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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
Re: Skin temperature differences as an indicatior of possible ulceration in diabetes
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]
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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
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.
Re: Skin temperature differences as an indicatior of possible ulceration in diabetes
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.
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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.
Re: Skin temperature differences as an indicatior of possible ulceration in diabetes
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]
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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.
Re: Skin temperature differences as an indicatior of possible ulceration in diabetes
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.
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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.
Skin temperature differences as an indicatior of possible ulceration in diabetes
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