Infrared dermal thermometry is highly reliable in the assessment of patients with Charcot neuroarthropathy

Abstract

Background Charcot neuroarthropathy (Charcot foot) is a serious limb-threatening complication most commonly seen in individuals with diabetic peripheral neuropathy. Although dermal thermometry is widely used by clinicians to assist in the diagnosis, monitoring, and management of the disease, there is limited high-quality evidence to support its reliability. Therefore, this study investigated the intra-rater and inter-rater reliability of infrared dermal thermometry in patients with Charcot neuroarthropathy. Methods We collected clinical, demographic, health status, and foot examination information on 32 adults with Charcot neuroarthropathy from a metropolitan high-risk foot service in Melbourne, Australia. Infrared dermal thermometry assessments were conducted by two independent raters at 10 anatomical sites of the Charcot foot using both a (i) touch and (ii) non-touch technique. Intra-rater and inter-rater reliability of the two assessment techniques were evaluated using intra-class correlation coefficients (ICCs), limits of agreement, standard error of measurement, and minimal detectable change statistics. Results Mean age was 59.9 (standard deviation [SD], 10.5) years, 68.8% were male, average duration of diabetes was 20.6 (SD, 15.1) years, 71.9% had type 2 diabetes, 93.8% had peripheral neuropathy, 43.8% had peripheral arterial disease, and 50% had previous foot ulceration. Charcot foot most commonly affected the tarsometatarsal joints (38.9%), had a median duration of 2.8 (interquartile range [IQR], 1.3 to 5.9) months, and a large proportion were being treated with total contact casting (69.4%). Overall, there was good to excellent intra-rater and inter-rater relative reliability for the ‘touch’ technique (ICC, 0.87 to 0.99; ICC, 0.83 to 0.98, respectively), and excellent intra-rater and inter-rater relative reliability for the ‘non-touch’ technique (ICC, 0.93 to 0.99; ICC, 0.91 to 0.99, respectively). In addition, measurement error was found to be relatively low across the 10 anatomical sites. Conclusions Infrared dermal thermometry can now be used with confidence in clinical and research settings to provide a reliable assessment of skin temperature in patients with Charcot neuroarthropathy, using either a touch or non-touch technique at 10 commonly used testing sites. A non-touch technique, however, was observed to have slightly higher reliability indicating it may be associated with less measurement error than the touch technique.

Duration of total contact casting for resolution of acute Charcot foot: a retrospective cohort study

“…After a 15-min acclimatisation period (i.e. following removal of the TCC and contralateral footwear/hosiery) [ 41 ], ten anatomical sites (plantar 1st/3rd/5th metatarsal heads, plantar aspect of base of 5th metatarsal [styloid process], dorsal aspect of base of 3rd metatarsal, medial aspect of base of 1st metatarsal, medial aspect of navicular, plantar medial tubercle of calcaneus, medial malleolus and lateral malleolus) are tested weekly, then extended out to fortnightly when oedema has stabilised [ 42 ].…”

Bone Marrow Changes and Lesions of Diabetic Foot and Ankle Disease: Conventional and Advanced Magnetic Resonance Imaging

“…Despite all the advances in MRI, no gold standard is currently available for the early diagnosis of active CNA, and most clinicians use the 2-degree Celsius temperature difference between two feet for the diagnosis. 45…”

Applications of thermal imaging with infrared thermography in Orthopaedics

“…They concluded that it can be used in clinical settings with good to excellent intra-rater and inter-rater relative reliability for both the techniques. [14] Nube et al quantified the temperature changes in Charcot's arthropathy; in acute phases there is increased local temperature with lower temperatures later on. The temperature variations due to treatment modalities can also be documented with IRT, which can monitor the progress of Charcot's arthropathy and study its pathogenesis and effects of management.…”