Coming events cast their shadows before: detecting inflammation in the acute diabetic foot and the foot in remission

The incidence of diabetic foot complications, most notably wounds, is increasing worldwide. Most people who present for care of a foot wound will become infected. Globally, this results in one major amputation every 30 seconds with over 2500 limbs lost per day. Presently, clinicians assess circulation, neuropathy and plantar pressures to identify the risk of foot ulceration. Several studies have suggested prevention of foot ulcers by identifying individuals at high risk and treating for lower extremity complications. Our group has proposed several diagnostics as well as prevention strategies, especially thermography and thermometry for management of patients with diabetic foot complications. These strategies employ non‐invasive assessment of inflammation for acute as well as chronic care for the foot, with the intent to prevent ulceration/re‐ulceration and subsequent traumatic amputations. The authors' review some important clinical studies and ongoing research in this area, with the long‐term goal to further the role of thermography and thermometry in clinical care for the diabetic foot. Copyright © 2012 John Wiley & Sons, Ltd.

[1]  G. Reiber,et al.  Diabetic Foot Care: Financial Implications and Practice Guidelines , 1992, Diabetes Care.

[2]  C. M. Agrawal,et al.  Preventing Diabetic Foot Ulcer Recurrence in High-Risk Patients , 2007, Diabetes Care.

[3]  D J Claremont,et al.  Thermography and Thermometry in the Assessment of Diabetic Neuropathic Foot: A Case for Furthering the Role of Thermal Techniques , 2006, The international journal of lower extremity wounds.

[4]  P. Scuffham,et al.  The health care costs of diabetic peripheral neuropathy in the US. , 2003, Diabetes care.

[5]  David G Armstrong,et al.  Skin temperature monitoring reduces the risk for diabetic foot ulceration in high-risk patients. , 2007, The American journal of medicine.

[6]  K. Roback,et al.  Feasibility of a thermographic method for early detection of foot disorders in diabetes. , 2009, Diabetes technology & therapeutics.

[7]  M. Bharara.  Liquid crystal thermography in neuropathic assessment of the diabetic foot , 2007 .

[8]  D. Armstrong,et al.  Whither Progress in the Diabetic Foot—Clinical and Research? , 2004, The international journal of lower extremity wounds.

[9]  Gojiro Nakagami,et al.  Ultrasonographic and thermographic screening for latent inflammation in diabetic foot callus. , 2009, Diabetes research and clinical practice.

[10]  David G Armstrong,et al.  Wound Inflammatory Index: A “Proof of Concept” Study to Assess Wound Healing Trajectory , 2010, Journal of diabetes science and technology.

[11]  D. Armstrong,et al.  Continuous activity monitoring in persons at high risk for diabetes-related lower-extremity amputation. , 2001, Journal of the American Podiatric Medical Association.

[12]  P. N. S. Rao,et al.  Correlation between Plantar Foot Temperature and Diabetic Neuropathy: A Case Study by Using an Infrared Thermal Imaging Technique , 2010, Journal of diabetes science and technology.

[13]  D. Armstrong,et al.  Activity monitors: should we begin dosing activity as we dose a drug? , 2001, Journal of the American Podiatric Medical Association.

[14]  Vijay Viswanathan,et al.  Cold immersion recovery responses in the diabetic foot with neuropathy , 2008, International wound journal.

[15]  A. Boulton,et al.  Foot ulcer risk is lower in South-Asian and african-Caribbean compared with European diabetic patients in the U.K.: the North-West diabetes foot care study. , 2005, Diabetes care.

[16]  Theophano Mitsa,et al.  Impaired Distal Thermoregulation in Diabetes and Diabetic Polyneuropathy , 2009, Diabetes Care.

[17]  C. M. Agrawal,et al.  Home monitoring of foot skin temperatures to prevent ulceration. , 2004, Diabetes care.

[18]  D. Armstrong,et al.  Variability in activity may precede diabetic foot ulceration. , 2004, Diabetes care.

[19]  David G Armstrong,et al.  Does dermal thermometry predict clinical outcome in diabetic foot infection? Analysis of data from the SIDESTEP * trial , 2006, International wound journal.

[20]  P. Scuffham,et al.  The Health Care Costs of Diabetic Peripheral Neuropathy in the U.S. , 2003 .

[21]  B. Raj,et al.  Infrared thermal imaging for detection of peripheral vascular disorders , 2009, Journal of medical physics.

[22]  D. Armstrong,et al.  Variability in activity may precede diabetic foot ulceration. , 2004, Diabetes care.

[23]  F. Ring.  Thermal Imaging Today and Its Relevance to Diabetes , 2010, Journal of diabetes science and technology.

[24]  B. Griffith,et al.  Proof of concept: hemodynamic response to long-term partial ventricular support with the synergy pocket micro-pump. , 2009, Journal of the American College of Cardiology.

[25]  Warm immersion recovery test in assessment of diabetic neuropathy – a proof of concept study , 2008, International wound journal.

[26]  J. Fletcher.  The foot in diabetes. , 1996, Nursing times.

[27]  M. Bharara,et al.  Diabetes and landmine‐related amputations: a call to arms to save limbs , 2009, International wound journal.

[28]  E Maltezos,et al.  Foot temperature in type 2 diabetic patients with or without peripheral neuropathy. , 2009, Experimental and clinical endocrinology & diabetes : official journal, German Society of Endocrinology [and] German Diabetes Association.

[29]  E. Maltezos,et al.  Association between Foot Temperature and Sudomotor Dysfunction in Type 2 Diabetes , 2010, Journal of diabetes science and technology.

[30]  D. Armstrong,et al.  Toward a change in syntax in diabetic foot care: prevention equals remission. , 2013, Journal of the American Podiatric Medical Association.

[31]  Stuart N Hoffman,et al.  Ambulatory foot temperature measurement: A new technique in polyneuropathy evaluation , 2003, Muscle & nerve.

[32]  David G Armstrong,et al.  Guest Editorial: are diabetes‐related wounds and amputations worse than cancer? , 2007, International wound journal.

[33]  David G Armstrong,et al.  Diabetic foot syndrome: evaluating the prevalence and incidence of foot pathology in Mexican Americans and non-Hispanic whites from a diabetes disease management cohort. , 2003, Diabetes care.

[34]  Kuo-Sheng Cheng,et al.  The Application of Thermal Image Analysis to Diabetic Foot Diagnosis , 2002 .

[35]  G. Reiber,et al.  The burden of diabetic foot ulcers. , 1998, American journal of surgery.

[36]  C. Hansen,et al.  Table 2 , 2002, Equality and Non-Discrimination under the European Convention on Human Rights.

[37]  R. V. van Deursen,et al.  Specific guidelines on footwear and offloading , 2008, Diabetes/metabolism research and reviews.

[38]  Michelle H. Chen,et al.  Development of a Thermal and Hyperspectral Imaging System for Wound Characterization and Metabolic Correlation , 2005 .

[39]  Gojiro Nakagami,et al.  Variations of plantar thermographic patterns in normal controls and non-ulcer diabetic patients: novel classification using angiosome concept. , 2011, Journal of plastic, reconstructive & aesthetic surgery : JPRAS.

[40]  D. Armstrong,et al.  Preventing foot ulcers in patients with diabetes. , 2005, JAMA.

[41]  S. Rutkove,et al.  Foot temperature in diabetic polyneuropathy: innocent bystander or unrecognized accomplice? , 2005, Diabetic medicine : a journal of the British Diabetic Association.

[42]  E. Sparrow,et al.  Assessing wound severity with color and infrared imaging of reactive hyperemia , 1996, Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society.