Biofeedback strategy and reduction of foot pressure in diabetic patient with neuropathy: Benefit of connected insoles FEETME: A preliminary study

Abstract

Plantar pressure reduction is mandatory to prevent foot ulceration in patients with diabetic peripheral neuropathy. Biofeedback strategy is a promising approach to reduce pressure at-risk zone and to lastingly train patient in this specific task. FeetMe One is a novel connected in-shoe device measuring plantar pressure and gait parameters. The objective was to evaluate the biofeedback method to reduce the plantar pressure at-risk zone as a clinical routine and monitored by FEETME insoles. The impact of the new walking was quantitatively analyzed by the plantar pressure map provided by these insoles. Wireless pressure-sensitive insoles (FeetMe One) calculate plantar pressure map and multiple gait patterns. We included 11 patients. In the first part, subjects walked without instruction to collect baseline trial (approximately 20 steps). After the at-risk zone identification, all subjects trained to reduce the max peak pressure on the basis of pressure map analysis. The patient was considered to have learned a new walking strategy as soon as the peak plantar pressure under the previously defined at-risk zone was within a range of 40–80% of baseline plantar pressure in 70% of the totality of steps and during three consecutive walking sequences. The retention tests were immediately performed after the learning and after 2 and 6 weeks to determine if motor pattern changes could occur over a long period. After the learning session, 8 patients succeeded in training a new walking strategy (9 fore foot and 2 heel). The max pressure threshold was lower than 80% for these patients. Five patients over 6 (2 lost in follow-up) persisted over 2 weeks to walk without plantar pressure overloaded in any specific area. The retention test after 6 weeks showed that the foot off-loading was still reduced without inducing a new at-risk zone. However, only 50% of steps were lower than the max pressure threshold for all patients. This study should be performed for a larger number of patients and a longer retention but these preliminary results are encouraging.