A “Foot Selfie”- Using Mobile Phones for Diabetic Foot Surveillance

Great work from Anthony and coworkers detailing practical aspects of working with our patients’ to refine remote monitoring. Our experience with “foot selfies” has been equally promising. In fact, we have weekly “foot selfie” rounds to review the previous week’s patient photos.

Background: Early detection of diabetic foot

ulcers can improve outcomes. However, patients do not always monitor their feet or seek medical attention when ulcers worsen. New approaches for diabetic-foot surveillance are needed. The goal of this study was to determine if patients would be willing and able to regularly photograph their feet; evaluate different foot-imaging approaches; and determine clinical adequacy of the resulting pictures.

Methods: We recruited adults with diabetes and assigned them to Self Photo (SP), Assistive Device (AD), or Other Party (OP) groups. The SP group photographed their own feet, while the AD group used a selfie stick; the OP group required another adult to photograph the patient’s foot. For 8 weeks, we texted all patients requesting that they text us a photo of each foot. The collected images were evaluated for clinical adequacy. Numbers of (i) submitted and (ii) clinically useful images were compared among groups using generalized linear models and generalized linear mixed models.

Results: A total of 96 patients consented and 88 participated. There were 30 patients in SP, 29 in AD, and 29 in OP. The completion rate was 77%, with no significant differences among groups. However, 74.1% of photographs in SC, 83.7% in AD, 92.6% in OP were determined to be clinically adequate, and these differed statistically significantly.

Conclusions: Patients with diabetes are willing and able to take photographs of their feet, but using selfie sticks or having another adult take the photographs increases the clinical adequacy of the photographs.

Monday morning “Foot Selfie” rounds at SALSA @USC. We review patients’ foot photos sent in the week before.

Monday morning, 0700. Foot Selfie Rounds for our patients in #DiabeticFoot remission @usc. This has been a simple but substantial addition to our peri-pandemic “all feet on deck” team approach to #ActAgainstAmputation #DiabeticFoot #AllFeetOnDeck

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