StarTalk Radio - Feet of Engineering with Michael DiTullo and Jason Hanft

Episode Date: September 9, 2022

Can a shoe design save your life? Neil deGrasse Tyson, Chuck Nice, and Gary O’Reilly explore how engineering can help save the lives– and feet– of thousands with diabetes, with industrial engineer Michael DiTullo and foot and ankle surgeon, Dr. Jason Hanft. NOTE: StarTalk+ Patrons can watch or listen to this entire episode commercial-free here: https://startalkmedia.com/show/feet-of-engineering-with-micheal-ditullo-and-jason-hanft/Photo Credit: Mikael Häggström, M.D., CC0, via Wikimedia Commons Subscribe to SiriusXM Podcasts+ on Apple Podcasts to listen to new episodes ad-free and a whole week early.

Welcome to StarTalk, your place in the universe where science and pop culture collide. StarTalk begins right now. This is StarTalk Sports Edition. Neil deGrasse Tyson here, your personal astrophysicist. We're going to title this one Best Foot Forward. That's a little mysterious to me. I got to learn more about that in a minute. Let me introduce my co-host, Chuck. Nice, Chuck. Hey, what's happening? Yeah. And I got Gary O'Reilly. Gary, former soccer pro.

Hi, Neil. All right, dude. And also sports announcer. Yes. And so, Gary, you cooked up this episode. So so I can't wait to find out what's going to happen. So tell me what you got in the oven. A question. What links a clinical podiatrist, 130,000 amputations a year, and a world-class sneaker designer? Anyone?

Have a guess. I'm going to say an apocalyptic design war. I know. Hold that an apocalyptic design war. I know. Hold that thought. All answers accepted, but there is only one answer. Jason takes Manhattan movie or something. Texas chain store meets Jason.

All right, so here we are. A little bit more daylight and a little bit more of a reveal. So this show is about smart engineering, right? Innovative material science, kick-ass sportswear design, all converging, as I said, to help people recover faster and live longer. The link to all of the above. Recover from sports injuries, I guess. Patience. Oh, it's too soon.

Sorry. Sorry. Okay. The link to all the above is sadly diabetes. Wow. So we are trapped, or are we, in a failing endocrine system. The results are only amputations, or is there a way to walk out of this particular hell? Let me introduce our two guests.

I see what you did there. Thank you kindly. We caught that, Gary. I know. It won't happen again. So Dr. Jason Hamft, the person that chose to question why things were not improving with his patient's conditions and then investigated. He is a foot and ankle surgeon and clinical podiatrist in Miami, Florida. This is the guy who had the gonads to then go out and do something about it. Let me then introduce our second guest, an industrial designer, Michael DiTorlo, with a client list that has included Google, Nike, Jordan, that would be the Michael version,

and Honda, as well as having been the design director at the sportswear giant Converse, winner of the Industrial Design Society of America Personal Recognition Award in 2019. So, Neil, please welcome our two guests, the good Dr. Jason and Michael. Well, excellent. Welcome. Welcome to StarTalk, guys. My gosh. Thank you for having us. Yeah, so let me say, let me start out by saying, could you just remind us why diabetes has anything at all to do with like circulation, which ultimately ends up in amputations? Because we hear that it has to do with, you know, your metabolism and processing of sugar.

And then all of a sudden somebody gets their legs amputated. Like what, how do you, how do you get from here to there? Let's take a half a step back. Let's talk about who gets from here to there. So, so as of today, one in 10 Americans is diabetic. By 2025, it's going to be one in three. And two out of those. In three years?

In three years? In three years? In three. Correct. Wow. And two out of those three will be black. No, that's a joke. So that is not an understatement. People of color and people, Native Americans,

have a 50% higher chance of becoming diabetic. Oh, my. Wow. So if you're looking at hundreds of millions of people around the world becoming diabetic, once they've had diabetes, the fluctuations in blood sugar affect the myelin, the covering of the nerves. And the nerves that are farthest from your central nervous system, your brain, have the longest amount of myelin. So this tissue, because of fluctuations in blood sugar, gets thicker and

thicker, and the electrical impulse cannot be conducted. So they develop what's called peripheral neuropathy, loss of feeling in the hands and feet. And this isn't if you step on a nail, you can't feel it. This is small amounts of pressure you can't feel. So here you have this large group of people who lose the feeling in their feet, and they get small amounts of pressure over time. A shoe rubbing, a sock balled up, an inappropriate fitting shoe. This cuts off the local circulation, leading to a wound. Of all the wounds that occur in the U.S., roughly 3 million a year, 85% of those will become infected within six weeks. That's the pathway to amputation.

Once you violate the tissue envelope of a diabetic patient, bacteria get in, and that's the pathway to these 120,000 plus amputations a year. So Jason, so specifically, what are the most common symptoms? Typically, they have no symptoms. Oh, because they have no feeling. So that's what I was going to ask because I read that the myelin is like a, I don't know, like a conductor. It allows the electrical impulses to run, you know, travel up your spinal cord and whatever. So if that stops or slows down, you're not feeling anything then. Correct.

So typically the only time that people present with a wound is when someone visualizes it. They don't know they have it until they either look, which most people can't see the bottom of their foot, or someone else looks at their foot. Is this nerve damage repairable? Or is this just one way street? Right now, there's no cure for diabetic peripheral neuropathy. There are adjuvant therapies, vitamins, etc.

And there are medicines to manage the symptoms, but there is nothing to bring back the feeling. All right, Jason, medical science throws a lot of resources at a number of problems. Has it thrown the resources at this particular condition, or is this condition just particularly baffling right now? It's quite baffling. Resources in the billions have been thrown at it, including genetic modifications, gene therapy, oral medicines, injectable medicines, tissue transplants. And to date, nothing has worked. Wow.

Well, that's our show, people. Thanks a lot. We're done. Okay. Okay, so allow me to dare such a suggestion that your only solution is for diabetes to go away. So curing diabetes doesn't cure neuropathy, even if you have patients who have peripheral neuropathy. No, no, no, no, I'm saying, no, no, no, no, I'm saying preventing diabetes in the first place, eradicating it from the species, puts you out of business. Is that correct?

Oh, please. Yes. That would be wonderful. Okay. There you go. That's all I'm trying to say here. That we can try to keep putting Band-Aids on a problem when the problem perhaps should be solved in a different way. Rather than bring out all the Band-Aids and the hacksaw for your amputations.

I mean, that's all I'm saying. I'm just making a simple point. And that's the difference between a truly caring medical professional and, you know, capitalism. Because the real answer is, no, Neil, we don't want to cure it. We just want to find a way. We want to keep treating want to cure it. We just want to find a way.

We want to keep treating it. That's right. We want to find a way. There's no money in the cure. There's no money in the cure. Only in the treatment. I must ask, from a patient walking into your clinic, and with the fact that now they're aware they have a diabetic ulcer,

and things go wrong, what is the timeline? I know you said it could be six weeks and an infection. So what then is a timeline to amputation? And then what after amputation are we talking about for their future if there is going to be one? And how long are we talking about? So this would be, just to be clear, this would be an ulcer in one of your extremities that would go unnoticed and then gets infected.

So this is an ulcer in the foot typically because the hand amputation rate is 100 times less than the foot amputation rate. Because you can see them. Because you don't walk on your hand and you can see them. The real issue is the pressure of walking, right? Once you get a hole, the pressure of walking keeps the wound from healing. It doesn't allow the body's healing processes or even external healing processes to take place. Seven to 26 times your body weight goes on the bottom of your foot with

every step. So if you're trying to heal a wound and you can't take the pressure off, low likelihood. So to answer your question about timing, it depends. The extent of when the infection is identified, right? If you're at home, you don't know you have a wound, you're not looking at your foot. If this infection is spread to the bone, there's a very high likelihood, north of 70%, that you'll end up losing a portion and or all of your foot. Doesn't the body respond to infection with a fever? And wouldn't that be a noticeable symptom? So in the non-diabetic or healthy non-immunocompromised patient, fever, redness, swelling, pain are the signs of infection.

But the diabetic patient is considered immunocompromised and they don't mount the same type of response. So frequently it goes on those. Jason, how many of your patients would you clinically identify as obese? Because that means that I may not be able to see my feet. I have been compounding literally the pressure and weight through my lower limbs. And it's built almost in a perfect way to end in a destructive process. I mean, the perfect storm, you're saying. Because if you're morbidly obese or obese in almost on any category, you don't really see the lower half of your body at all, right?

Yeah. So this is absolutely correct. There are two types of diabetes, type 1 and type 2. Type 2 is by the vast majority, people are overweight, increased BMI. So then not only can't they touch, feel the bottom of their feet, they can't see them. And unfortunately, this is one of the pillars of why this epidemic has not only expanded and continues to grow, but has gone sort of a shameful mark has been put on it, right? Because people who are heavy have this. So let me ask you this, since there's no symptoms, we also know that you're at risk if you are obese. Is there any preventative self-diagnostic tools that you might be able to use to say,

hey, I'm in this risk category now. Let me keep an eye on this. A foot mirror. Well, that is the simplest answer. Absolutely correct. With new technologies, with Bluetooth-enabled maps, temperature-sensing maps, visualization, and temperature measurement can be done remotely. So you can have a mat at the foot of your bed every night. You stand on it. It can measure

temperature, pressure, and report to a cloud where a medical practitioner can follow up on that. So there's absolutely technology available to assist. But in the simplest format, a mirror on a stick or a spouse inspecting your feet daily. And the American Diabetes Association recommends regular routine visual inspection of the foot. Wow. Look at that. It'd be great if as a part of your regular medical insurance, you'd be able to get some of those technological assistance. But then you said mirror on a stick, it's over.

That's what you get. You're like, I'd like to avail myself of some cloud technology. They're like, here's a mirror on a stick. So Jason, we're getting into a medical universe now that has brain-machine interfaces. And that work and development, would that be of any use to this peripheral neuropathy? So you can stimulate the central nervous system and you can interface with the central nervous system and trigger it.

But when the wire leaving the junction box isn't working properly, nothing goes any farther than where that myelin has been thickened. Right. It's like a jamming signal. That's crazy. It's an accurate description. Is there a potential chemical solution

once it thickens to reduce that? There are a number of companies that have tried. To date, nothing has been successful in clinical trials. The best way to keep your myelin thin is to keep your blood sugar under control. So if you don't have these massive swings of blood sugar, the myelin doesn't get thick. And there's lots of technology for assisting in keeping your blood sugar under control. Continuous glucose monitoring, pumps that instill medications, Wi-Fi communication to phones, vibrating headsets. I mean, there's all sorts of devices available out there to help you control your sugar.

All right, guys, we've got to take a short break. When we come back, we're going to find out why Michael DiTullo is actually one of our guests as well as Jason Hanft on StarTalk. We're back. StarTalk Sports Edition. We're talking about your lower extremities, like your feet and boots that might be worn over them. And we got with us two guests, Dr. Jason Hanft, who's an expert on, dare I say, amputations.

And we bring on in this segment, in full force, Michael DiTullo. Michael, you came in on the other side of this. What's your role in what's going on here? How are you trying to make this a better world? So, thanks, Neil. My background is as an industrial designer. Most people listening probably don't know

what an industrial designer is. I so know what it is, and you guys are my favorite people in the world. Thank you. Oh, my gosh. It makes living not only helpful, but beautiful. Chuck, Chuck,

we're going to leave Michael and Neil to get on. I was about to say, I'm going to have to turn my camera off for a minute. I was Neil's favorite person in the world.

I'm like, damn. No, no. This is terrible news I just found out. It's supposed to be like Rodney Dangerfield says, damn, this is terrible news I just found out. It's supposed to be like Ronnie Dangerfield says, hey, get a room. I'm going to make a Zoom breakout room for Neil and I. So I explain to people,

if you think of what an architect does for buildings and what a fashion designer does for apparel, I do that for literally everything else in your life. Your phone, your pen, your car, your chair. For better that for literally everything else in your life, your phone, your pen, your car, your chair. For better or for worse, everything you touch was designed by an industrial designer at some point. And so for me, I love working on challenges. I love learning. I always say I'm not a subject matter expert. I'm a creative generalist. So I love partnering with people like Jason who are super passionate and crazy knowledgeable because I feel like I could pull out of them

some crazy parameters that we can use to find an innovative solution. And in most cases, I mean, when you're, you know, design is like this fun mix of science and art. And I think when you're putting these two things together, the right solution oftentimes afterwards seems painfully obvious. But it's only until you get to that that it seems that way, if that makes sense. Yeah, things like a paperclip. I mean, the word on paperclips before somebody invented a paperclip. Exactly.

And so that's probably in the Hall of fame of industrial design among things. So, all right, so let's take a sample case. 400 pound person with diabetes walks in and Jason has a look and you have a look at this person. Now, how do you put your heads together and address what's going on here? Well, when Jason came to me about four years ago, the first thing we did was put together three basic principles. One, it has to functionally perform, obviously. But the it is now, the it is a what? You're right. So we wanted to create this protective boot that would create an environment where someone's wound could heal, right? Because

if you're walking, right? If you're a person, a normal person, you're going to still go to work, you're going to still go to the grocery store. So you can't avoid putting pressure on your foot. So we have to create an environment that alleviates the pressure so that someone's wound can actually heal. So that's principle one, has to function. Principle two, it has to be easy to put on and take off because again, we're dealing with a person with reduced mobility, reduced feeling, right? So they have to be able to put it on and off error-free

even at two in the morning when they have to run to the bathroom real quick. And I'm going to channel Chuck here and it has to look fabulous. Well, that's the third principle. The third principle is it couldn't work if it stays in someone's closet. Because if they feel too ashamed

to go to work in it, it can't work. It will fail 100% of the time that it's not used. And listen, you know how many people need orthopedic shoes? They do not wear them. Yeah. They're like, no, I refuse.

Yeah. That is exactly what was going on here before, Chuck. The devices that were on the market, there are other boots to protect the foot. But people couldn't or wouldn't use them all because of that appeal. They were not usable or good looking. Yeah. Right. So my goal was, my goal was, if you put this on with a pair of jeans, you know, it's going to look as much like a pair of Jordans as you can make it, you know, so that instead of going, instead of someone saying like,

oh, what's that? I want someone to say, oh, what is that? Tell me about that. Oh, yeah. Very good. More importantly, more importantly, you want them to say, who is that? More importantly, you want them to say, who is that? Oh, dear. My, those are, who is that? Who is wearing those? Who are you wearing? Yeah. So what's crazy is that we're building this out for function, right?

But the world of fashion, you look at like what Kanye West is doing with Adidas. It's not far off from where this is going, where a $600, $800 pair of Balenciagas is. So we're kind of like these worlds are kind of colliding right now. All right, Michael, you mentioned Jordan. So we'll bring up the goat, if you wish, and I do. You're designing specifically for Michael Jordan, right? Back in your day. Wait a minute.

Michael Jordan has diabetes? Do behave. Come on, that was good. I know it was, but I don't want to give you any credit. I don't want to give any credit. Okay. Sorry, Gary. Sorry, go ahead.

That's okay, man. So, everything you've designed for him and every other elite world-class athlete has maybe like a rise and you are pushing the foot forward so as the weight goes through the ball of the foot so as I can sprint or maybe in this case, Michael, rather than me. So you offset the heel. It's not a level flat.

So think of it as a skater's sneaker. It's flat to sit on a skateboard, right? Right. When you've got a sneaker that's like a basketball sneaker, it's raised, the heel is raised, you've got to drop. That's putting pressure on the ball of the foot for a reason so as you can launch forward. Now, everything you've learned to make that for those athletes,

you have to kind of pull apart. So how do you start to do the retrofit? Because you can't put the pressure through the ball of the foot, surely. Yeah, that's exactly right. This is the Jordan 22 PE that I worked on. This has got a 10 millimeter drop from the heel to the toe. A running shoe might have even more. That's pretty common, right?

They're anatomically forcing you onto the balls of your feet, which is exactly where the wounds from a diabetic foot ulcer are. They're typically on the balls of your feet, you know, that's aggravating those diabetic foot ulcers. And as Jason said, most folks who are getting treatment, they're leaving the office in their shoe. So they're leaving the office in the product that's aggravating their wound. So this product that Jason and I worked on, the Foot Defender, has a slight negative two millimeter heel drop.

It deceptively looks like footwear materials, but underneath this is an injection molded brace that goes all the way around the product. And then we've got a piece of sprung carbon fiber here. So that is really forcing the geometry of your leg backwards. So you just cannot put pressure on it. The bottom is also flat. So unlike a sneaker, right, where you have these huge rockers kind of leading you into and out of the product, by being flat, again, you can't get out over onto the balls of the feet. So there's so much

kind of geometry and science that goes into this thing that deceptively looks a lot like a shoe. That's amazing. Yeah. Michael. Go ahead. Michael, I'm sorry to cut you off here because, first of all, ingenious design. Secondly, love the form and function playing together.

Thirdly, and most importantly, how do you get me Jordans? He just wants to... Anyone else know that? Like everyone else. Just come visit me in Portland, Chuck. We'll take care of you. Yeah, I'm not that far from campus.

You've conquered the bit where the foot must move but remain rigid. You've redistributed the weight. But in doing that, are you then the blessing and the curse? Are you then creating other mysteries that you need to solve in this particular solution? I'm going to let Jason take that. So the answer to your question is yes, but that's where 35 years of biomechanical analysis comes into play. So if you look at the foot really carefully,

the mid part of the foot is a rigid arch. It rarely, if ever, touches the ground and it doesn't move. So you now have a structure by which you can transfer force to without causing a problem. Nice. And this is part of the reason, well, this is part of the reason it took seven years and 39 iterations to get to the device you're seeing today. Whereas once we, you know, force doesn't disappear.

Neil can appreciate that. But once you move force from one place to another, you have to come up with a mechanism by which to deal with it. Whether you're decreasing it by creating unique materials, viscoelastic materials that rebound and push it in another direction. Or you use very rigid materials to transfer it up the leg. Right, because you're not making this out of just one supply of rubber or plastic, were there commercially available materials to do this? Or did you have to be creative beyond that? Both.

So there were some in the footwear world. We used a number of materials that you would find in the footwear world. You know, wicking, anti-friction, foams, and cloth materials, textiles. But we were looking for maximum impact attenuation, right? So you have a 400-pound person whose muscles don't work and nerves don't work, so their foot's slapping the ground, much like you take your hand and just slam it on the table. So we looked at 700 different materials to try and find the best impact-reducing material around. And we then modified it.

So we essentially created a new material. It's a viscoelastic polyurethane that we are calling absorbium that has… Wow. That sounds like something you find in Wakanda. Absorbium. You find it right next to vibranium. And unobtainium is in the same column. Unobtainium, exactly.

So it removes somewhere between 87% and 90% of the impact force. Wow. Just by the mechanical and material properties. Just to be precise, just to be physics precise, force just by the mechanical and material properties. Okay. I hate to say this. Just to be precise, just to be physics precise, I would say, but tell me if I'm wrong, that it dissipates the force. You are absolutely on point.

Okay. Okay. Sent it someplace else. Yeah. Yeah. But here's the thing. Now, guys, please don't judge me for this. It's just how I think.

We do anyway, Chuck, so don't worry about it. Okay, good. All right. So you're talking about something that is probably, you know, the most prolific shock absorber for the foot in history. There's a crap load of money in running shoes for something like this. I mean, are you thinking about that, maybe? In some ways, it actually thinking about that? Maybe?

In some ways, it actually does the opposite, right? So in a running shoe, you want the foam to rebound really quickly. You want that force return. You don't want to lose the energy you put coming down. This is a dampener.

Right. So you want a return of energy if you're running. Right. It's a shock absorber. Right. So this takes, I got it.

And by the way, Chuck, that's why the blade works so well. Because all the energy that you use to land on it is recovered when the thing springs back. So, yeah. That's a very different utility. Michael, if we disassembled

this Defender boot, how many pieces are there? So like you do in an engine, the classic, take the engine apart and you lay all the bits out on the table. How many pieces are in there? Because my guess is this has a ridiculously large amount of pieces. Yeah, it's probably over 100. I mean, there's just so many different things going on

inside of this product. I mean, Jason talked about that absorbent material. I even just wanted to aesthetically give you the hints of where those are, right? We talked about the industrial designer's job to make it functional, but also I want to draw attention to that function. So those two pucks are under the heel and the forefoot here. So kind of visually telling that story. Can you hold that up again? Michael, can you hold that up again? See the sole of the shoe right

there. The guys, if you're listening to this on the podcast, apologies. But that's like a foot within a foot within a foot. What's going on there? Because you can't tell me that's just cosmetic because it's on the sole of the foot and one gets seen. So there must be a really good reason. Well, it is. I'm trying to kind of basically draw the eye inward because we have a symmetrical product here, right? So it's left and right. So that automatically makes it aesthetically a little off. But I'm trying to kind of fool the eye to make it feel slimmer, more acceptable.

You'll notice like all this traction is kind of oversized because you're wearing this inside and outside and I want kind of dirt and grime to kind of fall out as easily as possible, but give you this traction that's going to give you that kind of the grip you want. So we're actually using basically a Cupsule technology. So this is like one giant piece of rubber that's very stiff, that's used in kind of 80s basketball shoes, skate shoes. It's heavier and stiffer than a typical outsole, but we want that rigidity, right? So we're making all these choices to have functional benefits. Even this little hint of these kind of red embroidered hits, right?

They don't need to be there but they tell you without you having to look at the manual like this is how you get into and out of this thing these are the touch it's called design it's called design people so so it's very very by the way i gotta i gotta interject here i gotta interject for those who didn't otherwise think about this i'm not talking to you mich Michael, but Chuck or Gary. All right. One of the greatest contributions to this world that Apple Computer gifted us

is not even the computer. It's the fact that they made it normal for you to open the package and operate something without ever looking at an instruction manual. That's right. Intuitive design. They made that commonplace.

Correct. And I remember growing up, okay, here's this box. Where's the on switch? Open up the manual. Where's this switch? What happens if it has this? If it makes this sound? It's three flashes of light. What do I do now?

We have people growing up that have never looked in an instruction manual because of that. I'm just, I've got, I told you, Michael, I'm all, me and you are tight. You're getting a room to parry it. Thank you. And that was my goal with this, right? Like this person, they got a life to live. I don't want them

to spend time reading a technical manual. I want them to just get this thing from their doctor and be able to put it on kind of idiot's proof, I hate that term, but full proof in terms of just putting it on correctly and not have to read a manual and to be able to use it and heal. So Michael, the boots open toad, which is great if you live in Florida all year round, but you're up there in a different latitude. It's cold and your foot's cold. So how are we solving this problem?

But then I'm from Tokyo. Yeah, Michael, not everyone lives in Florida. What about us up here in Canada, eh? Very intentional, as you would have guessed, right? And Jason could speak to this more, but most of the folks that have this condition, right, their foot might be not a normal size. It might be swelling.

It might be wrapped in bandages. And Jason, do you want to speak to that from your professional? Sure. So everybody that goes in a foot defender has an open wound. That wound requires a bandage. If you put a closed toe on it, you're now confining a space. And you'll more likely get a rub or an area of pressure. And it'll be self-defeating.

What we found in cold temperatures is people are using really high technology. It's called a sock. You put a cold weather sock and even available are some thermally assisted socks, right? They have a battery that can warm

the foot. Electric socks? Yeah, they're totally toasty. So just so our seen those. Electric socks. Yeah, yeah, yeah. They're totally toasty. So just so our audience and I can remember, Jason, you're based where? Where are you now? South Florida, Miami. South Florida.

And Michael? Portland, Oregon. Opposite corner. Portland, Oregon. Okay, got it. But it's never really sub-freezing in Portland, right? It's always just cold and dank. Yeah, you get a little snow, but not much.

Yeah, yeah, okay. So that's where the Miami connection is coming in. You're in South Miami, Jason, right? Correct. Yeah, yeah. All right, let's take a quick break. When we come back, more on this sort of diabetic boot solution that might prevent amputations, which is something we would all want when StarTalk continues. We're back.

StarTalk Sports Edition. We've got Dr. Jason Hentft. Did I say that right, Jason? Hentft. Love it. And Michael DiTullo. Jason isentft. Did I say that right, Jason? Hentft. Love it. And Michael DiTullo. Jason is a surgeon who, unfortunately, is confronted with having to amputate many lower extremity from diseases, complications from diabetes.

And Michael DiTullo is figuring out how to not make that happen. And we need more folks like this walking among us in the world. So let's just pick up the conversation with this boot. Are we to say here that if you have a sore that develops on the bottom of the feet from complications from diabetes, this boot will allow it to heal? And do diabetics heal the way non-diabetics do, like on the same timeframe? And do they respond to the same topical medicines,

this sort of thing? Jason? Really interesting question. So the best way I can give you the answer to that is diabetics don't do anything the same as non-diabetics. But we do know that diabetics have the ability to that is diabetics don't do anything the same as non-diabetics. But we do know that diabetics have the ability to heal because wounds elsewhere in their bodies don't lead to an amputation every 20 seconds. And that's in the United States. Every 20 seconds,

someone in the U.S. is losing their leg to the complication of a diabetic fetal. Wow. That is disturbing. Yes. It's something we don't talk about, right? It's like, because like Jason said, there's this shame associated with it that someone feels like they're at fault. You hide it. You hide your wound in your shoe. You don't show anybody.

And so I think a big part of what we're trying to do is just get this out into the open and be like, hey, there's no shame in this. Let's fix it. I love that because, you know, this is one of the diseases that we often refer to as a lifestyle malady. And so the moment you add lifestyle to the description of the problem, it makes it seem like, well, you did this to yourself. You know, it's like lung cancer. People are far less likely to have compassion for a

person with lung cancer. Like, oh, you shouldn't have smoked. Yeah, yeah, forget yourself. It's terrible. Interesting point. It's terrible. So, Michael, maybe you can answer this. You would have traditionally gone to a medical device equipment manufacturer to do this.

But you turned around because you weren't getting the results you wanted and went to a shoe factory. Am I right? And why? What was not being delivered to you in the medical equipment manufacturer that you could get with a shoe factory? We struggled for two years. We were working with some medical device makers

to hit the performance targets, but we couldn't get the fit and finish that made it feel like an acceptable consumer product, that made it feel like you could get it at SlotLocker, to be short. And so we were having a brainstorm session in my studio, Jason and I, and I was like,

maybe we're just thinking about this totally wrong. We were working with a medical factory who were exposing all the hard plastic parts. And it just was a real challenge to make it look right. And then every time we wanted to make a change to tweak the performance, like massive tooling costs. I was like, let's start thinking about this less like a medical device and more like a technical shoe that has to do something. And I think we'll be able to train

a footwear factory how to make something with our technical parameters a lot easier than it would be to train a medical factory how to sew something like this. So that's what led to hiding all of the technical parts. You can just see these little, little peaks of it. You can see a tiny peak into the carbon fiber here. We expose it subtly, but by hiding all of it, we could create this nice piece of footwear. And then as we were prototyping and testing all different internal braces, we can make all those changes internally until we got the spec exactly right and then confirm that with the factory. And now we just check to make sure they're executing it exactly to the specification. Will you come live with me

and design everything in my house? Yes, let's do it. Do you do it all? Will you do something as simple as like a Michael Graves teapot? I love it. No, no, no. If you're a designer,

everything in front of you is subject to your scrutiny. I didapot. I love it. No, no, no. If you're a designer, everything in front of you is subject to your scrutiny. I did this watch. Oh my gosh. You know, yeah. There's no escaping it. It's a curse.

So Michael, you've incorporated a pump into this boot, haven't you? Now, for those of us of a certain vintage,

flashback to what? Was it late 80s, early 90s? Yeah, yeah. 80s, totally 80s. You've gone Reebok retro with a high top. Yeah.

Wait, let me just remind people. So was it Reebok? Yes. There was a pump, pump it up, where it was a high top sneaker. Oh, that's right. That had an air bag in it where you put on the sneaker, lace it up, but maybe it didn't fit perfectly in all places. So it had a pump on it which filled

the gaps with air so that your entire foot would be more smoothly snugly fit snugly fit is that the inspiration Michael?

were you borrowing? and it lasted it's like six months I think Neil you took my whole description from me but yeah you got it oh I'm sorry

I was just getting people up to speed so they can now listen to you. It's awesome. So Jason was like, hey, maybe we should put a pump in it to fill the gaps, right? Exactly like,

nobody's two legs are exactly the same. Even though it fits great and performs well, there could be this ceiling of gaps. So you fit it up and then you pump up the rest. And now you're basically just pushing the internal sleeve in constant contact with the body. So you get this proprioceptive effect that you feel much more secure.

So the bladder, the air bladder would fill in where it needs to and not fill in where it can't. Yes, because it's a totally custom fit. And then the bladder is basically shaped like a pair of lungs. So there's basically two chambers. It hovers over your heel. So you're kind of really locking the heel into place. So again, we don't want to cause any more injuries.

So any kind of repetitive movement inside is a potential for more injuries. Okay, Chris Rock was the lead performer in a Saturday Night Live skit back when that Reebok sneaker was popular. And it was Thanksgiving dinner. And it was in the spirit of the pump of the Reebok. They now sold turkeys that you could pump up. So the turkey had a little pump.

And you can make it bigger if you had more people coming for Thanksgiving. Just look that one up on Google. you should be able to find it so the other the other important and functional part of a pump is is not only sit but you can imagine if you're trying to control forces and the heel is pistoning up and down as the person walks because it's a rigid device if you don't lock the heel in you're going to load the front of the foot so it really it's all about this decreasing the pressure on the front of the forces on the front of the foot because that's where 88 of the wounds have wow so how widespread is this

product right now it's available everywhere in the united states we're shipping to other countries we really had our first product launch in April, commercially. Larry, that's so, so, so recent. Okay, I heard first product launch. Uh-oh, uh-oh. You've learned lessons from this. Obviously, it's taken more than five minutes to bring it from

a clean sheet of paper to this, what is it, a Category 1 medical device. What lessons have you learned along the journey? And how have you applied those then to new products? I don't think this show has enough time for all the lessons we've learned. Our entire team has learned lessons because we're doing things that no one's done before. Nobody has built a medical device for the lower extremity that is patient-centric, right?

Everything we did is built so that a patient will want to use it. Because if you had rocket boots and patients wouldn't wear them, what good are they? You've got rocket boots? Not yet, but we'll get there. Working on it. Oh, by the way, not to beat a dead horse,

but in the early days of the PC wars between IBM and Apple, Apple did not have much entry into the business world because IBM was already there. And Apple not have much entry into the business world because IBM was already there. And Apple got great inroads into the art world. So then how's Apple going to reach the business world? So they had a commercial where there's an Apple PC, there was a Mac, and there was an early in the Mac, and then there was an IBM PC. And the two executives are looking at it, and they say, which one is more powerful,

the Apple or the IBM PC? And then the person answers, the one that's more powerful is the one that people want to use. And there's a line of people waiting to use the Apple, the Mac. I love that. And there was like one person on the IBM PC.

That's all it is. That's that whole principle. Are you using it? Then it's useful. We don't claim to be the perfect pressure-reducing device, but we really are a pressure-reducing device that people can easily get on and off. And one of the things we discovered along the way was Michael and I and some other engineers spent a long time on this front spat,

the interior brace that Michael showed you earlier, and how it almost auto closes. You pull off three tabs, open it like a book, and then you let go and it falls back on itself. So it's really easy to do. But what we found was patients, about the first 50 to be exact, 49 out of 50, adjusted it once, put it on and off like a cowboy boot. They just slid their foot in, slid it out. They leave it by their bed at night. They don't have to adjust anything. They just slide their foot right in. And the device isn't designed to fit skin tight. It's designed to fit. It's small, medium, and large. So that's also where the pump part comes in handy. So if you're in between sizes, it'll help.

But with the device on and adjusted appropriately, it doesn't have to hug you tight or reduce circulation. Okay, so Michael, Jason just opened up a whole other product line here, which is you make this out of ostrich skin and other common leathers of cowboy boots, and you can start a whole new style. Oh, man. Right. Tell me about it. You'll own the market.

Yeah, and alligator skin. You'll corner the Texas market, that's right. The other learnings we found in all of our business has been built on what patients have told us. We essentially polled 5,000 patients and said, why aren't you using the devices you have? And the first answer was, I can't. The second answer was this stigma. I can't go to work and do it.

And the third one was, when I get home, I need to take my device off because it's dirty from being out in the world. So here are these people that are protecting their foot all day. They come home and they walk around in a sock or a flip-flop or a slide. And there's data out there that shows you actually walk more at home than you do at work for most people. So here they are all day being diligent. Then they come home and put their body weight times seven or more on their foot all night long. Okay. So Michael, you heard that, and then what did you do? Yeah, so I thought of, like, if we could think of the foot defender

as, like, our F1 car, right? This is where we're going to do all our research. F1 Formula One car. Listen to you. Oh, my gosh. Yeah. Okay. So this is where we're doing all of our R&D, right?

How can we take that down into, like, the BMW M3 that someone could drive to work every day, right? So we developed this product, the Cloud9. I drive my F1 to work every day. You get a ticket every day. My 12-year-old dream.

So this has all the same material science that went into the foot defender, but this is something someone could wear at home or when they don't into the foot defender, but this is something someone could wear at home or when they don't need the foot defender anymore or maybe before they even need the foot defender if we could get them ahead of time into something like this.

We're going to launch it in a bunch of different colors and it's just something you could rock around the house really comfortably. I would totally wear that no matter what. There you go. That is just like a super cool looking house. Wait, what's the difference between that and like clogs? It's the same architecture, right?

The same form factor. Yeah, it looks very Netherlands-y, right? Yes, but internally, we've got all the same material stack that's inside the foot defender. So that absorbium, those two absorbium pucks, there's like, how thick is that insole, Jason? Like 22 millimeter, yeah, 30 millimeter insole.

So it literally feels like you're walking on cloud nine. And then the last we developed, so- Just to be clear, cloud nine was a cloud rating system that where the ninth in the system was a cumulus cloud which included cumulus nimbus clouds the puffiest of the clouds

so that led to the tradition of saying I'm on cloud nine because you don't want to be on cloud seven because that's like cirrus clouds and you know

other whatever that's where angels go to die okay I actually never knew the origin of that yeah yeah it was a meteorologist who went around the world

and he classified cloud types. And it just so happened that cloud nine was the cumulus puffy cotton cloud in the sky. So, Jason, before we have to wrap all of this up, sadly, 130,000 amputations in the U.S. each year. How many do you estimate you could possibly take out of that number with this boot and this foot? So imagine if we could get our technology

on 10% of that number. Each one of those amputations costs the healthcare system half a million dollars. Each one? What? Now, the price of the amputation isn't for the surgery. It's the prosthetic. It's for the rehab

of the patient. It's for the healthcare of that patient. And by the way, the mortality rate at five years for these amputated diabetics is 50%. Damn. It's higher than most cancers. So you go from amputated diabetics is 50%. Damn. They're higher than most cancers.

So you go from amputation to five years of 50% mortality rate? Correct. Oh, my. So the whole idea behind our business, the whole idea behind the foot defender and its offshoots is stopping that moment of tipping from treating a wound to a mortal amputation. Right.

Wow. So can you talk to us about price point? Because it seems as though that might be an important factor. I looked online and there's like crap boots for like $60. And then there's like these super like high tech looking boots for $400 and everything in between. We are an approved reimbursable code by insurance. The code is L4361. It pays on average around the country around $295 for reimbursement.

So we're selling to doctors and medical distributors. They fix their own prices. Our current retail price is right in the middle of the range you just talked about at $250. Isn't that cheaper than modern Air Jordans? It's cheaper than a good pair of

running shoes at this point in time. That is just tremendous on every level. Congratulations guys. It's possible to put design and science That is just tremendous on every level. Congratulations, guys. Yeah, you guys, I mean, you know, it's possible to put design and science together and try to save the world. Didn't I tell you at the top, Neil?

The Sportiverse, try to find a solution to this problem. Exactly, exactly. Well, Michael, Jason, thank you for being guests on StarTalk. You've enlightened us and you've enlightened our audience. And we look forward to the end of an entire category of amputations because nobody wants to lose any part of their body at any time. All right, so you guys have a website or something that people can dial in on?

Absolutely, footdefender.com. Okay, that's clean and simple enough. Excellent. And Michael, do you have like a design page or something where I can just hang out in it? Yeah, you can just go to michaeldetulo.com or if you're on Instagram, the letter D, the number two, L-O,

Detulo, phonetically. Oh, okay. Yeah. I see what you, he designed that. Yeah, I see that. He even designed your own damn name. Yeah. All right, guys.

Gary, Chuck, always good to have you. Always a pleasure. I love this topic. And Gary, keep digging up these topics. Oh, yeah. This is coming out of your satchel. Yeah, we've got a production team, and we're going to keep mining. And hopefully we can find people of this quality and go forward.

Let's keep doing it. All right. Neil deGrasse Tyson here. As always, keep looking up.