Smart Boot Use to Measure Offloading Adherence

Improving the Science of Adherence Reinforcement and Safe Mobility in People With Diabetic Foot Ulcers Using Smart Offloading

The purpose of this study is to help people with diabetes who develop neuropathic diabetic foot ulcers (DFUs). These ulcers, or sores, if left untreated can increase the chance of amputation. Part of the treatment is to have the person wear a diabetic shoe or boot to help their foot heal. Sometimes people don't wear the boot like they are told. The investigators want to compare three different kinds of diabetic boots to see if they can help make it easier for people to wear their boots as instructed. The investigators will look at three groups of participants: the first group will wear a boot that can't be taken off. The second group will wear a boot that can be taken off, and they will get counseling about how important it is to follow instructions as to how often and when to wear the boot. The third group will wear a "smart" boot, which will interact with the person through a smart watch and smart phone, and give them direct feedback about how they are doing with following their boot wearing prescription. The investigators will also be looking at how much physical activity, like walking, the participants do. And they will compare how well participants sleep and rate their quality of life in the three different boots. The investigators think that giving participants information about how much they are wearing their boot using readily available technology will help them to follow the doctor's directions better, and help their wounds heal faster.

Smart boot with, removable, with reinforcement of adherence via smart watch and smart phone as well as remote patient monitoring.

Average daily hours of device wear during weight bearing activities, objectively measured using smart boot

Inclusion Criteria: Male or Female aged 18 or older Diabetic Foot Ulcer requiring offloading Able to provide written informed consent Exclusion Criteria: Wound present for more than one year HbA1c > 12% Ankle Brachial Index (ABI) of index limb is <0.9 and/or they are being considered for revascularization within the course of the study Ulcer involving bone or tendon Ulcer not caused by diabetes Unable or unwilling to attend prescribed clinic visits Fully confined to a wheelchair

Individually identifiable data will be deleted or masked before being made available to individuals who are not a part of the study (research staff). Results released will be sufficiently aggregated as to make individual identification of subjects highly unlikely. When individual research subjects are identifiable using substitute unique identifiers (i.e., subject 10) the translation table will be safeguarded from release outside of the study staff.