Monitoring neuropathic ulcer healing with infrared dermal thermometry (original) (raw)
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Skin temperature monitoring reduces the risk for diabetic foot ulceration in high-risk patients
American Journal of Medicine, 2007
To evaluate the effectiveness of home temperature monitoring to reduce the incidence of foot ulcers in high-risk patients with diabetes.In this physician-blinded, 18-month randomized controlled trial, 225 subjects with diabetes at high risk for ulceration were assigned to standard therapy (Standard Therapy Group) or dermal thermometry (Dermal Thermometry Group) groups. Both groups received therapeutic footwear, diabetic foot education, regular foot care, and performed a structured foot inspection daily. Dermal Thermometry Group subjects used an infrared skin thermometer to measure temperatures on 6 foot sites twice daily. Temperature differences >4°F between left and right corresponding sites triggered patients to contact the study nurse and reduce activity until temperatures normalized.A total of 8.4% (n = 19) subjects ulcerated over the study period. Subjects were one third as likely to ulcerate in the Dermal Thermometry Group compared with the Standard Therapy Group (12.2% vs 4.7%, odds ratio 3.0, 95% confidence interval, 1.0 to 8.5, P = .038). Proportional hazards regression analysis suggested that thermometry intervention was associated with a significantly longer time to ulceration (P = .04), adjusted for elevated foot ulcer classification (International Working Group Risk Factor 3), age, and minority status. Patients that ulcerated had a temperature difference that was 4.8 times greater at the site of ulceration in the week before ulceration than did a random 7 consecutive-day sample of 50 other subjects that did not ulcerate (3.50 ± 1.0 vs 0.74 ± 0.05, P = .001).High temperature gradients between feet may predict the onset of neuropathic ulceration and self-monitoring may reduce the risk of ulceration.
Infrared dermal thermometry for the high-risk diabetic foot
Physical therapy, 1997
The purpose of this study was to compare skin temperatures in patients with asymptomatic peripheral sensory neuropathy, patients with neuropathic ulcers, and patients with Charcot's arthropathy using the contralateral limb as a control. On a retrospective basis, patients with diabetes (N = 143) were divided into three groups: patients with asymptomatic sensory neuropathy (n = 78), patients with neuropathic foot ulcers (n = 44), and patients with neuropathic fractures (Charcot's arthropathy) (n = 21). We evaluated the subjects' skin temperatures with a portable hand-held infrared skin temperature probe at the time pathology was initially identified and at subsequent clinical visits for an average of 22.1 months (SD = 6.4). Skin temperatures of the contralateral foot were measured as a control. There were differences in skin temperature between the affected foot and the contralateral (i.e., nonaffected) foot among the patients with Characot's arthropathy (8.3 degrees F...
Journal of the American Podiatric Medical Association
Background: Diabetic foot ulcers (DFUs) are a major burden to patients and to the health-care systems of many countries. To prevent or treat ulcers more effectively, predictive biomarkers are needed. We examined temperature as a biomarker and as a causative factor in ulcer development. Methods: Thirty-seven individuals with diabetes were enrolled in this observational case-control study: nine with diabetic neuropathy and ulcer history (DFU), 14 with diabetic neuropathy (DN), and 14 nonneuropathic control participants (DC). Resting barefoot plantar temperatures were recorded using an infrared thermal camera. Mean temperatures were determined in four anatomical regions—hallux and medial, central, and lateral forefoot—and separate linear models with specified contrasts among the DFU, DN, and DC groups were set to reveal mean differences for each foot region while controlling for group characteristics. Results: The mean temperature reading in each foot region was higher than 30.0°C in t...
Home Monitoring of Foot Skin Temperatures to Prevent Ulceration
Diabetes Care, 2004
OBJECTIVE—To evaluate the effectiveness of at-home infrared temperature monitoring as a preventative tool in individuals at high risk for diabetes-related lower-extremity ulceration and amputation. RESEARCH DESIGN AND METHODS—Eighty-five patients who fit diabetic foot risk category 2 or 3 (neuropathy and foot deformity or previous history of ulceration or partial foot amputation) were randomized into a standard therapy group (n = 41) or an enhanced therapy group (n = 44). Standard therapy consisted of therapeutic footwear, diabetic foot education, and regular foot evaluation by a podiatrist. Enhanced therapy included the addition of a handheld infrared skin thermometer to measure temperatures on the sole of the foot in the morning and evening. Elevated temperatures (>4°F compared with the opposite foot) were considered to be “at risk” of ulceration due to inflammation at the site of measurement. When foot temperatures were elevated, subjects were instructed to reduce their activi...
2007
OBJECTIVE-The purpose of this study was to evaluate the effectiveness of a temperature monitoring instrument to reduce the incidence of foot ulcers in individuals with diabetes who have a high risk for lower extremity complications. RESEARCH DESIGN AND METHODS-In this physician-blinded, randomized, 15month, multicenter trial, 173 subjects with a previous history of diabetic foot ulceration were assigned to standard therapy, structured foot examination, or enhanced therapy groups. Each group received therapeutic footwear, diabetic foot education, and regular foot care. Subjects in the structured foot examination group performed a structured foot inspection daily and recorded their findings in a logbook. If standard therapy or structured foot examinations identified any foot abnormalities, subjects were instructed to contact the study nurse immediately. Subjects in the enhanced therapy group used an infrared skin thermometer to measure temperatures on six foot sites each day. Temperature differences Ͼ4°F (Ͼ2.2°C) between left and right corresponding sites triggered patients to contact the study nurse and reduce activity until temperatures normalized. RESULTS-The enhanced therapy group had fewer foot ulcers than the standard therapy and structured foot examination groups (enhanced therapy 8.5 vs. standard therapy 29.3%, P ϭ 0.0046 and enhanced therapy vs. structured foot examination 30.4%, P ϭ 0.0029). Patients in the standard therapy and structured foot examination groups were 4.37 and 4.71 times more likely to develop ulcers than patients in the enhanced therapy group. CONCLUSIONS-Infrared temperature home monitoring, in serving as an "early warning sign," appears to be a simple and useful adjunct in the prevention of diabetic foot ulcerations.
The international journal of lower extremity wounds, 2018
This study aimed to determine whether thermal imaging can detect temperature differences between healthy feet, nonulcerated neuroischemic feet, and neuroischemic feet with toe ulcers in patients with type 2 diabetes mellitus (T2DM). Participants were prospectively divided into 3 groups: T2DM without foot problems; a healthy, nonulcerated neuroischemic group, and an ulcerated neuroischemic group. Thermal images of the feet were obtained with automated segmentation of regions of interest. Thermographic images from 43 neuroischemic feet, 21 healthy feet, and 12 neuroischemic feet with active ulcer in one of the toes were analyzed. There was a significant difference in toe temperatures between the 3 groups ( P = .001), that is, nonulcerated neuroischemic (n = 181; mean temperature = 27.7°C [±2.16 SD]) versus neuroischemic ulcerated (n = 12; mean temperature = 28.7°C [±3.23 SD]), and healthy T2DM group (n = 104; mean temperature = 24.9°C [±5.04 SD]). A post hoc analysis showed a signific...
The aim of this systematic review was to evaluate the strength of the existing research to answer the question: Is an increase in skin temperature predictive of neuropathic foot ulceration in people with diabetes? Methods: This study is a systematic review and meta-analysis of temperature-monitoring in the prediction and prevention of diabetic foot ulceration. Two investigators conducted a literature search for all relevant articles from 1960 until July 2011. During this process the following data bases were searched: MEDLINE, Science Direct, AMED, Australian Medical Index, APAIS-Health, ATSIhealth, EMBASE, Web of Science and OneSearch. Keywords used in this search included diabetes, foot complications, ulceration, temperature-monitoring, prediction and prevention.
Benefit of Foot Thermogram Analysis in the Treatment of Diabetic Foot Ulcer: A Systematic Review
Biomedical Research and Therapy
Introduction: Foot thermograms depict vascular distribution among foot regions with a spectrum of thermal values. Infrared thermography (IRT) is used to explore challenges in diagnosing complications that involve temperature differences. Problem Statement: It is crucial to identify underlying diabetic ulcers in the foot plantar regions, which are typically missed in photographic images. Early detection of ulcer onset can reduce healing time and treatment costs; thus, IRT plays a vital role in identifying early-stage ulcers by detecting vascular changes. This systematic review aimed to identify studies of thermography in foot ulcer diagnosis, including analysis techniques, extracted features, and scores among patients. Method: A literature search was conducted in PubMed and Scopus databases to identify relevant articles published within the last 10 years. The main criteria for the search results were articles in English with abstracts, and full articles that examine the relationship between diabetes mellitus (DM), foot ulcer and thermography among DM patients. Results: The search identified 2,215 articles, with only 8 studies meeting the inclusion criteria. Foot thermograms were used to identify foot ulcer regions associated with temperature differences. The studies included parameters such as ankle brachial index (ABI), toe brachial index (TBI), age, sex, duration of diabetes, and type of diabetes for statistical analyses to verify the validity of temperature difference data in asymmetrical analysis. Conclusion: Further interventional studies should be conducted to investigate foot IRT in patients with DM, as a variation in temperature differences may challenge the validity of foot thermograms in foot ulcer grading.
Journal of diabetes science and technology, 2018
In clinical practice, both area and temperature of the ulcer have been shown to be effective in tracking the healing status of diabetes-related foot ulcer (DRFU). However, traditionally, the area of the DRFU is measured regardless of the temperature distribution. The current prospective, observational study used thermal imaging, as a more accurate tool, to measure both the area and the temperature of DRFU. We aimed to predict healing of DRFU using thermal imaging within the first 4 weeks of ulceration. A pilot study was conducted where thermal and color images of 26 neuropathic DRFUs (11 healing vs 15 nonhealing) from individuals with type 1 or 2 diabetes were taken at the initial clinic visit (baseline), at week 2, and at week 4. The thermal images were segmented into isothermal patches to identify the wound boundary and area corresponding to temperature distribution. Five parameters were obtained: temperature of the wound bed, area of the isothermal patch of the wound bed, area of...