Digital Health: 'Socksess' - Smart Sensing Socks For Monitoring Diabetic Feet And Preventing Ulceration
Lead Research Organisation:
Manchester Metropolitan University
Department Name: Musculoskeletal Sci & Sports Med Res Ctr
Abstract
Background: Diabetes damages nerves in the feet, known as 'neuropathy', affecting 1 in every 2 people with diabetes. This can cause people to lose all sensation and feeling in their feet and means that people with diabetes and neuropathy put high pressure on their feet without knowing. With nerves that are damaged, people do not have any natural way of knowing how much high pressure they put on their feet and can literally wear a hole in the bottom of their foot, known as a diabetic foot ulcer. Although it can start off as a small hole in the foot, a diabetic foot ulcer can become infected and someone may need to have part of their foot or leg removed (amputated) to stop the infection and save their life. In the UK, there are over 120 amputations every week because of a diabetic foot ulcer.
Our Aim: The 'Socksess' project aims to create new technology to help make people with diabetes aware of how much pressure they put on their feet and prevent ulcers. We will develop and test a new 'smart-sensing sock' that will 'reconnect people with their feet' and help prevent ulcers and amputations.
Our approach: We will do this through 'co-design' - working closely with people who have experience of living with diabetes, their families and healthcare professionals, to develop the technology, make design choices and publicise the work. We will also be supported by a panel of international experts in diabetic foot care and industry partners who will help guide long-term development, clinical evaluation and commercialisation.
Planned Work: the project involves four main areas of work:
1. Understanding the needs and preferences of people with diabetes, their carers and clinicians, to co-design a smart-sensing sock that will suit the lives of people with diabetes and help them to protect their feet.
2. Developing and testing small sensors built into stretchable sock fabric for measuring foot loading in two ways: i) directly against the foot (pressure) and ii) side-to-side (shear stress).
3. Testing prototypes of the smart-sensing socks in a group of people with diabetes who are at high-risk for getting an ulcer, and using this new technology to better understand how foot loading affects ulcer risk at specific points on the foot.
4. Developing an easy to use feedback system: a way of letting people know when the loading on their feet might be too high and begin to cause a foot ulcer. This will be co-designed (as in 1 above) to make it as easy as possible for everyone to use.
Working towards this goal, we will develop a number of advances:
- new sensing technology for measuring pressure and shear stress (side-to-side foot loading)
- integration of sensing into a 'smart-sock' measuring across the whole foot
- new data from our clinical studies providing better understanding of foot loading in diabetes
- Easy to use feedback system designed to 'reconnect people with their feet' and help them better monitor their foot health
Impact: This project will help address the global issue of diabetic foot ulcers and amputations that affect the lives of millions of people living with diabetes by developing a much-needed digital health monitoring solution. Through its ease of use, this technology will help to support a range of people with diabetes to better manage their foot health and 'reconnect with their feet', improving quality of life and preventing diabetic foot ulcers and amputations. The work will also bring benefits beyond use in diabetic foot health. It could also be used to assess and help manage conditions affecting mobility (e.g. arthritis) by monitoring and providing feedback on walking and balance. The technology could also help prevent bed sores on the feet and backs of the legs when people are lying in hospital beds for long periods of time. These smart-sensing socks could also help with better fitting of new footwear.
Our Aim: The 'Socksess' project aims to create new technology to help make people with diabetes aware of how much pressure they put on their feet and prevent ulcers. We will develop and test a new 'smart-sensing sock' that will 'reconnect people with their feet' and help prevent ulcers and amputations.
Our approach: We will do this through 'co-design' - working closely with people who have experience of living with diabetes, their families and healthcare professionals, to develop the technology, make design choices and publicise the work. We will also be supported by a panel of international experts in diabetic foot care and industry partners who will help guide long-term development, clinical evaluation and commercialisation.
Planned Work: the project involves four main areas of work:
1. Understanding the needs and preferences of people with diabetes, their carers and clinicians, to co-design a smart-sensing sock that will suit the lives of people with diabetes and help them to protect their feet.
2. Developing and testing small sensors built into stretchable sock fabric for measuring foot loading in two ways: i) directly against the foot (pressure) and ii) side-to-side (shear stress).
3. Testing prototypes of the smart-sensing socks in a group of people with diabetes who are at high-risk for getting an ulcer, and using this new technology to better understand how foot loading affects ulcer risk at specific points on the foot.
4. Developing an easy to use feedback system: a way of letting people know when the loading on their feet might be too high and begin to cause a foot ulcer. This will be co-designed (as in 1 above) to make it as easy as possible for everyone to use.
Working towards this goal, we will develop a number of advances:
- new sensing technology for measuring pressure and shear stress (side-to-side foot loading)
- integration of sensing into a 'smart-sock' measuring across the whole foot
- new data from our clinical studies providing better understanding of foot loading in diabetes
- Easy to use feedback system designed to 'reconnect people with their feet' and help them better monitor their foot health
Impact: This project will help address the global issue of diabetic foot ulcers and amputations that affect the lives of millions of people living with diabetes by developing a much-needed digital health monitoring solution. Through its ease of use, this technology will help to support a range of people with diabetes to better manage their foot health and 'reconnect with their feet', improving quality of life and preventing diabetic foot ulcers and amputations. The work will also bring benefits beyond use in diabetic foot health. It could also be used to assess and help manage conditions affecting mobility (e.g. arthritis) by monitoring and providing feedback on walking and balance. The technology could also help prevent bed sores on the feet and backs of the legs when people are lying in hospital beds for long periods of time. These smart-sensing socks could also help with better fitting of new footwear.
Publications
Corser J
(2025)
Developing a Smart Sensing Sock to Prevent Diabetic Foot Ulcers: Qualitative Focus Group and Interview Study.
in Journal of participatory medicine
Corser J
(2025)
Developing a Smart Sensing Sock to Prevent Diabetic Foot Ulcers: Qualitative Focus Group and Interview Study
in Journal of Participatory Medicine
Related Projects
| Project Reference | Relationship | Related To | Start | End | Award Value |
|---|---|---|---|---|---|
| EP/X001059/1 | 01/11/2022 | 15/06/2024 | £442,234 | ||
| EP/X001059/2 | Transfer | EP/X001059/1 | 16/06/2024 | 31/10/2025 | £78,686 |
| Description | Patient and public involvement and engagement (PPIE) and clinical practitioner workshops have been invaluable in developing a detailed understanding of the needs and preferences of the main stakeholders related to the 'smart sock' technology. This has helped with defining key aspects of the sensing technology, for example geometry (ensuring systems are flat, embedded within textiles), connectivity (enabling reliable interaction with a device for data collection), robustness (compatibility with washing, changes in humidity, temperature) and coverage (providing opportunity for measurement of plantar and dorsal foot surfaces). The qualitative research with patients and healthcare providers supporting development of key features of the smart sensing sock has been published in the Journal of Participatory Medicine (Corser et al., 2025). This is expected to have wider implications and impact for user-centred approaches for smart device design more broadly. Exploration of technological solutions for the health technology ('smart sensing socks) to satisfy needs and requirements has evaluated and mapped a range of potential approaches. We identified a sensor fabrication methodology that meets these needs while also being suited to future scale-up and integration with the complex knitted structures necessary to provide appropriate support and comfort for people at risk of diabetic foot ulcer. We have now published a unique open source raw dataset to characterise the development of the unique textile-based strain sensor. This work is currently under review for publication with the journal 'Sensors'. We have developed a production facility in the Manchester Metropolitan University for fabricating our own custom-designed socks using an industry-grade socks knitting machine. The equipment has an integral toe-closure facility which enables to close the toe part seamlessly which offers superior comfort in the toe region. To date we have investigated various commercially available socks and explored the sock material composition, knit structure, sock designs, yarn type and fibre composition. This enables optimisation of socks design for performance and incorporating the sensing element within the sock. The development process has been guided by stakeholder input, qualitative research, and garment design factors. We have developed socks with embroidered conductive yarns for connecting with the flexible resistance-based strain sensors. Following extensive development work, we have refined to a shortlist of three different types of socks. We are currently testing these sock designs for their performance with the flexible resistance-based strain sensors. As part of the socks knitting development work, we have undertaken an extensive review of current 'diabetic socks'. This has involved a systematic review of relevant scientific literature as well as a review and analysis of commercially available 'diabetic socks'. The systematic review and garment analysis is currently ongoing and a publication on this is in development. This review will make recommendations and suggestions for diabetic socks which will inform stakeholders in their practice. |
| Exploitation Route | As a follow-on from this project, we have developed the 'STOP-DFU' project and submitted an application to the cross UKRI call; Title - STOP-DFU: Sensing Technologyfor Objective Prevention ofDiabetic Foot Ulcers. Several aspects of the outcomes from this project will support the wider research and development ecosystem. For example, the Health behaviour framework that we have developed as part of this project will support other researchers working to develop health technologies across a range of areas. We are working towards generation of a British 'standard' for diabetic socks. We are currently exploring further funding mechanisms to take this project forwards including exploring commercial routes to market for various aspects of the project outputs including the novel textile-based strain sensor and textile sock development. |
| Sectors | Digital/Communication/Information Technologies (including Software) Education Healthcare Leisure Activities including Sports Recreation and Tourism |
| URL | https://www.preprints.org/manuscript/202502.1321/v1 |
| Description | The impact from this research is building as it continues to emerge and the project is still in progress. The intermediate outcomes of the project are contributing to a systematic review (just being submitted) on diabetic socks fabricated structure, fibre composition and clinical effectiveness. The wider body of research as part of this project together with the systematic review will contribute to a high-level position statement on diabetic socks and the role of technology. We have generated a dataset associated with the development of a novel silver adheisive textile-based strain sensor. The data contains the output of parametric testing covering the number of turns, sensor length and cure temperature of the strain gauge design, collected through quasi-static testing. The second set of data assess a series of robustness improvement made to the sensor, collected through quasi-static testing and some cyclic loading. The final set of data was used to assess sensor performance. Release of this dataset allows for wider academic and industry benefit and impact. This dataset has only just been released, but we expect to see impact emerging from this over the coming period. Our health behaviour and qualitative research has just been published with specific recommendations on patient and provider input to the development of the smart sensing sock. This research is expected to have wider impact and implications for smart health devices more broadly and we anticipate impact arising from this over the ensuing period. |
| First Year Of Impact | 2023 |
| Sector | Digital/Communication/Information Technologies (including Software),Healthcare,Leisure Activities, including Sports, Recreation and Tourism,Pharmaceuticals and Medical Biotechnology |
| Impact Types | Societal |
| Description | Parliamentary meeting AI and Healthcare Technology |
| Geographic Reach | National |
| Policy Influence Type | Contribution to a national consultation/review |
| Description | UK Parliamentary contribution - Wearable Technologies |
| Geographic Reach | National |
| Policy Influence Type | Contribution to a national consultation/review |
| URL | https://post.parliament.uk/approved-work-wearable-technologies-health-opportunities-and-challenges/?... |
| Title | Conductive fibre textile approach |
| Description | We have developed a method for electrical conductance of signals within a garment sock structure. |
| Type Of Material | Technology assay or reagent |
| Year Produced | 2023 |
| Provided To Others? | No |
| Impact | This innovative approach is allowing us to connect textile-based strain sensors to hard electronics at a distant location. This approach enables the measurement of textile-based strain sensing in a garment sock structure. |
| Title | Development of a Body-Worn Textile-Based Strain Sensor |
| Description | This dataset contain the raw data associated with the development of a silver adheisive based strain sensor. The data contains the output of parametric testing covering the number of turns, sensor length and cure temperature of the strain gauge design, collected through quasi-static testing. The second set out data assess a series of robustness improvement made to the sensor, collected through quasi-static testing and some cyclic loading. The final set of data was used to assess sensor performance. The data takes the form of text files collected from the proposed sensor and csv files from the instron used to conduct testing. |
| Type Of Material | Technology assay or reagent |
| Year Produced | 2025 |
| Provided To Others? | Yes |
| Impact | Wider academic and industry beneficiaries from this project. Development of further collaboration. |
| URL | https://archive.researchdata.leeds.ac.uk/1379/ |
| Title | Diabetic Sock Standards |
| Description | As part of the work for the Socksess project, we have developed tools and methods that will contribute towards the definition of a garment standard for a diabetic sock. |
| Type Of Material | Technology assay or reagent |
| Year Produced | 2025 |
| Provided To Others? | No |
| Impact | We are developing a consensus process to establish garment technology standards for a diabetic sock. We will work with the British Standards Institute (BSI) to define and establish this standard. |
| Title | Flexible resistance-based strain sensors |
| Description | A new method has been developed as part of the EPSRC 'Socksess' project for computer-controlled fabrication of flexible resistance-based strain sensors onto textiles. This method employs a computer-controlled 3D positioning system combined with a pressure-controlled extruder to allow precise deposition of conductive and flexible polymers onto textiles. This has been used to produce flexible strain-sensors based on the principle of using a change in sensor resistance during strain. The work is currently being developed into a publication. |
| Type Of Material | Technology assay or reagent |
| Year Produced | 2024 |
| Provided To Others? | No |
| Impact | This new method will underpin the development of the health technology as part of this EPSRC 'Socksess' project. The new method may also have wider implications for other health technologies. |
| Title | Guiding principles - Health behaviour considerations in adoption of health technology. |
| Description | From in-depth analysis of our qualitative health behaviour data, we have curated a set of Guiding Principles for health behaviour considerations in adoption of health technology using the Person Based Approach. These guiding principles will inform the design and development of the smart sensing socks in the EPSRC 'Socksess' project. |
| Type Of Material | Technology assay or reagent |
| Year Produced | 2024 |
| Provided To Others? | No |
| Impact | These guiding principles will inform the design and development of the smart sensing socks in the EPSRC 'Socksess' project. This set of guiding principles will also apply more broadly to help inform the design and development of other health technology interventions. |
| Title | New knitted sock structure. |
| Description | As part of the 'Socksess' project we have developed new methods for fabricating the knitted sock structure and embedding conductive fibres within the sock structure to enable measurement of strain. |
| Type Of Material | Technology assay or reagent |
| Year Produced | 2024 |
| Provided To Others? | No |
| Impact | This new method/research tool will underpin the development of the health technology as part of this EPSRC 'Socksess' project. |
| Title | Flexible strain sensor database |
| Description | New datasets have been acquired which characterise our flexible strain sensors produced as part of the 'Socksess' project and provide a resource for wider translation of this work into areas including soft robotics and biomedical applications. This dataset is informing the development of the smart sensing socks as we progress towards human testing within this current project. |
| Type Of Material | Database/Collection of data |
| Year Produced | 2024 |
| Provided To Others? | No |
| Impact | This dataset is informing the development of the smart sensing sock technology as part of the 'Socksess' project. These data will inform the final design of the sock technology used as part of our proof-of-concept human gait analysis testing within this current EPSRC project. |
| Title | Qualitative health behaviour dataset |
| Description | We have finalised qualitative data collection as part of our health behaviour work package, completing 22 semi-structured interviews with patients and carers, and focus groups with healthcare professionals including six registered podiatrists working with diabetes patients. |
| Type Of Material | Database/Collection of data |
| Year Produced | 2024 |
| Provided To Others? | No |
| Impact | The analysis from this dataset is informing the design and development of the smart sensing socks in the 'Socksess' project. The outputs from this dataset could also apply more broadly to help inform the design and development for other health technology interventions. |
| Description | Clinical Practitioner Engagement |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Professional Practitioners |
| Results and Impact | Multiple events have been held to engage with clinical practitioners working in the field of diabetes. These practitioner events were designed to understand the views of healthcare professionals on the utility and value of this health technology. The outcomes from these practitioner events have shaped the design and development of the smart sensing socks. |
| Year(s) Of Engagement Activity | 2023,2024 |
| Description | Digital Health Policy Event |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Industry/Business |
| Results and Impact | Digital Health Policy event organised by EPSRC. Presentation of project findings and engagement with colleagues from industry, academia and other sectors about research innovations arising from the Socksess project. |
| Year(s) Of Engagement Activity | 2024 |
| Description | Lord Clement-Jones |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Policymakers/politicians |
| Results and Impact | Meeting with Lord Clement-Jones about digital healthcare technologies and AI. The current EPSRC Socksess project was discussed and its implications considered for the UK healthcare sector. |
| Year(s) Of Engagement Activity | 2025 |
| Description | PPIE Activities |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Patients, carers and/or patient groups |
| Results and Impact | Multiple Public and Patient Involvement and Engagement (PPIE) events have been held with people living with diabetes, family members and their carers. These PPIE events were designed to understand the needs and preferences of the end users of this health technology. The outcomes from these PPIE events have informed the design and development of the smart sensing socks. |
| Year(s) Of Engagement Activity | 2023,2024 |
| Description | Parliamentary meeting |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Policymakers/politicians |
| Results and Impact | Parliamentary trust meeting in the House of Commons on AI and Healthcare. This meeting was chaired by the Shadow Minister for Science, Innovation and Technology (Dr. Ben Spencer, MP) and other participants of the meeting included MPs, members of the House of Lords, health industry leaders and senior academics. Opportunity to discuss the emergence of new technologies and innovations within the healthcare system. |
| Year(s) Of Engagement Activity | 2025 |
| URL | https://www.ipt.org.uk/Events/Forthcoming-Events/details/AI-and-Healthcare-Innovations-for-a-Healthi... |