## 4 Discussion and Conclusions  
Although wearable sensors are ubiquitously present on the market for health and sport activities, the same is not true for the medical application sector. Usable and useful patient-empowering telemedical applications in the disease context are still mainly research examples. This is, in part, due to the substantially higher requirements regarding development and regulatory hurdles for medical products. Nevertheless, many systems are on the verge of entering the new area of digital medicine. They have great potential to increase quality of life and care, prevent comorbidity, and improve healthcare processes. Wearable sensors will change the way that healthcare is conducted. The associated economic changes that this process will bring, as well as the requirements for the regulation of data and ethics, are largely unaddressed at this point in time. In any case, smart shoes as part of the IoHT will play an important role in this change process. Gait is an ideal target parameter, since it defines mobility and autonomy as the major aspects of quality of life in health and disease. A review article by [PERSON] et al. [97] underlines this, reporting a shift of interest towards body-worn sensor-based systems for gait analysis. In our opinion, the field of gait analysis should move even more from instrumented tests that increase the objectiveness and transparency of classical healthcare strategies towards pervasive telemedicine solutions that enable new monitoring concepts for continuous and individualized healthcare integrated into the everyday environment of patients. However, in order to move the medical application field forward, there is a definite need for more translational research between engineering and medical experts. According to a recently published review article in the field of gait assessment using inertial sensors [25], only 30% of the 669 analyzed papers include relevant patient cohorts, and only 13% of the papers actually report on an application in an operational clinical environment required for the highest technology readiness levels. In our opinion, the steps required to pave the way for a better clinical application of wearable sensors are the following:  
1. address disease-specific gait characteristics by objective and quantifiable gait parameters
2. assess the validity and reproducibility of gait-related measures
3. provide secure, safe, and reliable telemedical communication platforms linking wearable sensor-based diagnostics, patient, therapists, and care givers
4. integrate the medical and technological requirements during the development phase of wearable sensors
5. target user experience, both from medical- and consumer-use perspectives; this should also be a target of academic investigations using statistics and discussion on user compliance for different types of smart shoes (materials, features, usability)
6. include regulatory and economic requirements in the development process
7. motivate researchers to comprehensively address both technological solutions and medical requirements, and demonstrate their relevance in operational clinical environments. The example of sensor-based gait assessment nicely reveals that even though activity patterns are suitable to generate relevant parameters for healthy living, more advanced algorithms and experimental designs are needed for sport applications, but are needed even more importantly in the disease context. Close collaboration between engineers and clinicians is necessary to understand the needs of both fields (technical and medical), and to finally develop a practical solution that fits with the technical requirements and that is able to support medical experts in clinical diagnostics and care. As a third group, it is necessary to include patients in this digital health system, since the aim is to improve their care concept. In this context, it is necessary to evaluate the patients' needs and satisfaction during the use of newly developed telemedical applications.