Thermography and Thermometry in the Assessment of Diabetic Neuropathic Foot: A Case for Furthering the Role of Thermal Techniques

Abstract

There are currently 3 established techniques employed routinely to determine the risk of foot ulceration in the patient with diabetes mellitus. These are the assessment of circulation, neuropathy, and foot pressure. These assessments are widely used clinically as well as in the research domain with an aim to prevent the onset of foot ulceration. Routine neuropathic evaluation includes the assessment of sensory loss in the plantar skin of the foot using both the Semmes Weinstein monofilament and the biothesiometer. Thermological measurements of the foot to assess responses to thermal stimuli and cutaneous thermal discrimination threshold are relatively uncommon. Indeed, there remains uncertainty regarding the importance of thermal changes in the development of foot ulcers. Applications of thermography and thermometry in lower extremity wounds, vascular complications, and neuropathic complications have progressed as a result of improved imaging software and transducer technology. However, the uncertainty associated with the specific thermal modality, the costs, and processing times render its adaptation to the clinic. Therefore, wider adoption of thermological measurements has been limited. This article reviews thermal measurement techniques specific to diabetic foot such as electrical contact thermometry, cutaneous thermal discrimination thresholds, infrared thermography, and liquid crystal thermography.

Application of infrared thermography in computer aided diagnosis

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Screening of Foot Inflammation in Diabetic Patients by Non-Invasive Imaging Modalities

“…Thermometry of the diabetic foot has been established as an effective way for detecting inflammation and for assessing risks of ulceration (Bharara et al, 2006). Acute increase of the plantar temperature is regarded as a predisposing sign for pre-ulcer inflammation, requiring urgent intervention.…”

“…Thermography can estimate circulation and vascular patency by visualizing temperature distribution (Bharara et al, 2006;Nagase et al, 1996), and thus, it may be a potentially ideal tool for assessing inflammation and vascular stenosis of diabetic foot. We are using infrared (IR) thermography Nishide et al, 2009), which were also used in some of the abovementioned studies of diabetic foot thermometry (Sun et al, 2005;Sun et al, 2008;Sun et al, 2006) and in the more recent report evaluating healing tendency of the diabetic foot ulcer (Bharara et al, 2010).…”

An intelligent telemedicine system for detection of diabetic foot complications

“…Inflammation plays a central role in the occurrence of two of the most devastating diabetic foot complications, which are DFU and Charcot's Foot, while increased plantar foot temperature is one of the main indicators of inflammation [60][61][62][63][64][65]. Monitoring the temperature changes in diabetic foot frequently can be significantly useful in diabetic foot management with the intent to determine the risk of DFU [5,6,[63][64][65][66][67][68][69][70][71].…”

“…Monitoring the temperature changes in diabetic foot frequently can be significantly useful in diabetic foot management with the intent to determine the risk of DFU [5,6,[63][64][65][66][67][68][69][70][71].…”