Proposal of Wearable Sensor-Based System for

Foot Temperature Monitoring

J. Bullón Pérez1 , A. Hernández Encinas2 , J. Martı́n-Vaquero2 ,

A. Queiruga-Dios2 , A. Martı́nez Nova3 , and J. Torreblanca González4
1
Department of Chemical and Textile Engineering, University of Salamanca, Spain
perbu@usal.es
2
Department of Applied Mathematics, University of Salamanca, Spain
{ascen, jesmarva, queirugadios}@usal.es
3
Department of Nursing, University of Extremadura, Spain
podoalf@unex.es
4
Department of Applied Physics, University of Salamanca, Spain
torre@usal.es

Abstract. The design and development of wearable biosensor systems

for health monitoring has garnered lots of attention in the scientific com-
munity and the industry during the last years. The Internet of Things
(IoT) enables added value services by connecting smart objects in a se-
cure way in different applications, such as transport, health, building,
energy, ecology, or industry, through multiscale integration. This paper
presents a preliminary study on the design of a smart sock for dia-betic
patients. This smart sock will allow monitoring diabetic patient’s health
condition and temperature levels using foot temperature sensors. Sensed
vital signs will be transmitted to a dedicated transmitter/receiver pair,
such as a PC, PDA, or a mobile phone. It would make possible for pa-
tients to have real time information about their health condition, includ-
ing foot temperature levels and therefore managing their diet and/or
medication. As the market’s demand for medical information increases,
this smart sock will provide a significant part of the answer for patients.

Keywords: Health Care, Internet of Things, Smart Textile Systems,

Wearable Textile.

1 Introduction
According to the International Diabetes Federation Atlas [9], by 2035 the dia-
betes mellitus will rise to almost 600 million, and around 80% of these people will
live in developing countries. One of the problems suffered by diabetes patients
is related to several complications in their lower limbs, more specifically in their
feet. The severity of foot injuries is different depending on the socio-economic
conditions of the patients, as the type of footwear and the general body care
is not the same from region to region. In developed countries, foot ulcers has
a yearly incidence of around 2-4% , but the percentage is higher in developing
countries [5]. The foot ulcers are a result of peripheral sensory neuropathies,
© Springer International Publishing AG 2018 165
S. Omatu et al. (eds.), Distributed Computing and Artificial Intelligence,
14th International Conference, Advances in Intelligent Systems and
Computing 620, DOI 10.1007/978-3-319-62410-5_20
166 J. Bullón Pérez et al.

minor foot trauma, foot deformities related to motor neuropathies, or peripheral

artery disease. The consequence of a skin wound is that it become susceptible
to infection, which means an urgent medical problem. Only two-thirds of foot
ulcers have the appropriate treatment [13] and up to 28% result in lower ex-
tremity amputation. Every year, more than 1 million people with diabetes lose
at least a part of their leg as a consequence of the complications of diabetes. Foot
problems in diabetic patients represent a personal tragedy, and also affect pa-
tients’s family. Moreover, this healthy problems suppose a substantial financial
burden on healthcare systems and society in general. In low-income countries
the cost of treating a complex diabetic foot ulcer can be equivalent to 5.7 years
of annual income, potentially resulting in financial ruin for these patients and
their families [6].
To avoid the high mortality rate for amputees (as a result of the diabetic
desease) it would be necessary to have a diagnostic tool or a warning device
for those patients. Patients suffering this metabolic disease lose the protective
sensation caused by peripheral neuropathies. The development of such a warning
device could allow patients the daily use, so it would provide them with feedback
about when they are at risk.
Wearable health-monitoring systems have drawn a lot of attention from the
research community and the industry during the last decade, as it is pointed
out by the numerous and yearly increasing corresponding research and develop-
ment efforts ([10], [14]). Wearable systems for health monitoring may comprise
various types of miniature sensors, as wearable or even implantable devices.
These biosensors are capable of measuring significant physiological parameters
like heart rate, blood pressure, body and skin temperature, oxygen saturation,
respiration rate, electrocardiogram, etc. The obtained measurements are com-
municated either via a wireless or a wired link to a central node, such as a smart
phone or a microcontroller board, which may then in turn display the accord-
ing information on a user interface or transmit the aggregated vital signs to a
medical center. A wearable medical system may encompass a wide variety of
components: sensors, wearable materials, smart textiles, actuators, power sup-
plies, wireless communication modules and links, control and processing units,
interface for the user, software, and advanced algorithms for data extracting and
decision making [18].
Faced with this situation, we consider the possibility of using smart textiles
(also known as electronic or e-textiles), i.e. “textiles that can detect and react
to stimuli and conditions of the environment, as well as mechanical, thermal,
chemical, electrical or magnetic stimuli” [7]. Therefore, it is the physical inte-
gration of an intelligent system with a textile substrate, in our case a system to
monitor physiological signals.

2 The Internet of Things for Health Care

The IoT network for health care facilitates the transmission and reception of
medical data, and enables the use of healthcare-tailored communications. The
Proposal of Wearable Sensor-Based System for Foot Temperature Monitoring 167

architecture of those networks includes an outline for the specification of their

physical elements, functional organization, and its working principles and tech-
niques. Many studies [4], [8], [12], [20] have justified that the IPv6-based 6LoW-
PAN is the basis of the IoT healthcare networks. A service platform framework
focusing on users’ health information is presented in [23]. This framework shows
a systematic hierarchical model of how caregivers can access various databases
from the application layer with the help of a support layer.
IoT-based healthcare systems can be used in a wide range of fields, includ-
ing care for pediatric and elderly patients, the supervision of chronic diseases,
and the management of private health and fitness, among others. Those sys-
tems could be classified according two aspects: services (community healthcare
monitoring, children health information, wearable device access, etc.), and appli-
cations (blood pressure monitoring, body temperature monitoring, rehabilitation
system, healthcare solutions using smartphones, etc.) [11].
The IoT is growing rapidly. Therefore, the IoT healthcare domain may be the
target of attackers. To facilitate the full adoption of the IoT in the healthcare
domain, it is critical to identify and analyze distinct features of IoT security
and privacy, including security requirements, vulnerabilities, threat models, and
countermeasures, from the healthcare perspective.
The challenges for secure IoT healthcare services include: computational,
memory and energy limitations; scalability; communications media; multiplic-
ity devices; a dynamic network topology; a multi–protocol network; dynamic
security updates and tamper resistant packages, see Figure 1.

3 Proposal of Wearable Sensor-Based System

A major challenge in the development of a wearable sensor-based system for

foot temperature monitoring is to find the characteristics of diabetic feet that
will be the indicators of the condition of the patient’s feet. Commonly, pressure
has been and remains to be an important indicator of ulceration ([15], [16], [17],
[22]). The temperature is very closely associated with pressure, and it is a much
more reliable parameter to measure. This is based, in part, on the available
hardware. Thermistors that are highly accurate and also very small are readily
available. However, less attention has been paid to plantar temperature as an
indicator of ulcer risk as compared to pressure ([1], [2], [3]). Sadly, many patients
go to the emergency department after reaching a point of no return in regards to
their feet. Currently, there is no device available that can provide a portable and
continuous monitoring and assessment of the condition of the feet in diabetic
patients.
Technology has also entered the world of fashion. Fabrics and smart gar-
ments are the new –though not as popular– fashion trends in recent times. From
clothing made of fibers that maintain blood pressure, to socks that delay the
appearance of fungi, there are some of the latest discoveries in the development
of fashion. There exists a trend directly linked to the current social concern
of “feeling good”, coupled with the demands of quality demanded by the con-
168 J. Bullón Pérez et al.

Security service Exchange knowledge base

Feedback

Action command

PROTECTION DETECTION REACTION

SERVICE SERVICE SERVICE

Perceive Eliminates
Defend
against behavioral data

ATTACK THREAT VULNERABILITY

Security topics

Fig. 1. Intelligent security model.

sumer. In this new fabrication of textiles, it is not only clothing that has healthy
and often ecological characteristics, there is also a line of researchers who have
developed smart textiles that change color, emit sound, etc.
In addition to the purpose of the design, smart textiles can also play a role
in the health area. Such is the case of fabrics with metallic threads that can give
information about the body, clothes that can measure pulse and temperature, or
heart rate and breathing. The manufacturer of polyester Advansa has developed
a model that incorporates the assets of ThermoCool to regulate the temperature.
It was made together with the Chinese firm CAML (China Access Marketing
Ltd.), specialized in socks for the practice of the sport (http://www.camlhk.
com/). CAML is the first Chinese socks manufacturer to apply ThermoCool to
their products. The company, known for its line of hosiery for all types of winter
sports and, especially, for the practice of trekking, has launched a new special
collection for cyclists and runners with ThermoCool.
Some researchers from the University of Manchester have developed a system
to take measures of temperature in diabetic feet to study the etiology of diabetic
foot ulcerations [19]. In our study we are going to place several sensors in a sock
in order to take measurements of temperature in different places of the feet.
The proposed IoT-based device includes a system for monitoring the foot’s
temperature. It is based on the following main components (see Fig. 2):
– Textile-based sensors in a smart sock, that will receive the data (foot tem-
perature).
Proposal of Wearable Sensor-Based System for Foot Temperature Monitoring 169

– A central unit (base station), connected to the smart sock.

– An external device that receives the wireless information sent by the central
unit and estimates the dataset.

Base Station

Sensor nodes positions

ons

Body sensor node

Fig. 2. Scheme of the proposed wearable to measure temperature data.

The project of a smart sock for diabetic patients started with the search
for the published work, using as key words the temperature methods and the
diabetic foot. Moreover, in order to find the relevant devices for collecting foot
temperature data, the search had been widened to the European patents on-
line platform. This research was based on the instruments for the evaluation of
diabetic foot temperature, as well as its origin, technology base, and applica-
tions. In addition, the search strategy was to find patents and patent applica-
tions, and also look for updates and improvements. In order to find inventions
and non–patentable equipments, already available in the market, the search was
conducted through the Internet, establishing the following keywords in a search
engine: diabetic foot, foot temperature, monitoring temperature, evaluation of
temperature, and technology.
A smart insole for diabetic patients [21] is a temperature based smart insole
capable of continuously or intermittently measuring the foot temperature of the
patient at one or more locations of the foot while the insole is worn. This device
provides the feedback to the patient, warning about danger based on user’s
plantar temperatures. Furthermore, it frees the patient from the clinical setting
and increases patient’s confidence to be mobile, while at the same time allows the
patient self–monitoring their feet. The smart insole monitors foot temperature
with the help of several temperature sensors. In addition to this, the device
needs an algorithm to compare the data from the temperature sensors with a
individual’s signature profile, and provides a feedback value. Some additional
170 J. Bullón Pérez et al.

components are needed for communicating the feedback value. Another example
of this smart system also incudes a plurality of temperature sensors that generate
a signal. The signal is collected using a circuit electrically connected to the
temperature sensors. A software program receives the transmitted signal and
compares the transmitted signal to a signature profile to generate a feedback
signal that is transmitted to a final device.
The medical stocking for temperature detection proposed in [24] is provided
with a temperature sensor and an indicator connected to the sensor for provid-
ing a signal indicative or leg temperature. The stocking is additionally provided
with at least one strip of soft but substantially rigid material for inhibiting a
rolling down of the stocking. The strip extends longitudinally along the stocking
from an edge of the stocking’s mouth. In addition, a pressure application compo-
nent is provided on the stocking for automatically applying periodic compressive
pressure to the person’s leg.
To be more precise, the wearable sensor-based system proposed in this study,
for foot temperature monitoring, will include:

– Temperature sensors to collect the temperature data of the sock.

– The foot temperature profile of the individual (based on the temperature
readings from strategic locations of the foot).
– Based on a fuzzy inference engine, the sock makes a decision on whether to
alert the patient.
– The alert signal is transmitted in various ways, as visual, tactile or audible
indication, and combinations thereof.
– The alert signal can be transmitted wirelessly to a pager-type receiver carried
by the patient, a caregiver, or a physician’s office, for example.
– The system can be powered including one or more batteries which may be
rechargeable or non-rechargeable.

Although the wearable had not yet been developed, temperature measure-
ments were performed with different sensors, including the LM35 and NTC ther-
mistors. The first measurements have been taken with LM35 sensors connected
to a Microchip PIC series microcontroller. The initial sensor with which we are
working is the LM35 for its easy implementation and its response in circuit.
The LM35 is a temperature sensor, which is calibrated to an accuracy of 1◦ C
and is capable of measuring between -55◦ C and 150◦ C. It has 3 connection pins.
One is for power, one for mass (0 Volts) and one for the data output signal. It
is very simple to use. The extreme pins of LM35 are for power, while the center
pin provides the measurement at a voltage reference, at the rate of 10mV / ◦ C.
The microcontroller with which we are going to perform the data acquisition is
a PIC16F877A which has 40 terminals. Of all of them we are going to use the
eight destined to the analog-digital converter, an analog signal for its inputs will
be converted into a digital signal, which we will proceed to try to obtain a result,
which will be the temperature of the sensor in question.
Proposal of Wearable Sensor-Based System for Foot Temperature Monitoring 171

4 Conclusions and further work

Textile-based sensors are always made of textiles and define themselves through
their textile structure. We are developing a prototype as a smart sock that will
contain several sensors to measure real temperature data. These sensors will be
placed into the sock plants.
The proposed device is a wearable sensor-based system for foot tempera-
ture monitoring capable of continuously or intermittently measuring the foot
temperature of the diabetic patients at several locations of the feet.
The device will provide feedback to the patients, alerting about the risk based
on his/her feet temperatures.
The benefits of this smart device will include:
– To free the diabetic patients from the clinical setting and increase patient’s
confidence to be mobile, allowing to self-monitor their feet.
– Diabetic patients with peripheral neuropathy could wear the socks and be au-
tomatically alerted when their foot temperature has exceeded a determined
profile.
– Can be used to diagnose or monitor the foot diseases or disorders. Some foot
diseases or disorders cause an increase in temperature at certain locations of
the foot.

Acknowledgements
The authors acknowledge support from the Fundación Memoria D. Samuel Solórzano
Barruso, through the grant FS/14-2016.

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