International Journal of Control, Automation and Systems 17(X) (2019) 1-7 http://dx.doi.org/10.1007/s12555-019-0242-y ISSN:1598-6446 eISSN:2005-4092 http://www.springer.com/12555 Monitoring System for Diabetic Foot Ulceration Patients Using Robotic Palpation Woonjae Choi and Bummo Ahn* Abstract: Foot ulceration in diabetic patients is commonly occurred and leads to amputation of the leg. Fur- thermore, pathogenesis of the foot ulceration is not only clinical presentation variable and complicated, but also required medical management at early stage. However, patients, initially, have been neglected the condition of their feet because the initial ulcer does not have a major effect on the patient’s life. Therefore, the foot ulceration becomes serious, and then the patients come to treat in the hospital. Therefore, early diagnosis is important for the treatment of the foot ulceration in diabetic patients. Recently, the changes in mechanical properties (Elastic moduli) of the plantar tissue were found to be important factors in the diagnosis of diabetic foot ulceration. In this paper, we, therefore, developed a monitoring system that can measure the elastic moduli of the plantar tissue of patients, which can be used to check the condition of patients’ feet with monitoring the elastic moduli change of plantar tissue. The system was designed to be portable and easy to use, and is consists of probe, force sensor, linear actu- ator, micro control unit, display module, battery, and housing. To validate the system performance, we carried out palpation experiments with applying 3mm and 5mm palpation depths to tissue phantom. In addition, we measured the reaction forces according to the applied palpations and estimated the elastic moduli of the tissue phantom. We also performed the experiments on the plantar tissue of human at the same experimental condition and estimated the elastic moduli of the plantar tissue. From the results, the estimated elastic moduli on tissue phantom show similar value even if the palpation depths are different. The results were similar when the plantar tissues were tested, which means that the system can be used to monitor the foot ulceration in diabetic patients. Keywords: Diabetic foot ulceration, monitoring, portable system, robotic palpation. 1. INTRODUCTION About 15% of people diagnosed with diabetes are at risk for foot ulcers [1]. Foot ulceration in diabetic patients is commonly occurred and leads to amputation of the leg [2]. The mortality of the patients is relatively high and recurrence rate is also high because the pathogenesis of the ulceration is clinical presentation variable and compli- cated, and required medical treatment at early stage [2]. For the patients with foot ulceration, there are two differ- ent burdens; financial problem and limb amputation [3]. The financial costs of treating diabetic foot ulcers are es- timated to be $28,000 in 1999 in the United States [4]. The most costly and feared consequence of a foot ulcer is limb amputation, which occurs 10 to 30 times more often in diabetic persons than in the general population. Dia- betes underlies up to 8 of 10 non-traumatic amputations, of which 85% follow a foot ulceration [5]. Diabetic foot ulceration usually begin with minor skin damage. How- ever, it is difficult to treat the skin if the damage is in progress and become serious. In case of severe skin dam- age, a part of the foot may have to be amputated, but the patients can be treated properly without a big problem in case of early stage of the skin damage. In addition, it is hard to provide a self-monitoring of their feet and evalua- tion of risk factors periodically. Therefore, proper obser- vation and careful management need to be provided for the patients in order to prevent pain and disability caused by limb amputation [6]. The most common self-monitoring method is to thoroughly observe the foot every day and to check whether there are lesions or changes in the foot such as wounds, hard flesh, or corn [7]. In everyday life, however, it is difficult for patients to monitor their feet in an objective and quantitative method. To diagnose the diabetic foot ulcers in the early stage, it is necessary to understand the characteristics of the ulcers. Several research groups were performed the mechanical characterization of the plantar tissue of normal people and Manuscript received April 1, 2019; revised July 23, 2019; accepted July 28, 2019. Recommended by Editor Doo Yong Lee. This work was supported by the Bio & Medical Technology Development Program of the National Research Foundation (NRF) funded by the Korean Government (MSIP) (No. NRF-2017M3A9E2063101). Woonjae Choi and Bummo Ahn are with the Department of Robotics and Virtual Engineering with the University of Science and Technology, Daejoen, Korea and the Robotics R&D Group, Korea Institute of Industrial Technology, Ansan si, Gyeonggi-do 15588, Korea (e-mails: {woonjae012, bmahn}@ kitech.re.kr). * Corresponding author. c ⃝ICROS, KIEE and Springer 2019