Prediction of Diabetic Foot Ulceration: The Value of Using Microclimate Sensor Arrays

Abstract

Background: Accurately predicting the risk of diabetic foot ulceration (DFU) could dramatically reduce the enormous burden of chronic wound management and amputation. Yet, the current prognostic models are unable to precisely predict DFU events. Typically, efforts have focused on individual factors like temperature, pressure, or shear rather than the overall foot microclimate. Methods: A systematic review was conducted by searching PubMed reports with no restrictions on start date covering the literature published until February 20, 2019 using relevant keywords, including temperature, pressure, shear, and relative humidity. We review the use of these variables as predictors of DFU, highlighting gaps in our current understanding and suggesting which specific features should be combined to develop a real-time microclimate prognostic model. Results: The current prognostic models rely either solely on contralateral temperature, pressure, or shear measurement; these parameters, however, rarely reach 50% specificity in relation to DFU. There is also considerable variation in methodological investigation, anatomical sensor configuration, and resting time prior to temperature measurements (5-20 minutes). Few studies have considered relative humidity and mean skin resistance. Conclusion: Very limited evidence supports the use of single clinical parameters in predicting the risk of DFU. We suggest that the microclimate as a whole should be considered to predict DFU more effectively and suggest nine specific features which appear to be implicated for further investigation. Technology supports real-time in-shoe data collection and wireless transmission, providing a potentially rich source of data to better predict the risk of DFU.

In-shoe pressure thresholds for people with diabetes and neuropathy at risk of ulceration: A systematic review

“…A previous narrative analysis [29] covered both barefoot and in-shoe pressure analysis but we attempted a more comprehensive treatment of specific in-shoe pressure thresholds through a formal systematic review to reveal both the multiple ways in which thresholds are currently employed and the wide variation in their usage. This systematic review is focused on in-shoe plantar pressure in isolation, but pressure is just one aspect of foot microclimate monitoring that potentially includes temperature and humidity [62] not to mention growing research around wearables such as accelerometers which can measure physical activity type and intensity. In-shoe pressure thresholds may become part of multi-factorial prognostic models.…”

Machine learning prediction of diabetic foot ulcers in the inpatient population

“…[28][29][30][31][32][33][34] There has been extensive work toward the prediction of foot ulceration in patients with diabetes, but the main focus of previous attempts has involved using physical parameters to predict ulceration. 35,36 These parameters include temperature, humidity, pressure, and shear forces. Studies of this nature are often highly labor intensive, technically challenging, and expensive which inturn limits the sample size.…”

Relationship between Plantar Pressure and Sensory Disturbance in Patients with Hansen’s Disease—Preliminary Research and Review of the Literature

“…A further intervention study to compare orthotic treatment with and without detailed assessment with plantar pressure and sensation will be necessary. Lastly, while the "microclimate" of the plantar surface of the foot is focused on in the field of diabetes foot research, many of its elements (i.e., shear stress, temperature and humidity) were not considered [72,73]. Since there have been no reports, to the best of our knowledge, applying this principle in the field of Hansen's disease, further investigations will be fruitful.…”