E-Knitted Textile with Polymer Optical Fibers for Friction and Pressure Monitoring in Socks

In-shoe plantar pressure measurement technologies for the diabetic foot: A systematic review

Introduction

Loss of cutaneous protective sensation and high plantar pressures increase the risk for diabetic foot patients. Trauma and ulceration are imminent threats, making assessment and monitoring essential. This systematic review aims to identify systems and technologies for measuring in-shoe plantar pressures, focusing on the at-risk diabetic foot population.

Methods

A systematic search was conducted across four electronic databases (Scopus, Web of Science, PubMed, Oxford Journals) using PRISMA methodology, covering articles published in English from 1979 to 2024. Only studies addressing systems or sensors exclusively measuring plantar pressures inside the shoe were included.

Results

A total of 87 studies using commercially available devices and 45 articles proposing new systems or sensors were reviewed. The prevailing market offerings consist mainly of instrumented insoles. Emerging technologies under development often feature configurations with four, six or eight resistive sensors strategically placed within removable insoles. Despite some variability due to the inherent heterogeneity of human gait, these devices assess plantar pressure, although they present significant differences between them in measurement results. Individuals with diabetic foot conditions appears exhibit elevated plantar pressures, with reported peak pressures reaching approximately 1000 kPa. The results also showed significant differences between the diabetic and non-diabetic groups.

Conclusion

Instrumented insoles, particularly those incorporating resistive sensor technology, dominate the field. Systems employing eight sensors at critical locations represent a pragmatic approach, although market options extend to systems with up to 960 sensors. Differences between devices can be a critical factor in measurement and highlights the importance of individualized patient assessment using consistent measurement devices.

Thermoregulation in Two Models of Trail Run Socks with Different Fabric Separation

BACKGROUND

Trail running socks with the same fibers and design but with different separations of their three-dimensional waves could have different thermoregulatory effects. Therefore, the objective of this study was to evaluate the temperatures reflected on the sole of the foot after a mountain race with the use of two models of socks with different wave separations.

MATERIAL AND METHODS

In a sample of 34 subjects (twenty-seven men and seven women), the plantar temperature was analyzed with the thermal imaging camera Flir E60bx® (Flir systems, Wilsonville, OR, USA) before and after running 14 km in mountainous terrain at a hot temperature of 27 °C. Each group of 17 runners ran with a different model of separation between the waves of the tissue (2 mm versus 1 mm). After conducting the post-exercise thermographic analysis, a Likert-type survey was conducted to evaluate the physiological characteristics of both types of socks.

RESULTS

There was a significant increase in temperature in all areas of interest (p < 0.001) after a 14 km running distance with the two models of socks. The hallux zone increased in temperature the most after the race, with temperatures of 8.19 ± 3.1 °C and 7.46 ± 2.1 °C for the AWC 2.2 and AWC 3, respectively. However, no significant differences in temperature increases were found in any of the areas analyzed between the two groups. Runners perceived significant differences in thermal sensation between AWC 2.2 socks with 4.41 ± 0.62 points and AWC 3 with 3.76 ± 1.03 points (p = 0.034).

CONCLUSION

Both models had a similar thermoregulatory effect on the soles of the feet, so they can be used interchangeably in short-distance mountain races. The perceived sensation of increased thermal comfort does not correspond to the temperature data.

Wearable Pressure Sensors for Pulse Wave Monitoring

Cardiovascular diseases remain the leading cause of death worldwide. The rapid development of flexible sensing technologies and wearable pressure sensors have attracted keen research interest and have been widely used for long-term and real-time cardiovascular status monitoring. Owing to compelling characteristics, including light weight, wearing comfort, and high sensitivity to pulse pressures, physiological pulse waveforms can be precisely and continuously monitored by flexible pressure sensors for wearable health monitoring. Herein, an overview of wearable pressure sensors for human pulse wave monitoring is presented, with a focus on the transduction mechanism, microengineering structures, and related applications in pulse wave monitoring and cardiovascular condition assessment. The conceptualizations and methods for the acquisition of physiological and pathological information related to the cardiovascular system are outlined. The biomechanics of arterial pulse waves and the working mechanism of various wearable pressure sensors, including triboelectric, piezoelectric, magnetoelastic, piezoresistive, capacitive, and optical sensors, are also subject to systematic debate. Exemple applications of pulse wave measurement based on microengineering structured devices are then summarized. Finally, a discussion of the opportunities and challenges that wearable pressure sensors face, as well as their potential as a wearable intelligent system for personalized healthcare is given in conclusion.

The effect of frictional coefficients and sock material on plantar surface shear stress measurement

At present, there are no viable systems that can acquire in-shoe measurement of distributed shear forces. Foot-shoe interactions are such that skin shear is a notoriously difficult quantity to measure under the best of conditions. This is further complicated by the presence of forces normal to the skin surface that are large compared to the shear forces, which often results in crosstalk between pressure and shear signals. The present study used multibody dynamic simulations to investigate the combined effects of (i) coefficient of friction (COF) at skin-sock and sock-sensor interfaces, as well as (ii) sock stiffness on the accuracy of measured shear against the skin. These factors were systematically altered within a wide range (COF: 0.04, 0.34, 0.54, and 0.9; sock stiffness: 100, 250, 500, 1000, 1500 and 2000 N/m) to simulate a total of 96 scenarios. The correlation between the shear at the skin and at the sensor was used to compare each set of conditions. The results indicated that a high COF at the sock-sensor interface and a low sock stiffness would individually result in a significantly higher accuracy of shear measurements (p < 0.001). A low COF at the skin-sock interface was observed to reduce the occurred shear against the skin up to a factor of five, with very minimal effect on the accuracy of shear measurements (p = 0.98). These findings allow researchers to understand the potential effects of (i) sock stiffness, and (ii) coefficients of friction, on skin shear, and potentially correct for the effects of interface materials when trying to determine shear at the skin-sock interface.

Performance Evaluation of Knitted and Stitched Textile Strain Sensors

By embedding conductive yarns in, or onto, knitted textile fabrics, simple but robust stretch sensor garments can be manufactured. In that way resistance based sensors can be fully integrated in textiles without compromising wearing comfort, stretchiness, washability, and ease of use in daily life. The many studies on such textile strain sensors that have been published in recent years show that these sensors work in principle, but closer inspection reveals that many of them still have severe practical limitations like a too narrow working range, lack of sensitivity, and undesired time-dependent and hysteresis effects. For those that intend to use this technology it is difficult to determine which manufacturing parameters, shape, stitch type, and materials to apply to realize a functional sensor for a given application. This paper therefore aims to serve as a guideline for the fashion designers, electronic engineers, textile researchers, movement scientists, and human–computer interaction specialists planning to create stretch sensor garments. The paper is limited to textile based sensors that can be constructed using commercially available conductive yarns and existing knitting and embroidery equipment. Within this subtopic, relevant literature is discussed, and a detailed quantitative comparison is provided focusing on sensor characteristics like the gauge factor, working range, and hysteresis.

Relationship between Plantar Pressure and Sensory Disturbance in Patients with Hansen's Disease-Preliminary Research and Review of the Literature

Orthoses and insoles are among the primary treatments and prevention methods of refractory plantar ulcers in patients with Hansen’s disease. While dynamic plantar pressure and tactile sensory disturbance are the critical pathological factors, few studies have investigated whether a relationship exists between these two factors. In this study, dynamic pressure measured using F-scan system and tactile sensory threshold evaluated with monofilament testing were determined for 12 areas of 20 feet in patients with chronic Hansen’s disease. The correlation between these two factors was calculated for each foot, for each clinical category of the foot (0–IV) and across all feet. A significant correlation was found between dynamic pressure and tactile sensation in Category II feet (n = 8, p = 0.016, r² = 0.246, Spearman’s rank test). In contrast, no significant correlation was detected for the entire foot or within the subgroups for the remainder of the clinical categories. However, the clinical manifestation of lesion areas showed high variability: (1) pressure concentrated, sensation lost; (2) margin of pressure concentration, sensation lost; (3) pressure concentrated, sensation severely disturbed but not lost; and (4) tip of the toe. These results may indicate that, even though there was a weak relationship between dynamic pressure and tactile sensation, it is important to assess both, in addition to the basics of orthotic treatment in patients with Hansen’s disease presenting with refractory plantar ulceration.

Textile-integrated polymer optical fibers for healthcare and medical applications

With ever growing interest in far-reaching solutions for pervasive healthcare and medicine, polymer optical fibers have been rendered into textile forms. Having both fiber-optic functionalities and traditional fabric-like comfort, textile-integrated polymer optical fibers have been advocated to remove the technical barriers for long-term uninterrupted health monitoring and treatment. In this context, this paper spotlights and reviews the recently developed textile-integrated polymer optical fibers in conjunction with fabrication techniques, applications in long-term continuous health monitoring and treatment, and future perspectives in the vision of mobile health (mHealth), as well as the introductory basics of polymer optical fibers. It is designed to serve as a topical guidepost for scientists and engineers on this highly interdisciplinary and rapidly growing topic.

Smart Socks and In-Shoe Systems: State-of-the-Art for Two Popular Technologies for Foot Motion Analysis, Sports, and Medical Applications

The present paper reviews, for the first time, to the best of our knowledge, the most recent advances in research concerning two popular devices used for foot motion analysis and health monitoring: smart socks and in-shoe systems. The first one is representative of textile-based systems, whereas the second one is one of the most used pressure sensitive insole (PSI) systems that is used as an alternative to smart socks. The proposed methods are reviewed for smart sock use in special medical applications, for gait and foot pressure analysis. The Pedar system is also shown, together with studies of validation and repeatability for Pedar and other in-shoe systems. Then, the applications of Pedar are presented, mainly in medicine and sports. Our purpose was to offer the researchers in this field a useful means to overview and select relevant information. Moreover, our review can be a starting point for new, relevant research towards improving the design and functionality of the systems, as well as extending the research towards other areas of applications using sensors in smart textiles and in-shoe systems.