Thermal symmetry of healthy feet: a precursor to a thermal study of diabetic feet prior to skin breakdown

Macdonald, Andrew; Petrova, Nina L.; Ainarkar, S; Allen, John; Plassmann, P.; Whittam, Aaron; Bevans, John; Ring, Francis; Kluwe, Ben; Simpson, Robert L.; Rogers, Leon J.; Machin, G; Edmonds, M E

doi:10.1088/1361-6579/38/1/33

Cited by 49 publications

(34 citation statements)

References 18 publications

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“…This highlights the importance of an individual approach in temperature measurement in a complex disease such as diabetes, where multiple factors interact. Our findings are in agreement with a recent study finding differences of >0⋅5 ∘ C in 50% of plantar sites measured in healthy feet (15). Therefore, the baseline temperature differences between the left and right foot need to be measured and taken into account for home monitoring of skin temperature, to optimise validity and reduce false-positive outcomes.…”

Section: Discussionsupporting

confidence: 92%

An explorative study on the validity of various definitions of a 2·2°C temperature threshold as warning signal for impending diabetic foot ulceration

Wijlens

Holloway

Bus

et al. 2017

International Wound Journal

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Home monitoring of skin temperature is effective to prevent diabetic foot ulceration. We explored the validity of various definitions for the >2·2°C left-to-right threshold used as a warning signal for impending ulceration. Twenty patients with diabetes and peripheral neuropathy monitored their skin temperature with an infrared thermometer at the plantar hallux, metatarsal heads, midfoot and heel four times a day for 6 consecutive days. Environmental temperature and walking activity were monitored and associated with foot temperature. The average temperature difference between feet was 0·65°C. At single locations, a left-to-right temperature difference of >2·2°C was found 245 times (8·5% of measurements). Confirmation of these above-threshold readings on the following day was found seven times (0·3%). Corrected for individual left-to-right mean foot temperature differences, this reduced to four (0·2%). No ulcers developed in the week after monitoring. Left-to-right foot temperature differences were not significantly correlated with walking activity, environmental temperature or time of day. The >2·2°C left-to-right foot temperature threshold for impending ulceration is not valid as single measurement, but validity improves to acceptable levels when an above-threshold temperature difference is confirmed the following day and further improves with individual correction. The threshold is independent of time of day, environmental temperature and walking activity.

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Section: Discussionsupporting

confidence: 92%

An explorative study on the validity of various definitions of a 2·2°C temperature threshold as warning signal for impending diabetic foot ulceration

Wijlens

Holloway

Bus

et al. 2017

International Wound Journal

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“…This type of abrupt temperature changes had been associated to inflammatory regions [14,17], with the condition that the contralateral region is 2.2°C colder (this condition has been questioned its validity [18]). However, this region of abrupt temperature change indicates a vasodilation-vasoconstriction problem on that region of the plantar skin.…”

Section: Discussionmentioning

confidence: 99%

“…The thermography of the lower limbs has shown to be useful for identifying ischemic and inflammatory regions on the lower limbs in the diabetic patients [12–14]. Moreover, several digital techniques are available to classify the thermogram of the diabetic patient, which makes the thermography an adequate technique to be used to explore the feet of the diabetic patients.…”

Section: Introductionmentioning

confidence: 99%

The abrupt temperature changes in the plantar skin thermogram of the diabetic patient: looking in to prevent the insidious ulcers

Renero-Carrillo

2018

Diabetic Foot & Ankle

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Background: One of the complications of the diabetes mellitus is the amputation of the lower limbs. This complication may be developed after an insidious ulcer, that may be raised by the peripheral neuropathy or the ischaemic limb, and that the ulcer get infected. That is, to develop an ulcer, in the diabetic patient, three factors should be taken into the account, the autonomic nervous system, the blood supply and the inmune system. Methods: In this work, the thermogram is used to identify regions on the plantar skin with blood supply deficiencies and the behaviour of the thermoregulation process. Within the thermogram of the plantar skin, it can be identify local regions with low and high temperatures that corresponds to ischemic or inflammatory process on that part of the skin. Results: The findings within the 186 thermograms of diabetic patients, obtained from three hospitals and from INAOE facilities, showed, first, the thermograms of the plantar skin of two diabetic patients, acquired in two different times show that the temperature distribution and the average temperatures, vary slightly for a period of weeks. Second, the thermograms of two patients, who both developed insidious ulcers which evolved favourable, demonstrated the importance of the immune system and the drug therapy. These patients are, one who has a Charcot foot, and in the second one, the patient had loss the sensibility of the feet. Finally, the thermograms of two patients, showing abrupt temperature change within small regions in the plantar skin, are discussed. Conclusion: A diabetic patient, with an asymmetric thermogram, as physiological interpretation of the thermoregulation, may indicate a decrease of the blood supply, which may be corroborated by vascular ultrasound. The regions of abrupt temperature change, cold or hot spots, may correspond to ischaemic or inflammatory processes.

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“…To test this hypothesis, a novel prototype of a thermal imaging system for the feet (the Diabetic Foot Ulcer Prevention System) was developed by Photometrix Imaging Ltd in association with the University of South Wales . The application of this device in the assessment of healthy feet, as well as its reliability in temperature assessment of feet, have been previously reported . We have now investigated the safety and the performance of this instrument in a clinical setting.…”

Section: Introductionmentioning

confidence: 99%

Infrared thermography and ulcer prevention in the high‐risk diabetic foot: data from a single‐blind multicentre controlled clinical trial

et al. 2019

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Aim To assess the usefulness of monthly thermography and standard foot care to reduce diabetic foot ulcer recurrence. Methods People with diabetes (n = 110), neuropathy and history of ≥ 1 foot ulcer participated in a single‐blind multicentre clinical trial. Feet were imaged with a novel thermal imaging device (Diabetic Foot Ulcer Prevention System). Participants were randomized to intervention (active thermography + standard foot care) or control (blinded thermography + standard foot care) and were followed up monthly until ulcer recurrence or for 12 months. Foot thermograms of participants from the intervention group were assessed for hot spots (areas with temperature ≥ 2.2°C higher than the corresponding contralateral site) and acted upon as per local standards. Results After 12 months, 62% of participants were ulcer‐free in the intervention group and 56% in the control group. The odds ratios of ulcer recurrence (intervention vs control) were 0.82 (95% CI 0.38, 1.8; P = 0.62) and 0.55 (95% CI 0.21, 1.4; P = 0.22) in univariate and multivariate logistic regression analyses, respectively. The hazard ratios for the time to ulcer recurrence (intervention vs control) were 0.84 (95% CI 0.45, 1.6; P = 0.58) and 0.67 (95% CI 0.34, 1.3; P = 0.24) in univariate and multivariate Cox regression analyses, respectively. Conclusions Monthly intervention with thermal imaging did not result in a significant reduction in ulcer recurrence rate or increased ulcer‐free survival in this cohort at high risk of foot ulcers. This trial has, however, informed the design of a refined study with longer follow‐up and group stratification, further aiming to assess the efficacy of thermography to reduce ulcer recurrence.

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Thermal symmetry of healthy feet: a precursor to a thermal study of diabetic feet prior to skin breakdown

Cited by 49 publications

References 18 publications

An explorative study on the validity of various definitions of a 2·2°C temperature threshold as warning signal for impending diabetic foot ulceration

An explorative study on the validity of various definitions of a 2·2°C temperature threshold as warning signal for impending diabetic foot ulceration

The abrupt temperature changes in the plantar skin thermogram of the diabetic patient: looking in to prevent the insidious ulcers

Infrared thermography and ulcer prevention in the high‐risk diabetic foot: data from a single‐blind multicentre controlled clinical trial

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