The thermoregulation of healthy individuals, overweight-obese, and diabetic from the plantar skin thermogram: a clue to predict the diabetic foot

Development of a self-monitoring tool for diabetic foot prevention using smartphone-based thermography: Plantar thermal pattern changes and usability in the home environment

Thermography is a well-known risk-assessment tool for diabetic foot ulcers but is not widely used in the home setting due to the influence of the complicated home environment on thermographic images. This study investigated changes in thermographic images in complicated home environments to determine the feasibility of smartphone-based thermography in home settings. Healthy volunteers (age > 20 years) were recruited and required to take plantar thermal images using smartphone-based thermography attached to a selfie stick at different times of the day for 4 days. The thermal images and associated activities and environmental factors were then analyzed using content analysis. Areas with the highest temperature on the plantar thermal images were described and categorized. Device usability was evaluated using 10-point Likert scales, with 10 representing the highest satisfaction. A total of 140 plantar thermal images from 10 participants were analyzed. In 12 classifications, the three commonest patterns based on the highest temperature location were medial arch (42.1%), whole plantar (10.7%), and forefoot and medial arch (7.9%). The medial arch pattern is most frequently seen after awakening (67.5%) compared to other time points. Device usability was rated 7.5 out of 10 on average. This study was the first to investigate the plantar thermal patterns in the home settings, and the medial arch pattern was the most common hot area, which matches previous findings in well-controlled clinical settings. Therefore, smartphone-based thermography may be feasible as a self-assessment tool in the home setting.

The effects of auricular acupuncture on vascular parameters on the risk factors for diabetic foot: A randomized clinical trial

AIMS AND OBJECTIVES

To evaluate the effects of auricular acupuncture on vascular parameters on the risk factors for Diabetic Foot.

METHODS

Randomized and masked clinical trial. The sample was composed of 44 individuals with type 2 Diabetes Mellitus and they were randomly assigned to two groups: intervention (n = 22), which received five sessions of auricular acupuncture, and control (n = 22), which did not receive the therapy. Three evaluations were performed: before the intervention; one day after the last acupuncture session and 15 days after the second evaluation. For this, the subject's characterization instrument, the Ankle-Brachial Index measurement, and thermography were used. For data analysis, Mann-Whitney, Wilcoxon, Wilcoxon signed-rank, Fisher's Exact and Chi-Square tests were used.

RESULTS

Auriculotherapy provided results in the Ankle-Brachial Index Test, as well as in thermography, which showed significant temperature improvement.

CONCLUSIONS

The technique proved to be efficient in improving circulatory conditions and plantar temperature.

Comparison of sensitivity and plantar cutaneous temperature of patients with stroke and Diabetes Mellitus: A pilot case-control study

BACKGROUND

Stroke combined with Diabetes Mellitus may cause sensibility and vascular alterations.

OBJECTIVE

To determine whether sensitivity and plantar cutaneous temperature of clinically controlled patients with stroke and DM are different from those of patients with stroke only.

METHODS

This is a cross-sectional case-control study. The volunteers were assessed for sensitivity by monofilament esthesiometry in their plantar region, and for temperature by infrared thermal imaging. The data was presented as means and standard deviations and comparisons were conducted with the Mann-Whitney statistical test, with statistical significance set at p< 0.05.

RESULTS

Five cases and 11 controls were included according to the eligibility and pairing criteria. There were no discrepancies between the plegic and contralateral sides regarding temperature and sensibility of both cases and controls. However, in the control group, there was an observable tendency for different temperatures between the plegic and the contralateral sides, with p< 0.05 in most of the comparisons.

CONCLUSIONS

There is no evidence that the cases and controls have different plantar sensibility nor different plantar temperature on their plegic and contralateral sides. However, significant temperature discrepancies between both plegic and contralateral sides were observed in the control group.

Comparative thermal map of the foot between patients with and without diabetes through the use of infrared thermography

OBJECTIVE

The objective of the study is to analyze, through the use of infrared thermography, the variability of foot temperature in diabetic and non-diabetic patients by segmenting the sole of the foot in four study areas.

METHOD

A cross-sectional study was proposed on a sample of 479 subjects divided into two groups, a group of people with diabetes and a group of people without diabetes. The diabetes group comprised a total of 277 people, with an average age of 63.41 years, [138 men (49.8%) and 139 women (50.2%)], and the group without diabetes comprised 202 individuals, with an average age of 61.92 years, [99 men (49%) and 103 women (51%)]. The images were taken using the FLIR E60bx® camera. IBM SPSS Statistics 22 software was used for the statistical data analysis.

RESULTS

The results show temperature variability in the different areas of study of the sole of the foot bilaterally and there were also differences according to whether the patient belonged to the diabetic or the non-diabetic group.

CONCLUSIONS

The use of infrared thermography in the evaluation of the foot at risk could demonstrate the variability of temperature by study area, which could be useful in the area of healthcare for the diagnosis and prevention of injuries to compromised areas of the foot.

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

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