Diabetic foot ulcer prevention by home monitoring of temperature

NewsBot · Aug 21, 2020

Assessing Diabetic Foot Infections With the ThermoScale: A Comparative Thermometry Device Designed as a Patient Self-Screening Tool
Laure Arts et al
Int J Low Extrem Wounds. 2020 Aug 19

Diabetic foot infection (DFI) is an important risk factor for amputation, and late diagnosis or referral is often incriminated for poor outcome. To enable an earlier diagnosis of DFI, comparative foot thermometry has been suggested as a self-screening method for patients in a home setting. We validated the efficacy of the ThermoScale, a weighing scale outfitted with temperature sensors that allows accurate temperature measurement in both feet. Temperature differentials in DFI patients (n = 52) were compared with a control group of similar diabetic patients (n = 45) without any foot wounds. Based on these findings, we drafted a receiver operating characteristic curve to determine an area-under-the-curve of 0.8455. This value suggests that the ThermoScale, as a diagnostic test, is reasonably accurate. A cutoff value of 2.15 °C temperature difference corresponded with a sensitivity of 88.9% and a specificity of 61.5%. As wearables, portable health electronics, and telemedicine become increasingly popular, we think that comparative temperature measurement technology is valuable in improving early diagnosis of DFIs.
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NewsBot · Sep 20, 2020

Infrared dermal thermometry is highly reliable in the assessment of patients with Charcot neuroarthropathy
Sarah M. Dallimore, Nicholas Puli, Daniel Kim & Michelle R. Kaminski
Journal of Foot and Ankle Research volume 13, Article number: 56 (2020)

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.
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NewsBot · Nov 6, 2020

The Handheld Infrared Thermometry in the Diabetic Foot – Useful but Debatable Technique
Elena-Rodica Perciun et al
Vol 27 No 3 (2020): Issue 3/2020 The Romanian Journal of Diabetes, Nutrition and Metabolic Diseases

The noncontact (handheld) infrared thermometers are valuable instruments for evaluating diabetic foot pathology and foot ulcers prevention. Since there is no guideline to indicate the exact way they should be used, clinical judgement helps integrate the collected data in the case management process. Foot care providers have to consider that some factors might interfere with the measurement correctness. It has been suggested that in some cases other investigations have to be performed before taking any decisions, besides thermometry.
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NewsBot · Feb 14, 2021

Prevention of diabetic foot ulcers using a smartphone and mobile thermography: a case study
Makoto Oe et al
J Wound Care. 2021 Feb 2;30(2):116-119

Objective: Early identification of pre-ulcerative pathology is important to preventing diabetic foot ulcers (DFU), but signs of inflammation are difficult to detect on the feet of patients with diabetic neuropathy due to decreased sensation. However, infrared thermography can objectively identify inflammation. Therefore, a device that allows patients to visualise thermograms of their feet might be an effective way to prevent DFU. We aimed to determine the effects of a novel self-monitoring device to prevent DFU using a thermograph attached to a smartphone.

Method: A self-monitoring device comprising a mobile thermograph attached to a smartphone on a selfie stick was created, and its effects in two patients with diabetic neuropathy and foot calluses assessed.

Results: For one patient, he understood that walking too much increased the temperature in the skin of his feet (a sign of inflammation). The other patient could not detect high-risk findings, because the temperature of his skin did not increase during the study period.

Conclusion: This device might provide self-care incentives to prevent DFU, although some issues, such as the automatic detection of high-risk thermographic changes, need to be improved.
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NewsBot · Sep 22, 2021

Effectiveness of at-home skin temperature monitoring in reducing the incidence of foot ulcer recurrence in people with diabetes: a multicenter randomized controlled trial (DIATEMP)
Sicco A Bus et al
BMJ Open Diabetes Res Care. 2021 Sep;9(1):e002392

Introduction: The skin of people with diabetic foot disease is thought to heat up from ambulatory activity before it breaks down into ulceration. This allows for early recognition of imminent ulcers. We assessed whether at-home monitoring of plantar foot skin temperature can help prevent ulcer recurrence in diabetes.

Research design and methods: In this parallel-group outcome-assessor-blinded multicenter randomized controlled trial (7 hospitals, 4 podiatry practices), we randomly assigned people with diabetes, neuropathy, foot ulcer history (<4 years, n=295), or Charcot's neuro-arthropathy (n=9) to usual care (ie, podiatric treatment, education, and therapeutic footwear) or usual care plus measuring skin temperatures at 6-8 plantar sites per foot each day (enhanced therapy). If ∆T>2.2°C between corresponding sites on the left and right foot for two consecutive days, participants were instructed to reduce ambulatory activity until this hotspot disappeared and contact their podiatrist. Primary outcome was ulcer recurrence in 18 months on the plantar foot, interdigital, or medial/lateral/anterior forefoot surfaces; secondary outcome was ulcer recurrence at any foot site.

Results: On the basis of intention-to-treat, 44 of 151 (29.1%) participants in enhanced therapy and 57 of 153 (37.3%) in usual care had ulcer recurrence at a primary outcome site (RR: 0.782 (95%CI 0.566 to 1.080), p=0.133). Of the 83 participants in enhanced therapy who measured a hotspot, the 24 subsequently reducing their ambulatory activity had significantly fewer ulcer recurrences (n=3) than those in usual care (RR: 0.336 (95% CI 0.114 to 0.986), p=0.017). Enhanced therapy was effective over usual care for ulcer recurrence at any foot site (RR: 0.760 (95% CI 0.579 to 0.997), p=0.046).

Conclusions: At-home foot temperature monitoring does not significantly reduce incidence of diabetic foot ulcer recurrence at or adjacent to measurement sites over usual care, unless participants reduce ambulatory activity when hotspots are found, or when aiming to prevent ulcers at any foot site.
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NewsBot · Oct 13, 2021

Infrared Thermography as a Diagnostic Tool for the Assessment of Patients with Symptomatic Peripheral Arterial Disease Undergoing Infrafemoral Endovascular Revascularisations
Gladiol Zenunaj et al
Diagnostics (Basel). 2021 Sep 17;11(9):1701

Aim: The aim of this study was to evaluate the utility and reliability of temperature foot changes measured by infrared thermography (IRT) for the evaluation of patients with atherosclerotic peripheral arterial disease (PAD) before and after endovascular revascularisation.

Methods: This is an observational prospective study carried out on symptomatic PAD patients. Evaluations consisted of a clinical examination, duplex scan with ankle-brachial index calculation (ABI) and IRT measurements with infrared camera FLIR-ONE connected to a smartphone with android technology. Locations on the foot sampled with IRT were the anterior tibial, pedal, posterior and arcuate arteries. Results obtained with IRT on the symptomatic foot were compared to the contralateral foot and with the ABI values obtained bilaterally before and 24 h after revascularisation.

Results: Within one year, 40 patients were enrolled, among whom 87,5% suffered from critical limb ischaemia. In three patients, it was impossible to obtain ABI measurements because of ulcerations on the limb. Skin temperature changes obtained by IRT between the symptomatic limb and the contralateral limb had a mean difference of 1.7 °C (range: 1.1-2.2 °C), p < 0.001. There was a positive correlation between ABI and temperature values of the limb needed for treatment before revascularisation (p = 0.025; r = 0.36) and after revascularisation (p = 0.024, r = 0.31). The technical success rate was 100% in all cases, achieving a significant increase in temperature at all points of the foot analysed, with a median change of 2 °C (p < 0.001).

Conclusion: IRT is a safe, reliable and simple application. It could be a valuable tool for the assessment of the clinical presentation and severity of foot blood perfusion in symptomatic PAD patients and the evaluation of the technical success of endovascular revascularisation. IRT might have a role in follow-up of revascularisation procedures.
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NewsBot · Oct 17, 2021

Remote Diabetic Foot Temperature Monitoring for Early Detection of Diabetic Foot Ulcers: A Cost-Effectiveness Analysis
Brooks E, Burns M , Ma R, Scholten HJ, Becker S
ClinicoEconomics and Outcomes Research » Volume 13

Background: Foot temperature monitoring for the prevention and early detection of diabetic foot ulcers (DFU) is evidence-based and recommended in clinical practice. However, easy-to-use remote monitoring tools have been lacking, thereby preventing widespread adoption.
Objective: To evaluate the cost-effectiveness of remote foot temperature monitoring (RFTM) (Siren’s Neurofabric™ Diabetic socks) in addition to standard of care (SoC) versus SoC alone for early detection of DFU with diabetic neuropathy and a moderate to high risk of DFU.
Methods: A payer perspective decision-tree analysis was conducted to compare expected DFU occurrence and subsequent amputation rates and costs between treatment strategies over one year. Inputs in the model were sourced from publicly available literature and relevant health technology assessments. One-way sensitivity analyses were performed for each model variable.
Results: In the base-case scenario, RFTM plus SoC was a dominant strategy compared to SoC alone. RFTM plus SoC was associated with cost savings of $38,593 per additional ulcer avoided versus SoC alone, and $8027 per patient per year on average compared to SoC alone. These results were highly robust to one-way sensitivity analysis; all scenarios remained dominant if compliance was ≥ 13%.
Conclusion: RFTM is a cost-effective addition to SoC in patients with diabetic neuropathy at a moderate-to-high risk of DFU and subsequent amputation. Further, reduction in DFU and associated complications may result in improvements in the patient’s quality of life and mental health. Future studies are needed to evaluate the compliance and reduction of DFU occurrence in patients on RFTM.
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NewsBot · Dec 26, 2021

Is a Left-to-Right >2.2°C Difference a Valid Measurement to Predict Diabetic Foot Ulceration in People with Diabetes and a History of Diabetic Foot Ulceration?
Jill Featherston, Anke M. Wijlens, Jaap J. van Netten
The International Journal of Lower Extremity Wounds December 20, 2021

Monitoring foot skin temperatures at home have been shown to be effective at preventing the occurrence of diabetic foot ulcers. In this study, the construct validity of using >2.2°C difference between contralateral areas on the foot as a warning sign of imminent ulceration is explored. Thirty participants with diabetes at high risk of ulceration (loss of protective sensation and previous ulceration and/or amputation) monitored their foot temperatures at six sites, four times a day for six days using a handheld infrared thermometer. Walking activity, time of day, and environmental temperature were also monitored and correlated with foot temperatures. We found that contralateral mean skin temperature difference was 0.78°C at baseline. At single sites, left-to-right temperature differences exceeding the threshold were found in 9.6% of measurements (n = 365), which reduced to 0.4% when individually corrected and confirmed the next day. No correlation was found between contralateral temperature differences and activity, time of day, and environmental temperature. We conclude that using a >2.2°C difference is invalid as a single measurement in people at high risk of ulceration, but the construct validity is appropriate if both individual corrections and next day confirmation are applied.
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NewsBot · May 27, 2022

Meta-analysis of randomised controlled trials testing the effect of at-home foot temperature monitoring and reduction of ambulatory activity in response to hotspots on the incidence of diabetes-related foot ulcers
Jonathan Golledge et al
Diabetes Metab Res Rev. 2022 May 23

Aim: To perform an updated systematic review of randomised controlled trials examining the efficacy of at-home foot temperature monitoring in reducing the risk of a diabetes-related foot ulcer (DFU).

Methods: Systematic review performed according to PRISMA guidelines. Risk-of-bias was assessed using version 2 of the Cochrane risk-of-bias tool. Meta-analyses were performed using random effects models. Leave-one-out sensitivity analyses and a sub-analysis excluding trials considered at high risk-of-bias assessed the consistency of findings. The certainty of the evidence was assessed with GRADE.

Results: Five randomised controlled trials involving 772 participants meeting the IWGDF risk category 2 or 3 were included. All trials reported instructing participants to measure skin temperature at-home at six or more sites on each foot using a hand-held infra-red thermometer at least daily and reduce ambulatory activity in response to hotspots (temperature differences >2.2°C on two consecutive days between similar locations in both feet). One, one and three trials were considered at low, moderate and high risk-of-bias respectively. Participants allocated to at-home foot temperature monitoring had a reduced risk of developing a DFU (relative risk 0.51, 95% CI 0.31 to 0.84) compared to controls. Sensitivity and sub-analyses suggested that the significance of this finding was consistent. The GRADE assessment suggested a low degree of certainty in the finding.

Conclusion: At-home daily foot temperature monitoring and reduction of ambulatory activity in response to hotspots reduces the risk of a DFU in moderate or high risk people with a low level of certainty.
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NewsBot · May 31, 2022

Wearable medical apparatus to monitor temperature and pulsatile-blood-flow signal on forefoot to predict diabetic foot ulcers
Rameesh Lakshan Bulathsinghala, Serosha Mandika Wijeyaratne, Sandun Fernando, Thantirige Sanath Siroshana Jayawardana, Vishvanath Uthpala Indrajith Senadhipathi Mudiyanselage, Samith Lakshan Sunilsantha Kankanamalage
Research Journal of Textile and Apparel: 25 May 2022

Purpose
The purpose of this paper is to develop a prototype of a wearable medical device in the form of a bandage with a real-time data monitoring platform, which can be used domestically for diabetic patients to identify the possibility of foot ulceration at the early stage.

Design/methodology/approach
The prototype can measure blood volumetric change and temperature variation in the forefoot area simultaneously. The waveform extracted using a pulsatile-blood-flow signal was used to assess blood perfusion-related information, and hence, predict ischemic ulcers. The temperature difference between ulcerated and the reference was used to predict neuropathic ulcers. The medical device can be used as a bandage during the application wherein the sensory module is placed inside the hollow pocket of the bandage. A platform was developed through a mobile application where doctors can extract real-time information, and hence, determine the possibility of ulceration.

Findings
The height of the peaks in the pulsatile-blood-flow signal measured from the subject with foot ischemic ulcers is significantly less than that of the subject without ischemic ulcers. In the presence of ischemic ulcers, the captured waveform flattens. Therefore, the blood perfusion from arteries to the tissue of the forefoot is considerably low for the subject with ischemic ulcers. According to the temperature difference data measured over 25 consecutive days, the temperature difference of the subject with neuropathic ulcers occasionally exceeded the 4 °F range but mostly had higher values closer to the 4 °F range. However, the temperature difference of the subject who had no complications of neuropathic ulcers did not exceed the 4 °F range, and the majority of the measurements occupy a narrow range from −2°F to 2 °F.

Originality/value
The proposed prototype of wearable medical apparatus can monitor both temperature variation and pulsatile-blood-flow signal on the forefoot simultaneously and thereby predict both ischemic and neuropathic diabetes using a single device. Most importantly, the wearable medical device can be used domestically without clinical assistance with a real-time data monitoring platform to predict the possibility of ulceration and the course of action thereof.
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NewsBot · Jun 1, 2022

Plantar temperature and pressure distribution in subjects with diabetes mellitus and chronic charcot arthropathy – A case control study
Jinson Paul, K Felix Jebasingh, Suranjan Bhattacharji1, Suresh Devasahayam2, Kripa Elizabeth Cheriyan, and Nihal Thomas
Indian J Endocrinol Metab. 2022 Mar; 26(Suppl 1): S27.

Background: Chronic Charcot Arthropathy is a potentially limb- threatening complication of diabetes mellitus.

Aim: To assess the plantar temperature and pressure variation on graded ambulation in subjects with diabetes mellitus and chronic Charcot arthropathy in comparison to healthy subjects.

Results: A total of 24 cases and 26 controls were included. The mean forefoot temperature was significantly higher in the Charcot's foot of patients when compared to the controls at baseline, after 50, 100 and 200 steps. Graded ambulation resulted in reduction in the mean temperature at all regions. The mean plantar pressure was significantly higher in the Charcot's foot of the patients when compared to the controls at baseline at all three sites.

Conclusion: Plantar temperature measurement with Infrared camera could be used as a surrogate marker for shear force in patients with chronic CA to see the hot spots which can be a preceding event for foot ulcer.
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NewsBot · Jul 13, 2022

Digital foot health technology and diabetic foot monitoring: A systematic review
Claire Saliba Thorne et al
March 25, 2021

Highlights
•Reviewed the validity and reliability of in-shoe technology reading temperature and pressure.
•Improvement of technology reading in-shoe temperature and pressure measurements highlighted.
•Highlighted the effectiveness of in-shoe reading pressure and temperature concurrently.
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Background
In diabetic foot ulceration, a correlation between pressure and skin temperature is suspected. The aim of this systematic review is to provide a more rigorous analysis of existing literature related to the various technologies used to read and measure both in-shoe plantar pressures, and in-shoe skin temperatures simultaneously.
Methods
A systematic review of the literature related to the topic was searched in database sources such as Medline OVID, Cochrane Library, PubMed, CONAHL, PROSPERO, and Elsevier. Outcome measures of interest included validity, reliability and responsiveness of in-shoe temperature and/or pressure mapping device used, and characteristics and quantity of sensors used, anatomical landmarks and statistical analysis used to interpret the data. Quality of evidence and risk of bias was evaluated using the QUADAS-2.
Results
Nineteen studies were identified and included in this review. The majority of studies used a small sample size (mean n = 17) and recruited healthy participants. All studies have shown excellent validity but only a few tested for the reliability of the device. None of the studies tested for responsiveness of the device. Quality assessment results scored high risk in view of ‘patient selection’, ‘use of reference standard’ and ‘applicability’, and low risk in view of ‘use if index test’ and ‘flow and timing’.
Conclusions
The data outlined in this review confirms that further improvement, reliability testing and clinical validation of the developed systems is required despite the results of excellent performance in detecting changes of in-shoe skin temperature and pressure.
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NewsBot · Jul 17, 2022

Adherence to at-Home Monitoring of Foot Temperatures in People with Diabetes at High Risk of Ulceration
F J Rovers et al
Int J Low Extrem Wounds. 2022 Jul 15

We aimed to investigate adherence to at-home monitoring of foot temperature and its association with patient-, disease- and behavior-related factors, in people with diabetes at high risk of ulceration. We analyzed 151 participants in the enhanced therapy arm of the DIATEMP trial (all at high diabetes-related foot ulcer risk) who aimed to perform and log foot temperatures daily for 18 months or until ulceration. Adherence was the proportion of measurement days covered (PDC), with being adherent defined as PDC≥70%. If a hotspot was recorded, adherence to subsequently reducing ambulatory activity was assessed. Multivariate logistic regression analysis was performed to investigate associations with adherence. We found ninety-four participants (62.3%) adherent to measuring foot temperatures. This was higher in months 1-3 versus months 4-18: 118 (78.1%) versus 78 (57.4%; P < .001). Of 83 participants with a hotspot, 24 (28.9%) reduced ambulatory activity. Increasing age (P = .021, OR = 1.045) and better self-care (P = .007, OR = 1.513) were positively associated with adherence to measuring foot temperature. In conclusion, in people at high diabetes-related foot ulcer risk, adherence to measuring foot temperature was high in the first months after study commencing, but dropped over time. Adherence to reducing ambulatory activity when a hotspot was found was low over the entire study period.
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NewsBot · Jan 5, 2023

Smart Wearable Systems for the Remote Monitoring of Venous and Diabetic Foot Ulcers: State of the Art
Julio Souza, Sara Escadas, Daniel Rodrigues & Alberto Freitas
International Symposium on Ambient Intelligence: 01 January 2023

We reviewed the state of the art of smart wearable systems (SWS) that employ data science techniques to continuously monitor the health status of venous and diabetic foot ulcers (DFU). Our main objective was to analyze the literature to identify data collection and data science methods currently employed, as well as key research challenges that need to be addressed regarding the development of SWS applied to these selected vascular diseases. A narrative review was conducted, analyzing publications retrieved from PubMed and SCOPUS. Publications were first screened based on whether they describe a SWS applicable to the two selected vascular diseases, and must necessarily include data processing (descriptive, predictive and/or prescriptive analytics), either at planning or at the implementation stage. A total of 44 publications were included in the full-text analysis after screening. Our results were structured and presented according to three main topics consisting of data collection, smart features, and limitations and challenges. Overall, research on SWS for the targeted diseases are already robust and well defined in terms of what parameters should be measured, sensory devices and algorithms/clinical rules for recommendation level functionalities. Nevertheless, these projects lack evaluation on usability, adherence, satisfaction, as well as clinical validation, as works are mostly at proof-of-concept stage, focusing on pilots/small-scale preliminary studies to assess the developed systems. Therefore, and according to future work perspectives, authors should focus on the refinement of current systems and further evaluation and clinical validation of existing projects.
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NewsBot · Feb 8, 2023

Does the skin heat up before it breaks down in diabetic foot ulceration?
Wouter B Aan de Stegge et al
Diabetes Metab Res Rev. 2023 Feb 8

Aim: Most diabetic foot ulcers are caused by tissue stress from being ambulatory in people without protective sensation. These ulcers are suggested to be preceded by local skin temperature increase due to inflammation of underlying tissue, a so-called hotspot. Evidence to support this mechanism of ulcer development is meagre at best. We investigated if foot ulcers are preceded by increased skin temperature in people with diabetes and foot ulcer history.

Material and methods: Participants measured temperature at 6-8 plantar foot locations each day for 18 months and identified a hotspot with a temperature difference >2.2°C between corresponding foot locations for two consecutive days.

Results: Twenty-nine of 151 participants developed a non-traumatic ulcer while adherent to temperature measurements. In the two months prior to ulceration 8 (28%) had a true hotspot (i.e. at/adjacent to the ulcer) and the hotspot was on average no longer present 9 days before ulceration. Seven (24%) participants had a false hotspot (i.e. at another location) and 14 (48%) had no hotspot.

Conclusion: The skin of the majority of the ulcers does not heat up before it breaks down, or, when it does, not directly before breakdown, questioning the foot temperature increase - ulcer association.
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NewsBot · Apr 6, 2023

Towards Home-Based Diabetic Foot Ulcer Monitoring: A Systematic Review
Arturas Kairys et al
Sensors 2023, 23(7), 3618

It is considered that 1 in 10 adults worldwide have diabetes. Diabetic foot ulcers are some of the most common complications of diabetes, and they are associated with a high risk of lower-limb amputation and, as a result, reduced life expectancy. Timely detection and periodic ulcer monitoring can considerably decrease amputation rates. Recent research has demonstrated that computer vision can be used to identify foot ulcers and perform non-contact telemetry by using ulcer and tissue area segmentation. However, the applications are limited to controlled lighting conditions, and expert knowledge is required for dataset annotation. This paper reviews the latest publications on the use of artificial intelligence for ulcer area detection and segmentation. The PRISMA methodology was used to search for and select articles, and the selected articles were reviewed to collect quantitative and qualitative data. Qualitative data were used to describe the methodologies used in individual studies, while quantitative data were used for generalization in terms of dataset preparation and feature extraction. Publicly available datasets were accounted for, and methods for preprocessing, augmentation, and feature extraction were evaluated. It was concluded that public datasets can be used to form a bigger, more diverse datasets, and the prospects of wider image preprocessing and the adoption of augmentation require further research.
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NewsBot · Jun 27, 2023

Region-wise severity analysis of diabetic plantar foot thermograms
Naveen Sharma et al
Biomed Tech (Berl). 2023 Jun 9

Objectives: Diabetic foot ulcers (DFU) can be avoided if symptoms of diabetic foot complications are detected early and treated promptly. Early detection requires regular examination, which might be limited for many reasons. To identify affected or potentially affected regions in the diabetic plantar foot, the region-wise severity of the plantar foot must be known.

Methods: A novel thermal diabetic foot dataset of 104 subjects was developed that is suitable for Indian healthcare conditions. The entire plantar foot thermogram is divided into three parts, i.e., forefoot, midfoot, and hindfoot. The division of plantar foot is based on the prevalence of foot ulcers and the load on the foot. To classify the severity levels, conventional machine learning (CML) techniques like logistic regression, decision tree, KNN, SVM, random forest, etc., and convolutional neural networks (CNN), such as EfficientNetB1, VGG-16, VGG-19, AlexNet, InceptionV3, etc., were applied and compared for robust outcomes.

Results: The study successfully developed a thermal diabetic foot dataset, allowing for effective classification of diabetic foot ulcer severity using the CML and CNN techniques. The comparison of different methods revealed variations in performance, with certain approaches outperforming others.

Conclusions: The region-based severity analysis offers valuable insights for targeted interventions and preventive measures, contributing to a comprehensive assessment of diabetic foot ulcer severity. Further research and development in these techniques can enhance the detection and management of diabetic foot complications, ultimately improving patient outcomes.
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NewsBot · Jul 2, 2024

Digital infrared thermography and machine learning for diabetic foot assessment: thermal patterns and classification
Rogelio Castillo-Morquecho, Edgar Guevara, Jose Luis Ramirez-GarciaLuna, Mario Aurelio Martínez-Jiménez, María Guadalupe Medina-Rangel & Eleazar Samuel Kolosovas-Machuca
Journal of Diabetes & Metabolic Disorders: 12 June 2024

Objectives
Digital infrared thermography is a noninvasive tool used for assessing diseases, including the diabetic foot. This study aims to analyze thermal patterns of the foot sole in patients with type 2 diabetes mellitus using thermography and explore correlations with clinical variables. Additionally, a machine learning approach was developed for classification.

Methods
A total of 23 diabetic patients and 27 age- and sex-matched controls were included. Thermograms of the plantar foot surface were acquired and segmented into regions of interest. Mean foot temperature and temperature change index were calculated from predefined regions of interest. Pearson’s correlation analysis was conducted for temperature measures, glycated hemoglobin, and body mass index. A two-layered cross-validation model using principal component analysis and support vector machines were employed for classification.

Results
Significant positive correlations were found between mean foot temperature and glycated hemoglobin (ρ = 0.44, p = 0.0015), as well as between mean foot temperature and body mass index (ρ = 0.35, p = 0.013). Temperature change index did not show significant correlations with clinical variables. The machine learning model achieved high overall accuracy (90%) and specificity (100%) with a moderate sensitivity (78.3%) for classifying diabetic and control groups based on thermal data.

Conclusions
Thermography combined with machine learning shows potential for assessing diabetic foot complications. Correlations between mean foot temperature and clinical variables suggest foot temperature changes as potential indicators. The machine learning model demonstrates promising accuracy for classification, suitable for screening purposes. Further research is needed to understand underlying mechanisms and establish clinical utility in diagnosing and managing diabetic foot complications.
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NewsBot · Oct 1, 2024

Isolated and grouped relationships between type 2 diabetes and peripheral arterial disease on skin temperature in the foot plantar region
Raschelle Ramalho Rosas et al
J Therm Biol. 2024 Aug 18

The aim of the study was to verify relationships between isolated and grouped clinical conditions (Type 2 Diabetes Mellitus [T2DM] and Peripheral Arterial Disease [PAD]) with the skin temperature of the plantar region of the feet (Tskin_Feet). Twenty-four elderly women participated, divided into three groups: GT2DM + PAD (n = 8; 69.6 ± 8.0 years-old; 148 ± 5 cm; 63.8 ± 8.9 kg), GT2DM (n = 8, 69.3 ± 7.8 years-old, 151 ± 6 cm; 66.3 ± 10.8 kg), and control group (CG) (n = 8; 69.3 ± 6.6 years old; 148 ± 6 cm; 58.0 ± 5.3 kg). The T2DM was diagnosed based on HbA1C concentrations, and PAD was assessed using the Ankle-Brachial Index. Thermographic images were captured for both feet using the Flir thermal camera (model T420®) and analyzed using Flir Tools® software. The Inner canthus (IC) measurement was used as an indicator of core body temperature. Five regions of interest (ROIs) were determined for each image. The difference (Δ) between the temperature at the IC (average among right and left side) and of the each of the five ROIs in the plantar region (right foot and left foot) was calculated, where lower values indicated a closer proximity to the core body temperature. The one-way ANOVA was performed to verify differences between groups of clinical conditions. A significance level of 5% was assumed. The GT2DM group exhibited higher Tskin_Feet absolute values than the CG for all ROIs. However, just for ROI4 (hindfoot) of the right foot plantar was significant (p = 0.027). On the other hand, when analyzing the values difference between the average temperature at the IC of the temperature in the five evaluated ROIs on the right and left foot, the GT2DM group showed significantly lower values than the CG for for ROI 2 (forefoot) p = 0.0429 and ROI 4 (hindfoot) p = 0.009 on the right foot and for ROI 1 (forefoot) p = 0.0338; ROI 2 (forefoot) p = 0.0392 and ROI 5 (hindfoot) p = 0.0377 on the left foot. In conclusion, GT2DM presented a Tskin_Feet closer to the core temperature (IC) indicating a higher temperature. The presence of PAD appears to attenuate skin overheating.
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Jalahooldus · Oct 4, 2024

Continuing on this topic, it’s fascinating to see how Type 2 Diabetes and Peripheral Arterial Disease (PAD) impact the skin temperature of the feet. A higher skin temperature could indicate inflammation or circulatory issues, which is particularly critical for patients suffering from diabetes and PAD. Regular monitoring of skin temperature can be a useful tool for the early detection and prevention of potential complications.
Based on the study, it appears that the presence of PAD may help to reduce skin overheating, suggesting that these patients might require special attention to address circulation problems. In addition to thermography, consistent foot care can play a vital role in managing these conditions, ensuring that issues like trauma nails, calluses, and cracked heels are properly addressed.

NewsBot · Dec 1, 2024

Digital infrared thermography and machine learning for diabetic foot assessment: thermal patterns and classification
Rogelio Castillo-Morquecho et al
J Diabetes Metab Disord. 2024 Jun 12;23(2):1967-1976

Objectives: Digital infrared thermography is a noninvasive tool used for assessing diseases, including the diabetic foot. This study aims to analyze thermal patterns of the foot sole in patients with type 2 diabetes mellitus using thermography and explore correlations with clinical variables. Additionally, a machine learning approach was developed for classification.

Methods: A total of 23 diabetic patients and 27 age- and sex-matched controls were included. Thermograms of the plantar foot surface were acquired and segmented into regions of interest. Mean foot temperature and temperature change index were calculated from predefined regions of interest. Pearson's correlation analysis was conducted for temperature measures, glycated hemoglobin, and body mass index. A two-layered cross-validation model using principal component analysis and support vector machines were employed for classification.

Results: Significant positive correlations were found between mean foot temperature and glycated hemoglobin (ρ = 0.44, p = 0.0015), as well as between mean foot temperature and body mass index (ρ = 0.35, p = 0.013). Temperature change index did not show significant correlations with clinical variables. The machine learning model achieved high overall accuracy (90%) and specificity (100%) with a moderate sensitivity (78.3%) for classifying diabetic and control groups based on thermal data.

Conclusions: Thermography combined with machine learning shows potential for assessing diabetic foot complications. Correlations between mean foot temperature and clinical variables suggest foot temperature changes as potential indicators. The machine learning model demonstrates promising accuracy for classification, suitable for screening purposes. Further research is needed to understand underlying mechanisms and establish clinical utility in diagnosing and managing diabetic foot complications.
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NewsBot · Dec 17, 2024

Can Thermography Predict Diabetic Foot Ulcer Risk in Patients with Diabetes?

NewsBot · Dec 27, 2024

Advances in Machine Learning-Aided Thermal Imaging for Early Detection of Diabetic Foot Ulcers: A Review
Longyan Wu et al
Biosensors (Basel). 2024 Dec 13;14(12):614.

The prevention and early warning of foot ulcers are crucial in diabetic care; however, early microvascular lesions are difficult to detect and often diagnosed at later stages, posing serious health risks. Infrared thermal imaging, as a rapid and non-contact clinical examination technology, can sensitively detect hidden neuropathy and vascular lesions for early intervention. This review provides an informative summary of the background, mechanisms, thermal image datasets, and processing techniques used in thermal imaging for warning of diabetic foot ulcers. It specifically focuses on two-dimensional signal processing methods and the evaluation of computer-aided diagnostic methods commonly used for diabetic foot ulcers.
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NewsBot · May 6, 2025

Effectiveness of online education on thermography-based diabetic foot ulcer prevention for wound care specialists: a single-group quasi-experimental study
Muhammad Aminuddin et al
Diabetol Int. 2025 Jan 31;16(2):356-364.

Background: While there is an urgent need worldwide to establish methods that prevent diabetic foot ulcers, the effectiveness of a prevention protocol using thermography has been reported. As the number of diabetic patients in Indonesia is increasing, an online program for wound care specialists was developed to disseminate this protocol. The present study evaluated the impact of an online program on wound care specialists' knowledge of diabetic foot ulcer prevention using thermography.

Methods: This single-group quasi-experimental study was conducted in cooperation with the Indonesian Wound Enterostomal Continence Nurses Association with regard to curriculum and content design, and the evaluation methods of online education for thermography-based diabetic foot ulcer prevention using the learning management system. A questionnaire with 50 multiple-choice questions previously validated for content and readability on the knowledge of diabetic foot ulcer prevention using thermography was used for training evaluations.

Results: Of 106 Indonesian wound care specialists evaluated, the paired t-test revealed a significant difference between the before and after training questionnaire scores on knowledge (52.0 ± 10.3, 85.2 ± 10.6, respectively, p < 0.001). Repeated measures analysis of variance revealed interactions between time (before and after training) and gender, and between time and type of certificate (p = 0.046, p = 0.014, respectively).

Conclusions: An asynchronous e-learning program is an effective method to increase wound care specialists' knowledge of diabetic foot ulcer prevention. These findings suggest that online educational interventions are effective and can be tailored to meet the needs of healthcare professionals, thereby ultimately contributing to better patient care outcomes in preventing DFUs.
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NewsBot · Jun 10, 2025

A weighted Gompertz fuzzy ranking-based ensemble model for diabetic foot ulcer detection in skin and thermal imagery
Kamran Amjad et al
Computers and Electrical Engineering Volume 126, August 2025, 110475

Diabetic Foot Ulcers (DFUs) pose a significant health risk, often leading to severe complications in diabetic patients. Early and accurate detection of DFUs is crucial for effective intervention and management. This paper introduces an innovative ensemble methodology that leverages a weighted Gompertz function-based fuzzy ranking strategy for accurate and reliable DFU detection. The proposed technique adopts an ensemble framework where the weighted Gompertz function forms fuzzy rankings for the three fundamental classifiers, and their decision scores are integrated to yield final predictions on test cases. The ensemble model is constructed using three transfer learning-based models: InceptionV3, MobileNet, and InceptionResNetV2, which generate decision scores that are subsequently fused. The method showcases remarkable enhancements in classification accuracy, thoroughly evaluated on a dataset of 1055 foot images. Grad-CAM analysis showcases the models' focus on relevant regions, while ablation studies and comparison with the traditional ensemble method confirm our approach's reliability. These results highlight the crucial significance of hyperparameter tuning in enhancing model performance. Furthermore, our ensemble's efficacy extends to thermal imagery domains, validated by experiments on a diverse dataset comprising thermal images of diabetic foot cases. This adaptability across imaging modalities positions our methodology as a useful diagnostic tool, potentially aiding medical practitioners in efficiently detecting diabetic foot ulcers in both skin and thermal imagery domains. The proposed approach achieves an accuracy of 99.53 % on the initial dataset of foot images and attains a remarkable accuracy of 93.60 % on a separate dataset comprising thermal images. By improving diagnostic accuracy and adaptability, this approach can facilitate early DFU detection, reducing the risk of complications and enhancing patient outcomes.
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NewsBot · Jun 29, 2025

Effectiveness of online education on thermography-based diabetic foot ulcer prevention for wound care specialists: a single-group quasi-experimental study
Muhammad Aminuddin, Sukarni, Haryanto, Suriadi Jais, Amika Yamada, Kanae Mukai & Makoto Oe
Diabetology International

Background

While there is an urgent need worldwide to establish methods that prevent diabetic foot ulcers, the effectiveness of a prevention protocol using thermography has been reported. As the number of diabetic patients in Indonesia is increasing, an online program for wound care specialists was developed to disseminate this protocol. The present study evaluated the impact of an online program on wound care specialists' knowledge of diabetic foot ulcer prevention using thermography.
Methods

This single-group quasi-experimental study was conducted in cooperation with the Indonesian Wound Enterostomal Continence Nurses Association with regard to curriculum and content design, and the evaluation methods of online education for thermography-based diabetic foot ulcer prevention using the learning management system. A questionnaire with 50 multiple-choice questions previously validated for content and readability on the knowledge of diabetic foot ulcer prevention using thermography was used for training evaluations.
Results

Of 106 Indonesian wound care specialists evaluated, the paired t-test revealed a significant difference between the before and after training questionnaire scores on knowledge (52.0 ± 10.3, 85.2 ± 10.6, respectively, p < 0.001). Repeated measures analysis of variance revealed interactions between time (before and after training) and gender, and between time and type of certificate (p = 0.046, p = 0.014, respectively).
Conclusions

An asynchronous e-learning program is an effective method to increase wound care specialists' knowledge of diabetic foot ulcer prevention. These findings suggest that online educational interventions are effective and can be tailored to meet the needs of healthcare professionals, thereby ultimately contributing to better patient care outcomes in preventing DFUs
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NewsBot · Jul 3, 2025

Infrared Dermal Thermometry in Active Charcot Neuro-Osteoarthropathy of Foot
Ghosh, Jayaditya; Singh, Raveena; Rastogi, Ashu
Indian Journal of Endocrinology and Metabolism 29(3) 303-307, May–Jun 2025. | DOI: 10.4103/ijem.ijem_447_24

Introduction:
The ‘acclimatization time’ before temperature assessment for diagnosis and monitoring of active unilateral Charcot neuro-osteoarthropathy (CNO) of foot is not known. Therefore, we aimed to assess the appropriate acclimatization time for foot temperature at diagnosis and during follow-up assessment of patients with active CNO.

Methods:
Patients of diabetes with active unilateral CNO of foot were assessed for inter-feet temperature difference [affected foot–unaffected foot (°C)] at 10-, 30- and 45-minutes following shoe-off with a handheld infrared dermal thermometer. The primary objective was to assess the significance of different individual and paired time points for inter-feet temperature differences.

Results:
Overall, 30 patients were recruited and 96 paired inter-feet temperature difference readings were obtained. The median inter-feet temperature difference at 10 minutes was 3°C (2.4-4.4°C), 30 minutes was 3.2°C (2.5-4.45°C) and 45 minutes was 3.3°C (2.3-4.63°C) (P = 0.623). The correlation between paired temperature readings at 30 and 45 minutes (r = 0.914; P < 0.001) was better than that at 10 and 30 minutes (r = 0.724; P < 0.001).

Conclusion:
Paired inter-feet temperature difference obtained at 30 and 45 minutes following footwear removal is clinically-meaningful for the diagnosis and monitoring of active unilateral CNO of feet.
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NewsBot · Jul 6, 2025

Pilot Implementation of a Thermography-Driven Preventive Foot Care Protocol for Diabetes-Related Foot Ulcers in Community Health Centers: Non-Randomized Controlled Trial
Makoto Oe et al
Int J Low Extrem Wounds. 2025 Apr 29

AimThe purpose of this study was to clarify the effectiveness and implementation issues of a thermography-driven preventive foot care protocol for diabetes-related foot ulcers in Indonesian community health centers.MethodsIn the two trial centers examined between May 2023 and May 2024, one provided protocol-based care (Intervention group; n = 71), while the other provided standard education (Control group; n = 71). Participants were monitored for ulceration over a 1-year period.ResultsThere was no significant difference in the number of participants with ulceration between the intervention and control group (6 vs 8 cases, p = 0.573). However, there was a shorter time to ulceration (203.8 ± 8.7 vs 350.0 ± 13.9 days, p = 0.048) in the intervention group. Over the 1-year follow-up, protocol compliance was 100% for examinations, but 0% for callus and nail care. Participants without risk factors, such as neuropathy or angiopathy, also developed ulcers.ConclusionsResults suggested this protocol was ineffective in the community health center. It will be necessary to clarify the risk factors for foot ulcers in the target population, establish an appropriate protocol, prepare an environment for its implementation, and then conduct a randomized controlled trial in the future.
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Diabetic foot ulcer prevention by home monitoring of temperature

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Comprehensive Therapy vs. Standard Treatment in Diabetic Foot Ulcer Healing

Heavy Metals with Diabetic Foot Ulcers

Systemic Inflammatory Response index and Diabetic Foot Ulcer

Healing of diabetic neuropathic foot ulcers receiving standard treatment

Nanozymes for the Treatment of Diabetic Foot Ulcers

Rapha® device for the treatment of diabetic foot ulcers

COX-2 targeted therapy for diabetic foot ulcers

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Diabetic foot ulcer prevention by home monitoring of temperature

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Comprehensive Therapy vs. Standard Treatment in Diabetic Foot Ulcer Healing

Heavy Metals with Diabetic Foot Ulcers

Systemic Inflammatory Response index and Diabetic Foot Ulcer

Healing of diabetic neuropathic foot ulcers receiving standard treatment

Nanozymes for the Treatment of Diabetic Foot Ulcers

Rapha® device for the treatment of diabetic foot ulcers

COX-2 targeted therapy for diabetic foot ulcers

Share This Page

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