The Joy of Socks

The Joy of Socks

Foot care can be the Achilles’ heel of people with diabetes, says Dr. David Armstrong, a professor of surgery at the University of Arizona.

People with diabetes “over time will lose the gift of pain – they will develop neuropathy – and they can wear a hole in their foot just like you or I could wear a hole in a shoe or a sock,” says Dr. Armstrong.

The statistics on diabetes and foot issues are sobering. Up to 25% of people with diabetes will develop a foot ulcer in their lifetimes, and more than half of all foot ulcers will become infected. 20% of those infections result in amputation. Health officials badly want to reduce these numbers.

“Every 20 seconds a limb is lost due to diabetes, but all of these amputations could be prevented,” says Dr. Bijan Najafi, associate professor of surgery at the University of Arizona and director of the Interdisciplinary Consortium on Advanced Motion Performance (iCAMP). “We need to find a smart way to predict the risk of diabetic foot ulcer and help patients to take care of their own health.”

Traditionally, the best ways for people with diabetes to manage these problems has been to check their feet every day for wounds or sores, maintain a rigorous regimen of foot care, visit the podiatrist regularly, and wear specialized socks and shoes. Diabetic socks are generally designed to be form-fitting and seamless to eliminate any potential sources of irritation. They may have fibers with some antifungal or anti-microbial properties, but for the most part, their main purpose is to not make diabetic foot problems any worse.

But what if you could prevent these foot problems before they occur? Today there are new products available and others soon coming to market that have the potential to alter the landscape for people with diabetes who are working to take good care of their feet. Dr. Armstrong and Dr. Najafi work together at iCAMP, a subsidiary of the Southern Arizona Limb Salvage Alliance (SALSA), which has recently received several large grants to study smart sock technology and its potential to be useful to people with diabetes. The socks they are studying are made with fiber-optics which can sense changes in temperature, pressure, and joint angle, and then communicate that information via bluetooth or wi-fi to a user’s phone or to a medical caregiver’s computer. These 3 parameters (temperature, pressure, and joint angle) are indicators of the potential development of ulcers, and the socks are providing a new opportunity to provide more in-depth, real-time data about what is happening around the foot than has ever been available before. If successful, it’s likely to save millions in health care costs, since once an ulcer develops it can be very costly and difficult to manage.

“If we can find a change of temperature in the plantar area, we can alert patients and doctors to do preventive care before the breakdown of skin or ulcer is happening,” says Dr. Najafi.

Currently, Dr. Armstrong and Dr. Najafi are comparing data from these smart socks with information gathered on feet through observation, the old-fashioned way. The goal is to differentiate what data gathered by the smart socks is relevant for proper foot care and what data might be “noise” that could raise false alarms. Dr. Armstrong said the socks likely could hit the market within the next year or two.

Smart socks aren’t the only exciting newcomers to the world of diabetic footwear. A company called Cupron, Inc. has developed a way of embedding a copper-oxide compound in polyester fibers, and has created a line of socks called PRO Therapy System with the goal of preventing foot ulcers. According to Chris Andrews, President of Americas of Cupron, Inc., copper does two things: it kills fungus, bacteria, and viruses, and it stimulates the production of new skin cells, thus making skin more elastic.

Because diabetes compromises the immune system, people with diabetes are more vulnerable to common infections than those in the general population. According to some studies, people with diabetes are up to 5 times more likely to contract a fungal infection, and the consequences of those infections can be much more severe than would be typical.

“The first benefit is that, as recognized by the EPA, the sock will kill the cause of Athlete’s foot after twelve hours of contact with the sock,” Andrews says. “Effectively you’re creating a sanitized surface in contact with the skin.”

The sanitizing properties of the socks were why they were sent down a hole to a group of Chilean miners trapped for 68 days in 2010. While they haven’t been tested against all fungi, bacteria, and viruses, it is reasonable to expect that they would kill any present around the foot. Cupron Inc. hopes to gain FDA sanction to market the socks to take care of all common forms of foot fungi, bacteria, and viruses.

“If you’re able to kill fungi, you’re able to kill bacteria and viruses in a pretty straightforward manner. Fungi are probably the most difficult, as a rule,” Andrews says.

Wearing copper-infused socks also has a beneficial effect on skin elasticity, says Andrews. This is important because when skin is more elastic, it is better able to withstand the forces that feet regularly experience during everyday activities.

“If you can move from hard, brittle, static skin to softer, movable, more elastic skin, you’re lowering the risk of rupturing the skin and leading to skin ulcers,” he says.

Here’s how the socks work: The copper-oxide is uniformly distributed throughout the polyester fibers of the socks. When a person wears the sock and their foot sweats, even a little, the moisture causes the copper and the oxide to break apart, creating free copper ions. The ions are then transported by the moisture to the skin, where they are absorbed either by the skin or by any fungi that are present on the skin. This either kills the fungi or stimulates skin cells called fibroblasts, which are the parts of the skin that generate new skin cells. In an independent study, participants who wore the PRO Therapy socks for 4 weeks showed skin elasticity improvement by some 20% to 30%. Also, there’s no need to worry about the socks running out of copper-oxide; the process of wearing, and thereby wearing out, the sock continuously exposes more of it.

“The sock will fall apart before it stops functioning,” Andrews says.

While smart technology might advance diabetes foot care, experts in podiatry still stress the tried and true methods to prevent foot ulcers. Dr. Armstrong, for example, believes that seeing a podiatrist is even more important than taking advantage of the new developments in smart technology. According to him, being under the care of a podiatrist reduces a patient’s risk of complications (including amputation) by some 20% to more than 60% over a 6-year period. Following a podiatrist’s recommendations may make all the difference.

But as new options for better foot care become available on the market, it might be necessary for patients to recommend new treatments to podiatrists. According to Dr. Armstrong, many foot doctors may not have heard of these advances and may first react with skepticism, but the world of diabetes foot care is on the cusp of real change.

“The kind of things that are going to be available are going to happen sooner than many people in medicine will be able to track. So being your own advocate is probably the surest way to help yourself,” he says.

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