Great work from Anthony and coworkers details practical aspects of working with our patients to refine remote monitoring.1
In a study that initially involved 88 adult patients with diabetes, the researchers asked patients to take regular photographs of their feet over an eight-week period. The study authors assigned patients to either “Self Photo,” “Assistive Device (selfie stick)” or “Other Party (help from another adult)” groups. Researchers then evaluated the images for completion and clinical usefulness.1
Out of 88 study participants, the completion rate was 77 percent and researchers noted significant difference between the groups. Interestingly, clinical adequacy was present in 74.1 percent of photographs from the Self Photo group, 83.7 percent in the Assistive Device group, and 92.6 percent of the Other Party group.1
While consistency definitely improves assessment, I believe that a “foot selfie” of any kind is likely better than nothing. Accordingly, we may want to consider encouraging patients to use another helpful person or an assistive device to improve the quality and consistency of these photos.
Our experience with “foot selfies” over the years has been equally promising as the findings from Anthony and coworkers. In fact, we now have weekly “foot selfie” rounds to review the previous week’s patient photos (in fact, I write this just after finishing those rounds). We see these patients both via telemedicine and regular visits. However, we may modify the setting in which the next follow-up appointment takes place based on their submitted photos. Quite literally, every week our team identifies “zones of concern” on these photos that we watch carefully. This has led to many reduced hospitalizations at our institution.
Dr. Armstrong is Professor of Surgery at Keck School of Medicine of University of Southern California. He is the Director of the Southwestern Academic Limb Salvage Alliance (SALSA).
Editor’s Note: This blog has been adapted with permission from the author and originally appeared at:
Anthony CA, Femino JE, Miller AC, et al. Diabetic foot surveillance using mobile phones and automated software messaging, a randomized observational trial. Iowa Orthop J. 2020;40(1