Electronic BCG Sock Detects Risky Walking in Diabetes

Author: European Society of Cardiology
Published: 7 Apr 2024 - Updated: 3 Nov 2026
Publication Type: Reports and Proceedings

Table of Contents:
Synopsis - Definition - Overview - FAQs - Insights, Updates - Related Content

Synopsis

This research, presented at EHRA 2024, a European Society of Cardiology congress, by Dr. Ki Hong Lee of Chonnam National University Hospital in Korea, tested a sock fitted with a ballistocardiogram (BCG) sensor in 20 people with diabetes and 20 without. The sock measured heart rate almost exactly as well as an electrocardiogram, with a correlation of 0.99, and showed that people with diabetes put more pressure on the ball of the foot and less on the heel when walking. The pattern was strongest in those with poor circulation in the legs, measured by the ankle-brachial index. It matters because pressure on the forefoot raises the risk of ulcers that can become infected and lead to amputation, so a simple wearable could help people with diabetes, seniors and their care teams spot problems early and learn safer walking habits.*

At a Glance

1 - Each participant wore the sock for 40 seconds standing and 40 seconds walking.
2 - Foot pressure patterns did not differ by nerve damage, only by poor blood flow.
3 - People with diabetes have a two- to four-fold higher risk of heart disease and stroke.
4 - Around 537 million people worldwide, or about 1 in 10 adults, have diabetes, according to the International Diabetes Federation.

Topic Definition

Ballistocardiogram: A ballistocardiogram (BCG) is a recording of the tiny movements of the body caused by the heart pumping blood into the large arteries with each beat. Sensors in a bed, chair, scale or wearable can pick up these movements without electrodes on the skin, allowing heart rate and other cardiac signals to be measured passively and, in some designs, pressure or motion to be tracked at the same time.

Overview

An electronic sock that detects an unhealthy walking style linked with diabetes and poor circulation shows promise for preventing foot ulcers and amputation. The novel research is set to benefit the many patients with diabetes who have clogged arteries in the legs and is presented for the first time at EHRA 2024, a scientific congress of the European Society of Cardiology (ESC)(1).

Study author Dr. Ki Hong Lee of Chonnam National University Hospital, Gwangju, Republic of Korea said:

"Diabetes can affect the way people walk, also known as their gait. Patients with diabetes tend to put pressure on the metatarsal area of the foot, rather than the heel. This way of walking encourages ulcers, which can become infected and lead to amputation. Identifying walking issues early using an electronic sock would enable patients to learn a healthy walking style and prevent serious foot problems."

Around 1 in 10 people - 537 million in total - have diabetes worldwide(2), putting them at a two- to four-fold higher risk of coronary artery disease, stroke, heart failure, atrial fibrillation and peripheral artery disease compared to their healthy peers(3). Foot problems are common in diabetes. High blood sugar damages the nerves and blood vessels, with symptoms including numbness, tingling, pain, and loss of feeling. The symptoms can be difficult to detect in the early stages, meaning that cuts and ulcers may develop and become infected. The combination of an infection and poor blood flow makes healing difficult and can lead to gangrene and, ultimately, amputation.

This study examined whether a sock fitted with a ballistocardiogram (BCG) sensor could distinguish between healthy people and patients with diabetes. A BCG detects body motion as the heart ejects blood, and could potentially be used to measure heart rate and pressure exerted on the feet when walking.

The study enrolled 20 patients with diabetes and 20 controls without diabetes. All participants wore the BCG sock for 40 seconds while standing and 40 seconds while walking to measure heart rate and to assess pressure distribution on the foot. At the same time as wearing the sock, participants had an electrocardiogram (ECG) assessment of heart rate using a small patch attached to the wrist and a single electrode adhered to the chest. ECG is the gold standard tool in cardiology for measuring heart rate.

The purpose of the heart rate measurement was to assess the accuracy of the BCG sock as a measurement tool relative to ECG, the gold standard method. For this analysis, ECG values in each study participant (patients and controls) were compared with BCG values in the same participant. The researchers found that the heart rate measurements by the BCG sock and ECG were almost the same, with a correlation coefficient of 0.99 (95% confidence interval 0.99-1.00).

The foot pressure distribution measurements were performed to discover whether the BCG sock could 1) detect differences between patients with diabetes and healthy controls, and 2) detect differences between patients with diabetes according to whether or not they had damage to the nerves or blood vessels. Nerve damage was classified using the Michigan Neuropathy Screening Instrument (MNSI), while blood vessel damage was classified using the ankle-brachial index (ABI).

Regarding the BCG comparison between patients and healthy controls, this showed that patients with diabetes exerted higher pressure in the metatarsal area of the foot while walking compared to participants without diabetes. For the BCG comparison between patients with diabetes, the researchers found that compared to patients without blood vessel damage (ABI score of 0.9 or higher), those with blood vessel damage (ABI score less than 0.9) exerted significantly greater pressure on the metatarsal area of the foot during walking and less pressure on the heel. There was no significant difference in foot pressure distribution measurements between patients with or without nerve damage.

Dr. Lee said:

"The novel BCG sock produced accurate measurements of heart rate as indicated by the nearly identical values as ECG. The pressure measurements showed that the sock could identify patients with diabetes, and could also pinpoint patients with diabetes and poor circulation. Taken together, the results suggest that the electronic sock could be an easy, non-invasive way to find patients with diabetes who could benefit from gait training to prevent foot complications."

References

(1) The abstract 'Wearable self-powered ballistic signal detectors with ferroelectric composites arrays for cardiovascular and diabetic complication' was presented during the session 'Basic Science 1' on April 7, 2024, at 17:30 CEST at Moderated ePosters 1.

(2) International Diabetes Federation.

(3) Marx N, Federici M, Schütt K et al. 2023 ESC Guidelines for the management of cardiovascular disease in patients with diabetes. Eur Heart J. 2023;44:4043-4140.

Funding

This study was supported by a CNUH-GIST research collaboration grant funded by the Chonnam National University Hospital Biomedical Research Institute.

Disclosures: None.

Frequently Asked Questions

NOTE: Researched FAQs by Disabled World (DW)

What is the ankle-brachial index?

The ankle-brachial index compares blood pressure at the ankle with blood pressure in the arm. A result below 0.9 suggests narrowed arteries in the legs, known as peripheral artery disease.

How often should people with diabetes check their feet?

Daily foot checks are recommended, looking for cuts, blisters, redness, swelling or changes in skin and nails. A mirror or a helper can assist if it is hard to see the soles.

What is diabetic neuropathy?

Diabetic neuropathy is nerve damage caused by high blood sugar over time. In the feet it can cause numbness, tingling or pain and make injuries easy to miss.

Can special shoes prevent diabetic foot ulcers?

Therapeutic shoes and custom insoles can spread pressure more evenly and reduce ulcer risk. Medicare Part B covers them for some people with diabetes who meet certain conditions.

What is gait training?

Gait training is therapy, usually led by a physical therapist, that helps people improve how they walk through exercises, balance work and feedback on foot placement.

Are smart socks available to buy?

Some smart socks that track foot temperature or pressure are sold for diabetes care, but the BCG sock in this study is still a research device.

Why does poor circulation slow wound healing?

Healing needs oxygen and nutrients delivered by blood. When arteries are narrowed, less blood reaches the wound, making infection and tissue death more likely.

How common are amputations from diabetes?

Diabetes is a leading cause of lower limb amputation in many countries, and most amputations are preceded by a foot ulcer, which is why early prevention is so important.

Insights, Analysis, and Developments

Editorial Note: Foot ulcers are one of the most serious and costly complications of diabetes, and many begin quietly because nerve damage dulls the warning signs of pressure and pain. A sock that can track both the heart and the way weight falls on the foot offers a low-burden way to flag risk at home rather than waiting for a wound to appear. The study was small and presented as a conference abstract, so larger trials are needed to show whether the sock leads to fewer ulcers or amputations. Until then, daily foot checks, well-fitted shoes, regular podiatry visits and good blood sugar control remain the most reliable protection for people living with diabetes.*

Attribution/Source(s): This quality-reviewed publication was selected for publishing by the editors of Disabled World (DW) due to its relevance to the disability community. Originally issued as a press release by European Society of Cardiology and published on 7 Apr 2024. Last updated on 3 Nov 2026. This content may have been edited for style, clarity, or brevity.

* Editorial additions by Ian C. Langtree.