OrthoSense: An Adaptive Wearable System for Personalized Foot Comfort and Pressure Optimization

Diabetic foot ulcers are one of the most preventable yet devas-tating complications of diabetes, and India alone has almost101 million patients at high risk. Typical orthotic insolesare passive devices that rely on population-average pressurethresholds, ignoring the wide inter-patient differences in plan-tar anatomy, tissue tolerance, and gait. In this work, we intro-duce OrthoSense – an ESP32-based pneumatic insole that com-putes and stores a comfort-derived target pressure profile froma patient-reported comfort rating (1–5). A six-channel force-sensitive resistor (FSR) array covers four plantar zones, an in-ertial sensor gates actuation by gait phase, and a bounded lin-ear integrator updates per-zone targets on-device. In a bench-top evaluation with five healthy adult subjects, we achieved a31.4% mean peak lateral forefoot pressure reduction (34.1%single-trial peak, p < 0.001, paired t-test, 95% confidence in-terval: 30.3-32.5%), an unweighted mean reduction of 21.2%across four plantar zones, and a pressure-weighted mean reduc-tion of 23.0%. The end-to-end sensing-to-actuation latency was148 ms (22 ms), and 94% of trials fell below the recommended200 ms target. Bluetooth low energy (BLE) packet loss over a5-minute walk session was below 1.2%, and the 8-10 hour bat-tery life was confirmed using an itemized power budget that in-cluded manufacturer- and empirically-derived derating factors.The proposed pneumatic insole takes the next step beyond pre-viously available pressure-based solutions by computing andmaintaining an individually determined, no-compromise set-point directly from patient comfort feedback, enabling a practi-cal and clinically meaningful path toward personalized diabeticfoot offloading.