The diabetic foot research

Background in DF thermography- In DF disease, the early diagnosis is one of the key issue. Once DF is detected, the patient can benefit of dedicated treatments which are associated to DF education, regular foot care, and therapeutic foot insole. However, the incidence of serious complications, i.e. the occurrence of an ulcer and associates lower limb amputations, could further be reduced according to diabetes experts. Among all possible features, temperature is an important characteristic. The STANDUP project intends to go further by offering simple and efficient tools for the evaluation of the thermal parameters in DF. There is a relationship between increased temperature and foot complications in diabetes: increased temperature may be present up to a week before a foot ulcer occurs [ARM-07]. Temperature of the corresponding area of the right and left foot do not usually differs more than 1°C in diabetic foot. A temperature difference greater than 2.2°C is considered as abnormal and is called hyperthermia. Detecting hyperthermia in the plantar foot surface for high risk patients at home and providing adequate therapy reduces the incidence of foot ulcer by 3 times [ARM-07]. This main result tackles the industry since the commercial potential of such a system is tremendous. Various technologies have been developed to measure plantar foot temperature in various situations and to detect hyperthermia [ROB-09]. New products are under active development.

None of the above systems is efficient, nor friendly and easy to use. Others are not yet available. In the recent past years, the price of traditional infrared camera has been dramatically reduced while their technical capacities has been significantly increased. Such technologies are serious candidates for detecting thermal changes in diabetic foot disorders [ROB-10]. The main advantages of thermography are that it is simple to use, non-invasive, painless, contactless, non-irradiating, and fast. In 2015, the Flir Company has proposed a new thermal camera (FlirOne) to plug in a smartphone [FLI-16]. Both a thermal image and a color image can be taken at the same time and at the same spatial position. The cost of the FlirOne camera is very low, 280 EUR today (2017). It is very likely that the device will be cheaper in the next years. This smartphone based system opens the possibility to assess DF thermal status in a mobile, instantaneous, friendly, efficient and cheap way and to exchange the results through communication channels.

The STANDUP project has been developed based on the following facts:

a) The new potential of thermal information in the domain of DF in a friendly and efficient way with a smartphone;

b) The recent tremendous technological developments of smartphones and of thermal camera for smartphones;

c) The strong interdisciplinary knowledge of our group regarding DF;

d) Technologies that we have developed in our group regarding DF (see WP1, WP2, WP3 and WP4 where this aspect is presented with more details);T

e) The strong market and therefore commercial potential for a new system for DF thermal analysis;

f) The market knowledge of our group;

g) the potential of STANDUP results to be applied in other medical domains as for example the early breast cancer detection using thermography [USU-98].

Based on the above facts, we intend to develop, test in clinical situation, improve and disseminate to the market in a very near future a smartphone based system to assess hyperthermia in DF, to develop a system to contribute to the early diagnosis of DF, to follow in an efficient way DF ulcer during treatment, and to improve the conception of foot insole and the choice of personalized foot pad using thermal information. The specific objectives of the STANDUP project are defined in the differents workpackages accessible here:

Work packages