Smartphones, smartwatches, smartpens, why not a smart sock? But why a smart sock you ask? Well, diabetes management, of course!

Think about it; there is a business out there where patients with diabetes are at high risk of foot ulcers that can lead to infections, longterm treatment, and possible amputation. There has been enough research out there to indicate foot care is of high importance in diabetes management. 
 
But the current market is focused on socks, inserts, and shoes prescribed by podiatrists to help with care. It's not a sexy field, but someones got to do it. And, in this age of adding technology (which generally means a sensor that can pair with an app on a mobile device), someone decided to 'disrupt' the foot market.
 
So enter Siren, a new digital health start-up focused on upgrading the current socks available for patients with diabetes.1 What, pray tell, do these socks do? Well, to break it down:
  • Neurofabric Technology—a proprietary material that essentially allows sensors to be interwoven into the sock
  • Temperature Sensing—6 sensors are located at separate points across the foot to determine possible infection setting in
So, the technology senses temperature and warns of possible infections, which ultimately are the issue with diabetic ulcers. Poor circulation means less immune response, along with other factors, and eventually could lead to a lost limb. 
 
Siren supplies users with a plan service, where for $19.95 a month (which amounts to $239.40/year), they get 5 socks up-front and 5 new socks 6-months later. You can't order individual socks, but they do come in several colors, outside of white and black. No idea if you can mix and match the colors though from what I can tell. The company says they are comfortable and based on my understanding of the sensors you're not supposed to feel anything wearing them.
 
So that's cool, but is it worth the cost? I mean, you can buy 3-pairs of diabetic crew socks in some pharmacies for $5.99. So, in comparison that is 10-socks a year vs 120-socks. Quite the difference. You would hope that there is some data saying these things work better than regular diabetic socks and lead to improved outcomes, right? Well, this is where I stumbled when reading up on Siren. There is no research out about their product. Even searching for possible in-progress studies on ClinicalTrials.gov yielded no results. On their website, under 'Research' they list 3 studies from the mid-to-early 2000's, with population sizes of several hundred, studied related to wether temperature-monitoring could serve as a tool to identify those at risk for ulcers. So, I am a little surprised here.
 
The reason is that Siren isn't the only one eyeing this field. There are some other companies and researchers looking to create their own smart socks. One company is looking at socks that don't measure temperature but sense pressure.2 Another sock in research measures temperature, pressure, and joint angle.3 Those research products aren't in the production phase yet, but they have published articles detailing the science. However, there is no longterm data on patient management. So, currently, as it stands, there isn't really any data saying these smart socks make a difference from what I can tell. Does there need to be though?
 
The concept makes sense, and I really can't fault the designers as I do think it's a good idea. But ideas only go so far for some people, and those that matter happen to be those willing to pay more than $200 a year on 10 socks. And namely, that would be an insurance company, I feel. If you want patients to be on these products, coverage by an insurance company would be the end-goal here. But to get there, you're gonna need some research saying they are better than standards of care. I expect, with that in mind, to see some data or study released in the near future highlighting whether smart socks make a difference in patient care, and then I will probably be a little more positive about smart clothing.
 
References
  1. Siren website. https://siren.care/. Accessed April 4, 2018.
  2. Smart Sock For Diabetic Neuropathy, SenseGO, Helps Patients Manage Symptoms. Medical Daily website. January 27, 2016. www.medicaldaily.com/sensego-diabetic-neuropathy-foot-ulcers-amputations-smartphone-app-machine-371208. Accessed April 4, 2018.
  3. Najafi B, Mohseni H, Grewal GS, Talal TK, Menzies RA, Armstrong DG. An Optical-Fiber-Based Smart Textile (Smart Socks) to Manage Biomechanical Risk Factors Associated With Diabetic Foot Amputation. J Diabetes Sci Technol. 2017;11(4):668-677.