Skin temperature differences as an indicatior of possible ulceration in diabetes

jorh · Aug 10, 2008

Members do not see these Ads. Sign Up.
As a rule of thumb please could someone who has used an infra red thermometer explain where on the foot a pt should test their skin surfce temperatures on a regular basis? You cannot be vague about this - several 'x marks the spots' would be necessary and how easy is it for a pt living alone to test their temperature over the plantar MPJ area? Perhaps I have misunderstood the testing - is it a temperature reading of the whole foot or specific locii?
Thanks

Admin2 · Aug 11, 2008

Re: Skin temperature differences as an indicatior of possible ulceration in diabetics

Related:
Temperature monitoring threads
Home Monitoring of Foot Skin Temperatures to Prevent Ulceration
Skin temperature measurement

betafeet · Aug 13, 2008

Hello Jorh,

Name would be good! this seems to be a good paper to review http://www.northampton.ac.uk/downloads/podiatry/rachel_dinning.pdf

Jude

betafeet · Aug 13, 2008

Would be good to have an evaluation of different makes for example best price best product most accurate.

Jude

NewsBot · Feb 7, 2009

Impaired Distal Thermoregulation in Diabetes and Diabetic Polyneuropathy.
Rutkove SB, Veves A, Mitsa T, Nie R, Fogerson PM, Garmirian LP, Nardin RA.
Diabetes Care. 2009 Feb 5. [Epub ahead of print]

Objective: To determine how thermoregulation of the feet is affected by diabetes and diabetic polyneuropathy (DP) in both wakefulness and sleep. Research Design and Methods: Normal subjects, diabetic subjects without neuropathy, diabetic subjects with small fiber DP, and those with advanced DP, were categorized based on neurological examination, nerve conduction studies, and quantitative sensory testing. Subjects underwent foot temperature monitoring using an iButton(R) device attached to the foot and a second iButton(R) for recording of ambient temperature. Socks and footwear were standardized, and subjects maintained an activity diary. Data was collected over a 32-hour period and analyzed. Results: 39 normal subjects, 28 patients with diabetes but without DP, 14 patients with isolated small fiber DP, and 27 patients with more advanced DP participated. No consistent differences in foot temperature regulation between the four groups were identified during wakefulness. During sleep, however, multiple metrics revealed significant abnormalities in the diabetic patients. These included reduced mean foot temperature (p < 0.001), reduced maximal temperature (p < 0.001), increased rate of cooling (< 0.001), as well as increased frequency of variation (p = 0.005), supporting that patients with DP and even those with only diabetes but no DP have impaired nocturnal thermoregulation. Conclusion: Nocturnal foot thermoregulation is impaired in patients with diabetes and DP. Since neurons are highly temperature sensitive and since foot warming is part of the normal biology of sleep onset and maintenance, these findings suggest new, potentially treatable mechanisms of diabetes-associated nocturnal pain and sleep disturbance
Click to expand...

NewsBot · Oct 14, 2009

Feasibility of a thermographic method for early detection of foot disorders in diabetes.
Roback K, Johansson M, Starkhammar A.
Diabetes Technol Ther. 2009 Oct;11(10):663-7.

Background: Foot complications due to diabetes impose a major economic burden to society and loss of health-related quality of life for the patients. Early diagnosis and intensified preventive measures have proved useful to limit the incidence of foot ulcers and lower limb amputations in diabetes, and the development of new tools for early diagnosis has therefore become an attractive option. This article covers a feasibility study of the SpectraSole (Linköping, Sweden) Pro 1000 foot indicator, an innovation based on liquid crystal thermography. The technology identifies increases in temperature, a known indicator of inflammation.

Methods: Sixty-five patients with diagnosed diabetes were examined with the foot indicator immediately after their ordinary foot examinations according to current practice, and findings from the two investigations were compared.

Results: Sixty-nine examinations were performed. The foot indicator identified increased temperature in 31 cases, of which six had not been detected in the preceding ordinary examinations. The instrument was perceived as easy to use, and the thermographs could be used to visualize problem areas of the foot, which might contribute to better compliance with therapeutic advice.

Conclusions: The foot indicator detected a relatively high share of the different types of complications but not all. It can be used as a complement to current practices for foot examination. The instrument provides rapid imaging of the foot temperature, and the study indicates that it yields valuable diagnostic information in early stages of foot disease.
Click to expand...

NewsBot · Jan 8, 2011

Predicting neuropathic ulceration: analysis of static temperature distributions in thermal images.
Kaabouch N, Hu WC, Chen Y, Anderson JW, Ames F, Paulson R.
J Biomed Opt. 2010 Nov-Dec;15(6):061715.

Foot ulcers affect millions of Americans annually. Conventional methods used to assess skin integrity, including inspection and palpation, may be valuable approaches, but they usually do not detect changes in skin integrity until an ulcer has already developed. We analyze the feasibility of thermal imaging as a technique to assess the integrity of the skin and its many layers. Thermal images are analyzed using an asymmetry analysis, combined with a genetic algorithm, to examine the infrared images for early detection of foot ulcers. Preliminary results show that the proposed technique can reliably and efficiently detect inflammation and hence effectively predict potential ulceration.
Click to expand...

NewsBot · Jan 25, 2011

Variations of plantar thermographic patterns in normal controls and non-ulcer diabetic patients: Novel classification using angiosome concept.
Nagase T, Sanada H, Takehara K, Oe M, Iizaka S, Ohashi Y, Oba M, Kadowaki T, Nakagami G.
J Plast Reconstr Aesthet Surg. 2011 Jan 21. [Epub ahead of print]

Thermometry of the plantar skin temperature has been one of the important parameters for assessing ulceration risks in diabetic patients. Recent progress of infrared thermographic technology allows us to obtain imaging of temperature distribution of the whole plantar skin. However, it has not been fully elucidated to what extent the individual variation of the plantar thermographic patterns shows different trends between normal controls and diabetics. In this study, we made a novel framework of conceptual classification with 20 different categories of plantar thermographic patterns according to the foot angiosome concept. The thermographic images from 32 normal volunteers and 129 non-ulcer diabetic patients, recruited from Diabetes Foot Outpatient Clinic of the University of Tokyo Hospital, were allocated to the above-mentioned framework categories. In the normal group, thermographic patterns of more than 65% of feet were allocated to the two typical categories, including the 'butterfly pattern' among the 20 categories, whereas 225 feet (87.2%) of the diabetic groups were variously allocated to 18 out of the 20 categories. This is the first study, which describes detailed plantar thermographic patterns, showing wider variations in the diabetic patients than in the normal subjects. Thermography will be one of the screening options to assess circulatory status in both daily foot care and surgical intervention.
Click to expand...

NewsBot · Aug 14, 2012

Thermographic findings in a case of type 2 diabetes with foot ulcer and osteomyelitis.
Oe M, Yotsu RR, Sanada H, Nagase T, Tamaki T.
J Wound Care. 2012 Jun;21(6):274-8.

Using thermography, skin temperature was evaluated in a 76-year-old patient with type II diabetes mellitus, presenting with diabetic foot ulceration on the right hallux and a corn on the left fourth toe. Increased skin temperature was observed in both the right hallux and the left fourth toe, though there were no visible clinical signs of infection. Unexpectedly, the high temperature area was seen to extend from the left fourth toe to the ankle. The patient was later diagnosed with osteomyelitis, due to the presence of a high-intensity area on T2-weighted magnetic resonance imaging, suggesting the elevated skin temperature was due to osteomyelitis. Based on these observations, thermography could prove useful for screening for foot ulcers with osteomyelitis.
Click to expand...

NewsBot · Oct 16, 2013

Infrared Thermal Imaging for Automated Detection of Diabetic Foot Complications.
Netten JJ, Baal JG, Liu C, Heijden FV, Bus SA.
J Diabetes Sci Technol. 2013 Sep 1;7(5):1122-1129.

BACKGROUND:
Although thermal imaging can be a valuable technology in the prevention and management of diabetic foot disease, it is not yet widely used in clinical practice. Technological advancement in infrared imaging increases its application range. The aim was to explore the first steps in the applicability of high-resolution infrared thermal imaging for noninvasive automated detection of signs of diabetic foot disease.
METHODS:
The plantar foot surfaces of 15 diabetes patients were imaged with an infrared camera (resolution, 1.2 mm/pixel): 5 patients had no visible signs of foot complications, 5 patients had local complications (e.g., abundant callus or neuropathic ulcer), and 5 patients had diffuse complications (e.g., Charcot foot, infected ulcer, or critical ischemia). Foot temperature was calculated as mean temperature across pixels for the whole foot and for specified regions of interest (ROIs).
RESULTS:
No differences in mean temperature >1.5 °C between the ipsilateral and the contralateral foot were found in patients without complications. In patients with local complications, mean temperatures of the ipsilateral and the contralateral foot were similar, but temperature at the ROI was >2 °C higher compared with the corresponding region in the contralateral foot and to the mean of the whole ipsilateral foot. In patients with diffuse complications, mean temperature differences of >3 °C between ipsilateral and contralateral foot were found.
CONCLUSIONS:
With an algorithm based on parameters that can be captured and analyzed with a high-resolution infrared camera and a computer, it is possible to detect signs of diabetic foot disease and to discriminate between no, local, or diffuse diabetic foot complications. As such, an intelligent telemedicine monitoring system for noninvasive automated detection of signs of diabetic foot disease is one step closer. Future studies are essential to confirm and extend these promising early findings.
Click to expand...

NewsBot · Oct 16, 2013

Morphological Pattern Classification System for Plantar Thermography of Patients with Diabetes.
Mori T, Nagase T, Takehara K, Oe M, Ohashi Y, Amemiya A, Noguchi H, Ueki K, Kadowaki T, Sanada H.
J Diabetes Sci Technol. 2013 Sep 1;7(5):1102-1112.

BACKGROUND:
A plantar temperature distribution can be obtained by thermography; however, the advantage has not been effectively utilized in the past. We previously proposed a classification method based on the angiosome concept, but the method was insufficient because it was too subjective and complicated for clinicians. In this study, we propose a new classification system of plantar forepart thermographic patterns using an image segmentation technique.
METHODS:
A cross-sectional observational study was conducted including 32 healthy volunteers and 129 patients with diabetes mellitus (DM). Individual thermographic variations and trends were evaluated. A comparison was conducted between the patterns obtained by our previous angiosome-based research and the patterns found by the new classification system.
RESULTS:
The system objectively found wider variations of the plantar forepart thermographic patterns in the patients with DM compared with those in the control subjects. In patients with DM, the system showed that the whole-high pattern was most frequent (46%), followed by the butterfly pattern (12%). In the control group, the butterfly pattern was most frequent (44%), followed by the whole-high pattern (19%). Both ankle and toe brachial indices were higher in feet with high temperature area in the inner side of the plantar.
CONCLUSIONS:
Thermographic patterns found by the new computer-based system were similar to those obtained in our previous subjective work. The classification system found forefoot-low pattern and tiptoe-low pattern objectively. The system based on infrared thermography will be a screening tool to assess circulatory status in daily foot care of patients with DM.
Click to expand...

NewsBot · Oct 31, 2013

Plantar thermography is useful in the early diagnosis of diabetic neuropathy.
Balbinot LF, Canani LH, Robinson CC, Achaval M, Zaro MA.
Clinics (Sao Paulo). 2012 Dec;67(12):1419-25.

OBJECTIVES:
This study evaluated plantar thermography sensitivity and specificity in diagnosing diabetic polyneuropathy using cardiac tests (heart rate variability) as a reference standard because autonomic small fibers are affected first by this disease.
METHODS:
Seventy-nine individuals between the ages of 19 and 79 years old (28 males) were evaluated and divided into three groups: control (n = 37), pre-diabetics (n = 13) and type 2 diabetics (n = 29). The plantar images were recorded at baseline and then minutes after a provocative maneuver (Cold Stress Test) using an infrared camera that is appropriate for clinical use. Two thermographic variables were studied: the thermal recovery index and the interdigital anisothermal technique. Heart rate variability was measured in a seven-test battery that included three spectral indexes (in the frequency domain) and four Ewing tests (the Valsalva maneuver, the orthostatic test, a deep breathing test, and the orthostatic hypotension test). Other classically recommended tests were applied, including electromyography (EMG), Michigan inventory, and a clinical interview that included a neurological physical examination.
RESULTS:
Among the diabetic patients, the interdigital anisothermal technique alone performed better than the thermal recovery index alone, with a better sensitivity (81.3%) and specificity (46.2%). For the pre-diabetic patients, the three tests performed equally well. None of the control subjects displayed abnormal interdigital anisothermal readouts or thermal recovery indices, which precluded the sensitivity estimation in this sample of subjects. However, the specificity (70.6%) was higher in this group.
CONCLUSION:
In this study, plantar thermography, which predominately considers the small and autonomic fibers that are commonly associated with a sub-clinical condition, proved useful in diagnosing diabetic neuropathy early. The interdigital anisothermal test, when used alone, performed best.
Click to expand...

NewsBot · Apr 2, 2014

Quantitative estimation of temperature variations in plantar angiosomes: a study case for diabetic foot.
Peregrina-Barreto H, Morales-Hernandez LA, Rangel-Magdaleno JJ, Avina-Cervantes JG, Ramirez-Cortes JM, Morales-Caporal R.
Comput Math Methods Med. 2014;2014:585306

Thermography is a useful tool since it provides information that may help in the diagnostic of several diseases in a noninvasive and fast way. Particularly, thermography has been applied in the study of the diabetic foot. However, most of these studies report only qualitative information making it difficult to measure significant parameters such as temperature variations. These variations are important in the analysis of the diabetic foot since they could bring knowledge, for instance, regarding ulceration risks. The early detection of ulceration risks is considered an important research topic in the medicine field, as its objective is to avoid major complications that might lead to a limb amputation. The absence of symptoms in the early phase of the ulceration is conceived as the main disadvantage to provide an opportune diagnostic in subjects with neuropathy. Since the relation between temperature and ulceration risks is well established in the literature, a methodology that obtains quantitative temperature differences in the plantar area of the diabetic foot to detect ulceration risks is proposed in this work. Such methodology is based on the angiosome concept and image processing.
Click to expand...

NewsBot · Apr 4, 2014

Assessment of Signs of Foot Infection in Diabetes Patients Using Photographic Foot Imaging and Infrared Thermography.
Hazenberg CE, van Netten JJ, van Baal SG, Bus SA.
Diabetes Technol Ther. 2014 Apr 1.

Background: Patients with diabetic foot disease require frequent screening to prevent complications and may be helped through telemedical home monitoring. Within this context, the goal was to determine the validity and reliability of assessing diabetic foot infection using photographic foot imaging and infrared thermography.

Subjects and Methods: For 38 patients with diabetes who presented with a foot infection or were admitted to the hospital with a foot-related complication, photographs of the plantar foot surface using a photographic imaging device and temperature data from six plantar regions using an infrared thermometer were obtained. A temperature difference between feet of >2.2°C defined a "hotspot." Two independent observers assessed each foot for presence of foot infection, both live (using the Perfusion-Extent-Depth-Infection-Sensation classification) and from photographs 2 and 4 weeks later (for presence of erythema and ulcers). Agreement in diagnosis between live assessment and (the combination of ) photographic assessment and temperature recordings was calculated.

Results: Diagnosis of infection from photographs was specific (>85%) but not very sensitive (<60%). Diagnosis based on hotspots present was sensitive (>90%) but not very specific (<25%). Diagnosis based on the combination of photographic and temperature assessments was both sensitive (>60%) and specific (>79%). Intra-observer agreement between photographic assessments was good (Cohen's κ=0.77 and 0.52 for both observers).

Conclusions: Diagnosis of foot infection in patients with diabetes seems valid and reliable using photographic imaging in combination with infrared thermography. This supports the intended use of these modalities for the home monitoring of high-risk patients with diabetes to facilitate early diagnosis of signs of foot infection.
Click to expand...

NewsBot · May 13, 2014

The influence of ambient temperature on foot temperature in patients with diabetic foot ulceration
Piotr Foltynski, et al
Biocybernetics and Biomedical Engineering; Available online 9 May 2014

Background
Patients with diabetic neuropathy exhibit a higher foot temperature than those without neuropathy and they are at risk for foot ulceration. Ambient temperature and foot ulceration additionally influence foot temperature in such patients. The aim of the study was to assess the influence of ambient temperature on foot temperature in patients with an ulcer on one of the feet.
Methods
Miniature temperature data loggers were used for the monitoring of foot skin and ambient temperature. Twenty patients with diabetic neuropathy and ten healthy subjects were monitored for about 24 h each.
Results
The temperature of the foot with an ulcer correlates significantly with ambient temperature, with the slope of the regression line of 0.09. The temperature of the non-ulcerated foot also correlates significantly with ambient temperature, with the slope of 0.31, however the correlation coefficient and the slope are significantly higher than in the case of the foot with an ulcer. The difference of temperature of the foot with an ulcer and temperature of the foot without an ulcer correlates well with ambient temperature with the slope of −0.219. The temperatures of left and right feet were studied as a function of ambient temperature in healthy individuals and there were no statistically significant differences between correlation coefficients and slopes.
Conclusions
It is apparent that ambient temperature influences foot temperature even during foot ulceration. Thus ambient temperature should be taken into consideration in any application when foot temperatures are important, especially in the prediction of diabetic foot ulceration.
Click to expand...

NewsBot · Aug 9, 2014

Diagnostic Values for Skin Temperature Assessment to Detect Diabetes-Related Foot Complications.
van Netten JJ1, Prijs M, van Baal JG, Liu C, van der Heijden F, Bus SA.
Diabetes Technol Ther. 2014 Aug 6.

Background: Skin temperature assessment is a promising modality for early detection of diabetic foot problems, but its diagnostic value has not been studied. Our aims were to investigate the diagnostic value of different cutoff skin temperature values for detecting diabetes-related foot complications such as ulceration, infection, and Charcot foot and to determine urgency of treatment in case of diagnosed infection or a red-hot swollen foot.

Materials and Methods: The plantar foot surfaces of 54 patients with diabetes visiting the outpatient foot clinic were imaged with an infrared camera. Nine patients had complications requiring immediate treatment, 25 patients had complications requiring non-immediate treatment, and 20 patients had no complications requiring treatment. Average pixel temperature was calculated for six predefined spots and for the whole foot. We calculated the area under the receiver operating characteristic curve for different cutoff skin temperature values using clinical assessment as reference and defined the sensitivity and specificity for the most optimal cutoff temperature value. Mean temperature difference between feet was analyzed using the Kruskal-Wallis tests.

Results: The most optimal cutoff skin temperature value for detection of diabetes-related foot complications was a 2.2°C difference between contralateral spots (sensitivity, 76%; specificity, 40%). The most optimal cutoff skin temperature value for determining urgency of treatment was a 1.35°C difference between the mean temperature of the left and right foot (sensitivity, 89%; specificity, 78%).

Conclusions: Detection of diabetes-related foot complications based on local skin temperature assessment is hindered by low diagnostic values. Mean temperature difference between two feet may be an adequate marker for determining urgency of treatment.
Click to expand...

NewsBot · Dec 8, 2014

Detection of diabetic foot hyperthermia by infrared imaging
Vilcahuaman, L.; Harba, R. ; Canals, R. ; Zequera, M.
Engineering in Medicine and Biology Society (EMBC), 2014 36th Annual International Conference of the IEEE

In diabetic foot, the occurrence of an ulcer is often associated with hyperthermia. Hyperthermia is defined as a temperature greater than 2.2oC in a given region of one of the foot compared to the temperature of the same region of the contralateral foot. Unfortunately, hyperthermia is not yet assessed in current diabetic foot therapy. In this paper, we propose an easy way to detect a possible hyperthermia by using an infrared camera. A specific acquisition protocol of the thermal images is proposed. A dedicated image analysis is developed: it is composed of a contour detection of the 2 feet using the Chan and Vese active contour method associated to the ICP rigid registration technique. Among 85 type II diabetes persons recruited in the Dos de Mayo hospital in Lima, Peru, 9 individuals show significant hyperthermia. It is expected that the new possibility of detecting hyperthermia in hospitals or in diabetic health centers which is now available, thanks to the proposed method, will help in reducing foot ulcer occurrence for diabetic persons.
Click to expand...

NewsBot · Dec 10, 2014

Thermography in the follow up of the diabetic foot: best to weigh the enemy more mighty than he seems.
Pafili K, Papanas N.
Expert Rev Med Devices. 2014 Dec 6:1-3.

Thermography is being increasingly appreciated as a further modality contributing to the early detection of incipient tissue damage predisposing to diabetic foot ulceration in selected high-risk patients. Among currently available modalities, liquid crystal thermography and infrared thermography have been most widely used. The former is effective, but its main limitation is low sensitivity. The latter permits non-contact measurements at different angles of the foot, independent of the quality of the camera used. It has been suggested that 5-year use of such techniques for daily self-examination among high-risk patients may contribute to the significant reduction of diabetic foot complications. Clearly, further experience with thermography in the real-life setting is now very welcome.
Click to expand...

NewsBot · Dec 14, 2014

Thermography in the follow up of the diabetic foot: best to weigh the enemy more mighty than he seems
Kalliopi Pafili, and Nikolaos Papanas
Expert Review of Medical Devices; Posted online on December 6, 2014.

Thermography is being increasingly appreciated as a further modality contributing to the early detection of incipient tissue damage predisposing to diabetic foot ulceration in selected high-risk patients. Among currently available modalities, liquid crystal thermography and infrared thermography have been most widely used. The former is effective, but its main limitation is low sensitivity. The latter permits non-contact measurements at different angles of the foot, independent of the quality of the camera used. It has been suggested that 5-year use of such techniques for daily self-examination among high-risk patients may contribute to the significant reduction of diabetic foot complications. Clearly, further experience with thermography in the real-life setting is now very welcome.
Click to expand...

NewsBot · Dec 19, 2014

This clinical trial was just registered:
Diabetic Foot Ulcer Prevention System (DFUPS)

To evaluate a recently developed non-invasive infrared thermal camera called Diabetic Foot Ulcer Prevention System (DFUPS) in a clinical setting by studying healthy volunteers.
Click to expand...

NewsBot · Feb 28, 2015

This clinical trial was just registered:
Implementation of Foot Thermometry and SMS to Prevent Diabetic Foot Ulcer

Purpose
This protocol aims to implement daily temperature measurements of feet and SMS to prevent diabetic foot ulcer in patients with diabetes mellitus type 2 and high risk patient.

Design: Physician-blinded, randomized, 12-month trial.

Setting: Recruitment will be performed in Diabetes Outpatient Clinics at two Ministry Health tertiary hospitals: Cayetano Heredia Hospital and Arzobispo Loayza Hospital.

Population: Subjects will be eligible if they have a diagnosis of diabetes mellitus type 2, are between 18 - 80 years of age, have a present dorsalis pedis pulse in both feet, are in risk group 2 or 3 using the diabetic foot risk classification system as specified by the International Working Group on the Diabetic Foot, have an operating cell phone or a caregiver with an operating cell phone, and have the ability to provide informed consent.

The investigators hypothesize that through the synergies created by implementing an enhanced intervention that combines the proven method of temperature measurement for the reduction of diabetic foot ulcer with the proven method using SMS reminders, the investigators will leapfrog these conventional interventions to improve patient measurement compliance and reduce diabetic foot ulcer in low middle income country.
Click to expand...

NewsBot · Mar 5, 2015

Automatic detection of diabetic foot complications with infrared thermography by asymmetric analysis
Chanjuan Liu ; Jaap J. van Netten ; Jeff G. van Baal ; Sicco A. Bus ; Ferdi van der Heijden
J. Biomed. Opt. 20(2), 026003 (Feb 11, 2015). doi:10.1117/1.JBO.20.2.026003

Early identification of diabetic foot complications and their precursors is essential in preventing their devastating consequences, such as foot infection and amputation. Frequent, automatic risk assessment by an intelligent telemedicine system might be feasible and cost effective. Infrared thermography is a promising modality for such a system. The temperature differences between corresponding areas on contralateral feet are the clinically significant parameters. This asymmetric analysis is hindered by (1) foot segmentation errors, especially when the foot temperature and the ambient temperature are comparable, and by (2) different shapes and sizes between contralateral feet due to deformities or minor amputations. To circumvent the first problem, we used a color image and a thermal image acquired synchronously. Foot regions, detected in the color image, were rigidly registered to the thermal image. This resulted in 97.8%±1.1% sensitivity and 98.4%±0.5% specificity over 76 high-risk diabetic patients with manual annotation as a reference. Nonrigid landmark-based registration with B-splines solved the second problem. Corresponding points in the two feet could be found regardless of the shapes and sizes of the feet. With that, the temperature difference of the left and right feet could be obtained.
Click to expand...

NewsBot · Aug 6, 2015

Intraindividual Variability and Long-Term Changes of Thermal Quantitative Sensory Testing.
Kr?ig?rd T, Sothynathan I, Sindrup SH.
J Clin Neurophysiol. 2015 Aug;32(4):352-356.

Thermal threshold examinations are widely used in the clinical setting and in studies to assess the function of the peripheral sensory nervous system. Little is known about the variation from one side of the body to the other and the long-term temporal changes and variability. In this study, 134 healthy subjects were stimulated at the dorsum of the hand, lower arm, upper arm, thorax, abdomen, thigh, lower leg, and dorsum of the foot bilaterally to determine the cold detection threshold and the warmth detection threshold. Forty-eight subjects were reexamined after 2 weeks and 26 weeks at the hand and foot. Bilateral stimulations resulted in relative intertrial variations ranging from 19% to 40%. There was no significant temporal change for repeated measures. Analysis of the individual measurements of each subject at baseline and at 26 weeks, however, resulted in relatively large intertrial variations of 19% to 42%. Sample sizes ranging from 42 to 76 subjects in each group would be required to detect a minimal relevant difference of the magnitude of the 95 percentile of the absolute changes. Attention should be given to the relatively large intraindividual variation when used as a tool for diagnosis or monitoring in the clinical setting. Cold and warmth detection threshold are well suited as outcome measures in longitudinal studies.
Click to expand...

NewsBot · Oct 11, 2015

A pilot study testing the feasibility of skin temperature monitoring to reduce recurrent foot ulcers in patients with diabetes - a randomized controlled trial.
Skafjeld A et al
BMC Endocr Disord. 2015 Oct 9;15(1):55.

BACKGROUND:
Although monitoring foot skin temperatures has been associated with diabetic foot ulcer recurrence, no studies have been carried out to test the feasibility among European Caucasians. Moreover, the educational and/or motivational models that promote cognitive or psychosocial processes in these studies are lacking. Thus, we conducted a pilot randomized controlled trial to test the feasibility of monitoring foot skin temperatures in combination with theory-based counselling to standard foot care to reduce diabetic foot ulcer recurrence.
METHODS:
In a single-blinded nurse-led 1-year controlled trial, conducted at a hospital setting in Norway, 41 patients with diabetic neuropathy and previous foot ulcer were randomized to the intervention (n = 21) or control groups (n = 20). All participants were instructed in foot care and recording observations daily. Additionally, the intervention group was taught how to monitor and record skin temperature at baseline, and received counselling every third month supporting them to use the new treatment. Subjects observing temperature differences >2.0 ?C between corresponding sites on the left and right foot on two consecutive days were asked to contact the study nurse and reduce physical activity. Fisher exact test was used to evaluate the effect of the intervention on the proportion of subjects with a foot ulcer. Kaplan-Meier survival analysis was performed to compare the two groups in regard to the time to development of a foot ulcer.
RESULTS:
In the intervention group, 67 % (n = 14/21) monitored and recorded skin temperatures ≥80 % of the time while 70 % (n = 14/20) of the controls recorded foot inspections. Foot ulcer incidence was 39 % (7/21) vs. 50 % (10/20) in the intervention and control groups, respectively (ns).
CONCLUSIONS:
This feasibility study showed that the addition of counselling to promote self-monitoring of skin temperature to standard care to prevent recurrence of foot ulcer is feasible in patients with diabetes in Norway. Home skin temperature monitoring was performed as frequently by the intervention group as usual foot observations in the controls despite the extra effort required. We did not detect a difference in foot ulcer recurrence between groups, but our study may inform future full scale studies.
Click to expand...

NewsBot · Apr 12, 2016

Use of smartphone attached mobile thermography assessing subclinical inflammation: a pilot study.
Kanazawa T et al
J Wound Care. 2016 Apr 2;25(4):177-182.

OBJECTIVE:
To verify the reliability and validity of FLIR ONE, a device connected to a smartphone, for the assessment of inflammation based on relative temperature increase compared with the thermography routinely used in pressure ulcer (PU) and diabetic foot assessment.
METHOD:
Participants in this pilot cross-sectional observational study were recruited from the patients in the PU team rounds and the diabetic foot outpatient clinic at the university hospital in January 2015. Cohen's kappa coefficient with its 95% confidence intervals was used to evaluate the criterion-related validity and inter- and intra-rater reliability for the thermal imaging assessment. For assessing criterion-related validity, a hand-held high-end infrared thermography device was used to provide reference data. Comparison of thermal images between the smartphone-connected device and the hand-held device was performed with both a 'predetermined range' and an 'automatically-set range.' For assessing inter-rater reliability, two assessors evaluated the thermal images taken by the mobile thermography. For assessing intra-rater reliability, one assessor evaluated the thermal images twice. The thermal images were shown to the assessors at random.
RESULTS:
Among 16 thermal images obtained from eight patients, kappa coefficients for each value were as follows: for the predetermined range and automatically-set range, respectively, the criterion-related validity was 1.00 (95% confidence interval 1.00-1.00) and 1.00 (95% confidence interval 1.00-1.00); the inter-rater reliability was 1.00 (95% confidence interval 1.00-1.00) and 1.00 (95% confidence interval 1.00-1.00); and the intra-rater reliability was 1.00 (95% confidence interval 1.00-1.00) and 1.00 (95% confidence interval 1.00-1.00).
CONCLUSION:
This pilot study suggests that FLIR ONE can work as an alternative device for assessing subclinical inflammation in PUs and the diabetic foot in clinical settings. Our results may facilitate clinicians in accepting the routine use of thermal imaging assessment at the patients' bedside.
Click to expand...

NewsBot · Apr 12, 2016

Using Noncontact Infrared Thermography for Long-term Monitoring of Foot Temperatures in a Patient with Diabetes Mellitus.
Staffa E et al
Ostomy Wound Manage. 2016 Mar;62(3):54-61.

Foot complications in persons with diabetes mellitus (DM) are associated with substantial costs and loss of quality of life. Increasing evidence suggests changes in skin temperature, measured using an infrared thermographic system (IRT), may be a predictor of foot ulcer development in patients with DM. The purpose of this case study is to describe the long-term IRT findings and overall clinical outcomes of a patient with DM and peripheral vascular disease. Foot temperature measurements using IRT were obtained slightly more than 1 year before and immediately following endovascular treatment of a 76-year-old man, a nonsmoker with type 2 DM, hypertension, and ischemic heart disease with cardiac arrhythmia. Although he was otherwise asymptomatic, the infrared measurement showed an average temperature difference of 2.3˚ C between the left and right foot until he developed a small, trauma-induced wound on the left foot, at which time left foot temperature increased. He was diagnosed with rectosigmoid adenocarcinoma, underwent surgery and chemotherapy, and subsequently was evaluated for peripheral vascular disease. Before undergoing peripheral angiography and percutaneous transluminal angioplasty, IRT evaluation showed a hot spot on the left heel. Immediately following endovascular treatment, the mean temperature difference between the right and left foot was low (0.2˚ C), but a Stage I pressure ulcer was visible on the left heel. Skin breakdown in that area was observed 2 months later, and the wound continued to increase in size and depth. The patient died shortly thereafter due to complications of cancer. In this case study, a series of infrared images of foot skin temperatures appeared to show a relationship with blood circulation and wound/ulcer development and presentation. IRT has the ability to instantaneously measure the absolute temperature of the skin surface over a large area without direct skin contact. However, the devices are very sensitive and prospective clinical studies to determine the validity, reliability, sensitivity, and specificity of these measurements for routine use in patients who are at risk for vascular disease and/or foot ulcers are needed.
Click to expand...

NewsBot · Jul 12, 2016

Portable System for Monitoring the Microclimate in the Footwear-Foot Interface.
Sandoval-Palomares JJ et al
Sensors (Basel). 2016 Jul 8;16(7). pii: E1059.

A new, continuously-monitoring portable device that monitors the diabetic foot has shown to help in reduction of diabetic foot complications. Persons affected by diabetic foot have shown to be particularly sensitive in the plantar surface; this sensitivity coupled with certain ambient conditions may cause dry skin. This dry skin leads to the formation of fissures that may eventually result in a foot ulceration and subsequent hospitalization. This new device monitors the micro-climate temperature and humidity areas between the insole and sole of the footwear. The monitoring system consists of an array of ten sensors that take readings of relative humidity within the range of 100% ? 2% and temperature within the range of -40 ?C to 123.8 ? 0.3 ?C. Continuous data is collected using embedded C software and the recorded data is processed in Matlab. This allows for the display of data; the implementation of the iterative Gauss-Newton algorithm method was used to display an exponential response curve. Therefore, the aim of our system is to obtain feedback data and provide the critical information to various footwear manufacturers. The footwear manufactures will utilize this critical information to design and manufacture diabetic footwear that reduce the risk of ulcers in diabetic feet.
Click to expand...

NewsBot · Nov 10, 2017

Computer aided diagnosis of diabetic foot using infrared thermography: A review.
Adam M et al
Comput Biol Med. 2017 Oct 26;91:326-336. doi: 10.1016/j.compbiomed.2017.10.030.

Diabetes mellitus (DM) is a chronic metabolic disorder that requires regular medical care to prevent severe complications. The elevated blood glucose level affects the eyes, blood vessels, nerves, heart, and kidneys after the onset. The affected blood vessels (usually due to atherosclerosis) may lead to insufficient blood circulation particularly in the lower extremities and nerve damage (neuropathy), which can result in serious foot complications. Hence, an early detection and treatment can prevent foot complications such as ulcerations and amputations. Clinicians often assess the diabetic foot for sensory deficits with clinical tools, and the resulting foot severity is often manually evaluated. The infrared thermography is a fast, nonintrusive and non-contact method which allows the visualization of foot plantar temperature distribution. Several studies have proposed infrared thermography-based computer aided diagnosis (CAD) methods for diabetic foot. Among them, the asymmetric temperature analysis method is more superior, as it is easy to implement, and yielded satisfactory results in most of the studies. In this paper, the diabetic foot, its pathophysiology, conventional assessments methods, infrared thermography and the different infrared thermography-based CAD analysis methods are reviewed.
Click to expand...

jorh Welcome New Poster

Admin2 Administrator Staff Member

betafeet Active Member

betafeet Active Member

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

Do foot orthotics alter skin temperature?

Foot skin temperature and blood flow in type 2 diabetes

Increased skin temperature in those with tight calf muscles

Prolonged physical inactivity leads to a drop in toe skin temperature during local cold stress

Skin temperature measurement

Home Monitoring of Foot Skin Temperatures to Prevent Ulceration

Podiatric Skin and Nail Involvement and Biomechanical Pathology in Renal Transplant Recipients

Share This Page