Nov. 12, 2021 -- “Foot Selfies” may represent a simple solution to keeping tabs on patients who are at high risk for diabetic foot complications.

Patients with foot ulcers-- or who are at risk for them-- are told to check their feet regularly at home but doing so can be difficult for individuals who aren’t flexible or who have vision problems. Those who live alone may not be able to ask someone else to check their feet for them. Some use hand mirrors, but those can be difficult to manipulate and don’t offer feedback.

To address this problem, Mark Swerdlow, now a fourth-year medical student at the University of Southern California, Keck School of Medicine, Los Angeles, built a simple 3D-print device that allows patients to take standardized photos of the entire bottom surface of their own feet using a phone app with voice commands.

This “Foot Selfie System” eliminates the need for assistance and allows the images to be sent to a clinician.

Swerdlow gave a live demonstration of the device during the recent virtual meeting of the Diabetes Technology Society. Results from a feasibility study of 15 patients were also published online Oct. 31 in the Journal of Diabetes Science and Technology.

“The point of it is to be a very simple tool that essentially anybody can use,” Swerdlow says.

Meanwhile, when asked to comment, Jan S. Ulbrecht, MD, called it “a very good idea.”

But Ulbrecht noted that there are “many unanswered questions,” – for example, “will people be willing to spend money to buy this gadget?” He also questioned who, at the clinic, would look at what could turn out to be numerous images.

That said, “clearly there could be an artificial intelligence (AI) filter and patients could be taught to not rely on someone looking but rather report a concern [and] a human would [then] look at the pictures,” says Ulbrecht, who is Medical director of the Diabetes Foot Clinic at Mount Nittany Health System, State College, Pennsylvania.

Patients Used the Device and Liked It

The Foot Selfie System consists of a heel platform, a smartphone holder, and a base that connects the two via telescoping rods. The Foot Selfie smartphone app-- for iOS and Android-- directs users to take voice-activated photos, view them, and upload them to a protected storage server for review by health care providers. The app reminds patients to image their feet if they haven’t done so in the past 24 hours.

The device sits on the floor in front of the patient, who is seated. The patient opens the phone app to the “take photos” screen, then places the phone in the holder either before or after placing the device on the ground. The patient then places their heel onto the platform so that the entire underside of the foot is facing the phone. A voice command triggers the image capture. The app then audibly tells the patient to switch to the other foot for the next photo.

The patient then picks up the phone to view the photos, which can be enlarged, and any concerns flagged. When ready, the patient presses an upload button to send the image to their healthcare provider.

The study population was 10 males and 5 females, with average age of 57.4 years. All were American Diabetes Association Diabetic Foot Risk Category 3, which is defined as presence of diabetes with, for example, a previous history of ulcer or lower extremity amputation.

At the start of the study, three patients had five distinct active wounds, and nine had 13 distinct pre-ulcerative lesions.

Participants were instructed to image their feet daily and were followed for an average of 5 months. Instructing the patients to use the system took an average of 5 minutes per patient.

The investigators examined the images weekly during “Foot Selfie Rounds.” They identified seven new wounds and 26 new pre-ulcerative lesions, while also noting healing of seven wounds and reversal of 20 pre-ulcerative lesions.

Participants uploaded images on an average of 76% of eligible days, and all but one person imaged their feet on at least 50% of eligible days.

Of the five individuals hospitalized during the study, foot wound issues were the reason in only one patient.

In questionnaires, most participants reported that they would continue to image their feet daily, or every other day, outside of the study. On a scale of 1 to 10 for ease of use, they gave the device a median score of 10 (extremely easy). All answered “true” to the statement “the system is a useful tool in monitoring my feet.” And in response to “How useful does this system seem to you in helping to prevent foot ulcers?”, the median score rose from 8 at enrolment, to 9.5 at 6 months.

The proportion who said they preferred the Foot Selfie System over their previous methods of foot screening was 80% at one week and 90% at 6 months. And at all timepoints, all users said that they would recommend the system to someone else who was concerned about developing a foot wound.

Asked on a scale from 1 (not at all) to 10 (absolutely) if the benefits of using the system outweigh the disadvantages, the median score was 10 throughout the study.

The Foot Selfie System isn’t available commercially yet, but Swerdlow and colleagues are exploring ways to mass-produce the device and intend to conduct a larger study.

In the Meantime, just get Patients to take Pics of Their Feet

Meanwhile, clinic director and principal study investigator David G. Armstrong, , MD, says that patients at Keck’s Southwestern Academic Limb Salvage Alliance who were not part of the study and don’t have the device are encouraged to informally take photos of their feet with their phones at home - or have others do it for them - and send them in.

“Not a week goes by where we don’t spot a problem early and prevent a hospitalization,” he says.

Medscape Medical News

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