Technology (May 2019 edition), titled: "Measuring Plantar Tissue Stress in People with Diabetic Peripheral Neuropathy: A Critical Concept in Diabetic Foot Management.”
An international team of researchers examined the concept of Plantar Tissue Stress (PTS) as a major cause of diabetes-related foot wounds, ulcers in particular. PTS is a new concept that integrates several well-known foot damage factors into one measure, including plantar pressure, shear stress, daily weight-bearing activity, and time spent in prescribed offloading interventions (meaning how well patients follow doctors orders to take pressure off their feet).
The article notes that "only recently has technology enabled their combined measurement" to give physicians a sort of aggregate measure of the factors causing foot-related stress that leads to ulcers.
The article reports on initial uses of PTS measures with patients, and concludes by calling for new care guidelines and standards for measuring and reporting PTS in people with neuropathy.
The authors also suggest new methods to prevent diabetes foot complications. One of those is a new pressure-sensing "smart insole" that would continuously monitor Plantar Tissue Stress during everyday activities and provide real-time alerts to patients via smartwatches to reduce their PTS. This technology from Canadian company SurroSense Rx is currently in clinical trials.
Think of it like the "Time in Range" measure that continuous glucose monitors can provide, but for diabetes-related foot stress.
Fascinating foot stuff, indeed!
A SmartMat for Detecting Diabetes Foot Problems
There's also a plethora of other companies developing new tech and treatments for diabetes-related foot complications like ulcers. It's big business. As one of the most devastating and costliest diabetes-related complications, data suggests that as many as one of every three dollars spent on diabetes is linked to lower extremity complications.
That's according to Dr. Jon Bloom, CEO and co-founder of the company Podimetrics in Massachusetts that's focused on the diabetes foot ulcer space -- especially for veterans (where one of every four has diabetes and 80% of amputations are related to a diabetes foot ulcer). They're developing tech to remotely catch early signs of diabetic foot ulcers, often five weeks or before they would present in clinics.
The Podimetrics product is a cellular-connected SmartMat that patients place their feet on for just 20 seconds a day. The scanned data is beamed to the Podimetrics care team to review for damage and potential diagnosing of detected issues. The company can then provide preventative treatments under the direction of their clinical team.
Podimetrics was founded in 2011 and snagged FDA clearance for its SmartMat product in 2015. It's been advancing and expanding slowly over the years. Now with technology advancement at a new high, recent headlines show the company has raised $13.4 million to help expand even more into the Veterans Affairs (VA) segment.
While these new tools are important, PWD advocate Chris again points to the simple and practical things patients need to know: it comes down to conscientious foot care and regular checkups.
"Things happen, but you need to know what you are looking for when doing foot checks -- changes to the shape of feet and not just cracks in skin," Chris says, looking back. "Know your pathway to care and get fast action, and if you get an infection, hit it hard and fast."