# OpenFootLab.com — the intelligence layer that feeds the ecosystem

_The verdict, with the defendable data behind it. Question on the table: should openfootlab.com be
the condition-agnostic **lab / intelligence** domain that feeds the ecosystem?_

## The keystone (from the founder, lived)

> "I personally see my **foot health as my #1 condition — not diabetes**. I understand diabetes
> increases complications and high risk — yes. But the foot is what I manage."

This is the entire thesis, said by the person who lives it. It is *more* defensible than the
diabetes framing, not less: the moat was never "I live diabetes" — it's **"I live the at-risk
foot."** Diabetes is a **risk multiplier**, not the condition being managed. If the founder — a
type-1 diabetic post-amputation — ranks foot health above diabetes, then a **foot-at-risk
platform** is the honest product, and a **foot** intelligence domain (openfootlab.com) is its
honest home. The diagnosis is the setting; the foot is the subject.

## Verdict: **Yes — with discipline.**

Build openfootlab.com as the **intelligence layer** — the home of the models, the studies, the
Foot Passport open spec, the datasets, the evals, and the clinical-review program. It **feeds**
the consumer products (LocalDiabetic is the flagship, driven by the lived-diabetic moat; athletes,
amputees, neuropathy patients are future front doors). It does **not** replace LocalDiabetic and it
must **consolidate** the foot-lab intelligence, not add sprawl.

## Why (the case for)

**1. The intelligence is foot-health, and that's defendable beyond diabetes.** You can only name a
lab after what it actually studies. The thing we're building — capture standards, the MedGemma
foot models, the observation schema, the passport spec, the LocalStudies — is *foot-health
intelligence*. It is not diabetes-specific, and the data proves it (below). Boxing it under
"OpenDiabetic" mislabels the asset and structurally caps who can draw on it.

**2. A neutral hub is the only thing every segment can share.** A diabetic can't be the front door
for an athlete, an amputee, or a chemo patient with neuropathy — "opendiabetic.com" actively
repels them. "openfootlab.com" invites all of them. One lab, many products.

**3. Separation of concerns = leverage.** Lab (intelligence) vs Product (the app someone uses).
The lab cooks once and feeds many. LocalDiabetic consumes it for the diabetic wedge; a future
"performance foot" product consumes the same models and passport for athletes. You build the
expensive thing (models, evals, spec) once.

**4. A "lab" is where you publish receipts — which is the whole ethos.** LocalStudy (FL-STUDY-001),
the Foot Passport open spec, the golden set, the MedGemma accuracy work, the clinician-review
program — these read as *research infrastructure*. That's defendability made visible. A lab domain
is the natural, credible home for "proven, not promised."

**5. The Foot Passport is already condition-agnostic** (spec v1.0, prompt v2, free-text profile).
It was built to hold any at-risk foot. It wants a condition-agnostic home. openfootlab.com is it.

## Why-not (the failure modes to avoid)

- **Don't fragment the brand.** There are already many diabetic-* domains. openfootlab.com only
  earns its place if it is THE singular lab hub that *consolidates* the foot intelligence currently
  split between opendiabetic.com and the passport work — not a tenth scattered site. One logo, one
  design, one voice (brand discipline holds).
- **Don't abandon the lived moat.** The "I live the disease" story and the diabetic wedge are the
  personal, defensible edge. LocalDiabetic stays the flagship consumer product and the human story.
  OpenFootLab is the engine underneath, not a rebrand away from it.
- **Don't split SEO/GEO.** Canonical strategy: openfootlab.com = the lab (models/studies/spec/
  datasets); consumer products link *up* to it as the source of truth. Avoid duplicate foot content
  competing between opendiabetic.com and openfootlab.com — pick the canonical home and redirect.
- **Only worth it if maintained.** A vanity domain that rots hurts credibility. Stand it up as the
  real hub or not at all.

## The defendable data (why the thesis holds)

Foot risk is defined by a **mechanism, not a diagnosis** — can't *feel* it (neuropathy), can't
*heal* it (ischemia), can't take the *pressure* (deformity/missing tissue). None require diabetes:

- **Amputation:** of people *living* with limb loss, **~45% is trauma** (mostly young men, MVCs the
  leading cause) and only ~2/3 of the vascular half is diabetic → **more than half of amputees are
  not diabetic.** [Ziegler-Graham 2008; NTDB]
- **Insensate (non-diabetic) populations, large:** chemotherapy-induced neuropathy in **~52%** of
  chemo patients (persists in ~58% of breast-cancer survivors); Charcot-Marie-Tooth (most common
  hereditary neuropathy); spinal cord injury (pressure-ulcer prevalence **23–39%**); spina bifida;
  **leprosy — the #1 cause of the insensate foot worldwide;** rheumatoid arthritis (foot
  involvement **30–90%**, ulcers ~10%). [PMC sources in `Foot-Risk-Beyond-Diabetes.md`]
- **Athletes:** the foot is **~20% of all sports injuries**; plantar fasciitis hits **~17% of
  runners**; black toenail, stress fractures, blisters — foot problems that end seasons. A large,
  self-motivated, *non-medical* wedge. [NCAA data; plantar-fasciitis reviews]
- **The record itself is the value:** care is fragmented (typical patient = 2 PCPs + 5 specialists /
  4 practices per year); the owned, portable, longitudinal passport is the continuity the system
  can't provide.

Conclusion: **"other conditions require foot-health monitoring" is not a claim — it's the
epidemiology.** That confirms the premise, so the answer to "then do we build the neutral lab
domain?" is yes.

## What lives on openfootlab.com

- **LocalStudy** — the open evals (FL-STUDY-001 and forward), pre-registered, receipts public.
- **The Foot Passport open spec** — the portable format any software can implement.
- **The models** — MedGemma foot-LoRA (27B cook / 4B edge), the SigLIP classifier, versioned with
  golden-set scores.
- **The datasets / golden set** — clinician-labeled ground truth (opt-in, PHI-safe).
- **The clinical-review program** — the podiatrist-in-the-loop that turns behavior into
  clinically-sound (Dr. G is the first reviewer).
- **The intel** — the deep dives (beyond-diabetes, the record you own, MedGemma accuracy roadmap).

Consumer products (LocalDiabetic first) draw from all of it. **OpenFootLab is the brain; the apps
are the hands.**

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_Positioning line: **"OpenFootLab — the foot-health intelligence that feeds the ecosystem. You
don't have to be diabetic to need it."**_