Abstract
Background: Diabetes mellitus is a public health problem worldwide. The diabetic foot has a degenerate vascular structure, and its patients present neurological problems, which require the earliest possible identification.
Introduction: The objective of the research was to use infrared thermography to analyze the temperature difference of the feet of users with diabetes mellitus with neuropathy, vasculopathy, neurovascular disease, or none of them, segmenting the sole of the foot in four areas for the study.
Methods: A type of descriptive, cross-sectional and observational study was developed in a group of 277 patients with diabetic pathology (138 men and 139 women), with an average age of 63.41 ± 17.69 years and a body mass index of 29.08 ± 5.86, delimited in four groups: 22 (7.94%) with neuropathy, 32 (11.55%) with vasculopathy, 83 (29.96%) with neurovasculopathy and 140 (50.54%) without previous pathology. Thus, almost half of the sample (49.46%) presented some type of complication (neuropathic, vasculopathic or both). The photographic images were made with an infrared camera model FLIR E60bx®. The data obtained were analyzed using the IBM SPSS Statistics 22 statistical program.
Results: There were lower temperatures under the 1st metatarsal head, the 5th metatarsal head, the heel, and pulp of the big toe of both left and right feet of the patients in the neuropathy, vasculopathy, and neurovasculopathy groups relative to the group with neither pathology.
Conclusion: Infrared thermography can be useful in assessing the foot at risk to reveal the variability of temperature according to the study area, which may be useful for medical judgment and the predisposition to identify lesions in compromised regions of the foot.
Keywords: Diabetes mellitus, diabetic foot, thermography, mapping temperature, infrared rays, thermal foot maps.
[1]
International Diabetes Federation IDF Diabetes Atlas [Internet]. 7.a ed.. Brussels:. International Diabetes Federation; 2015; p. 144..
[2]
Setacci C, de Donato G, Setacci F, Chisci E. Diabetic patients: Epidemiology and global impact. J Cardiovasc Surg (Torino) 2009; 50(3): 263-73.
[3]
American Diabetes Association. Standards of Medical Care in Diabetes-2017. Summary of Revisions Diabetes Care 2017; 40(Suppl. 1): S4-5.
[4]
Mikulska D, Maleszka R, Parafiniuk M. The usefulness of thermography as a diagnostic method in dermatology on the basis of clinical trials in 2001-2005. Ann Acad Med Stetin 2006; 52(3): 91-7.
[5]
Hildebrandt C, Zeilberger K, John Ring EF, Raschner C. The Application of Medical Infrared Thermography in Sports Medicine. En: An International Perspective on Topics in Sports Medicine and Sports Injury [Internet]. InTech 2012.Recuperado a partir de:. http://www.intechopen.com/books/an-international-perspective-on-topics-in-sports-medicine-and-sports-injury/the-application-of-medical-infrared-thermography-in-sports-medicine
[6]
Astasio-Picado A, Escamilla ME, Martínez NA, Sánchez RR, Gómez–Martín B. Thermal map of the diabetic foot using infrared thermography. Infrared Phys Technol Pergamon 2018; 93: 59-62.
[7]
Akimov EB, Son’kin VD. Skin temperature and lactate threshold during muscle work in sportsmen. Fiziol Cheloveka 2011; 37(5): 120-8.
[8]
Merla A, Luca Romani G. Functional Infrared Imaging in Clinical Applications. In: Medical Devices and Systems. 2006; pp. 32-1-32- 18..
[9]
Ng EY-K. A review of thermography as promising non-invasive detection modality for breast tumor. Int J Therm Sci 2009; 48(5): 849-59.
[10]
Costello JT, McInerney CD, Bleakley CM, Selfe J, Donnelly AE. The use of thermal imaging in assessing skin temperature following cryotherapy: A review. J Therm Biol 2012; 37(2): 103-10.
[11]
Hildebrandt C, Raschner C, Ammer K. An overview of recent application of medical infrared thermography in sports medicine in Austria. Sensors (Basel) 2010; 10(5): 4700-15.
[12]
Pennes HH. Analysis of tissue and arterial blood temperatures in the resting human forearm. 1948. J Appl Physiol 1998; 85(1): 5-34.
[13]
Bagavathiappan S, Saravanan T, Philip J, et al. Infrared thermal imaging for detection of peripheral vascular disorders. J Med Phys 2009; 34(1): 43-7.
[14]
Goller H, Lewis DW, McLaughlin RE. Thermographic studies of human skin subjected to localized pressure. Am J Roentgenol Radium Ther Nucl Med 1971; 113(4): 749-54.
[15]
Benbow SJ, Chan AW, Bowsher DR, Williams G, Macfarlane IA. The prediction of diabetic neuropathic plantar foot ulceration by liquid-crystal contact thermography. Diabetes Care 1994; 17(8): 835-9.
[16]
Stess RM, Sisney PC, Moss KM, et al. Use of liquid crystal thermography in the evaluation of the diabetic foot. Diabetes Care 1986; 9(3): 267-72.
[17]
Armstrong DG, Lavery LA, Liswood PJ, Todd WF, Tredwell JA. Infrared dermal thermometry for the high-risk diabetic foot. Phys Ther 1997; 77(2): 169-75. discussion 176-7
[18]
American Diabetes Association. Standards of Medical Care in Diabetes-2014. Diabetes Care 2014; 37(Suppl. 1): S14-80.
[19]
American Diabetes Association. Standards of Medical Care in Diabetes-2016: Summary of Revisions. Diabetes Care 2016; 39((Supplement 1))
[20]
Ang L, Jaiswal M, Martin C, Pop-Busui R. Glucose control and diabetic neuropathy: Lessons from recent large clinical trials. Curr Diab Rep 2014; 14(9): 528.
[21]
Martin CL, Albers JW, Pop-Busui R. DCCT/EDIC Research Group. Neuropathy and related findings in the diabetes control and complications trial/epidemiology of diabetes interventions and complications study. Diabetes Care 2014; 37(1): 31-8.
[22]
Ismail-Beigi F, Craven T, Banerji MA, et al. Effect of intensive treatment of hyperglycaemia on microvascular outcomes in type 2 diabetes: an analysis of the ACCORD randomised trial. Lancet 2010; 376(9739): 419-30.
[23]
Pop-Busui R, Boulton AJM, Feldman EL, et al. Diabetic neuropathy: A position statement by the American diabetes association. Diabetes Care 2017; 40(1): 136-54.
[24]
Pafili K, Papanas N. Thermography in the follow up of the diabetic foot: best to weigh the enemy more mighty than he seems. Expert Rev Med Devices 2015; 12(2): 131-3.
[25]
Argimon JM, Jiménez J. Métodos de investigación clínica y epidemiológica. 4th ed. Barcelona: Elsevier 2013.
[26]
Feldman EL, Stevens MJ, Thomas PK, Brown MB, Canal N, Greene DA. A practical two-step quantitative clinical and electrophysiological assessment for the diagnosis and staging of diabetic neuropathy. Diabetes Care 1994; 17(11): 1281-9.
[27]
Guindo J, Martínez-Ruiz MD, Gusi G, Punti J, Bermúdez P, Martínez-Rubio A. Métodos diagnósticos de la enfermedad arterial periférica. Importancia del índice tobillo-brazo como técnica de criba. Rev Española Cardiol. Spanish Society of Cardiology 2009; 09(Suppl. D): 11-7.
[28]
Surós Batlló A, Surós Batlló J. Semiología médica y técnica exploratoria.Masson, Ed. Masson;. 2001; p. 1184.
[29]
Téllez de Peralta G. Tratado de cirugía cardiovascular [Internet].Sociedad Española de Cirugía Cardiovascular,. Ed. Madrid: Díaz de Santos; 1998; p. 889.
[30]
Ammer K. The glamorgan protocol for recording and evaluation of thermal images of the human body. Appendix II: Regions of interest. Thermol Int 2008; 4: 136-44.
[32]
Williams JR. The Declaration of Helsinki and public health. Bull World Health Organ 2008; 86(8): 650-2.
[33]
Roback K. An overview of temperature monitoring devices for early detection of diabetic foot disorders. Expert Rev Med Devices 2010; 7(5): 711-8.
[34]
Ammer K, Ring FF. Standard Procedures For Infrared Imaging in
Medicine.En Mary Diakides, Joseph D Bronzino DRP, editor.. Medical Infrared Imaging. United States CRC Press,: Taylor & Francis Group 2012; pp. 22-1-22-14.
[35]
Boyko EJ, Ahroni JH, Stensel VL. Skin temperature in the neuropathic diabetic foot. J Diabetes Complications 2001; 15(5): 260-4.
[36]
Chao CC, Hsieh SC, Yang WS, et al. Glycemic control is related to the severity of impaired thermal sensations in type 2 diabetes. Diabetes Metab Res Rev 2007; 23(8): 612-20.
[37]
Giacomini MK, Cook DJ. Users’ guides to the medical literature: XXIII. Qualitative research in health care A. Are the results of the study valid? Evidence-Based Medicine Working Group. JAMA 2000; 284(3): 357-62.
[38]
Malterud K. Qualitative research: Standards, challenges, and guidelines. Lancet 2001; 358(9280): 483-8.
[39]
Ring EFJ, Ammer K, Jung A, et al. Standardization of thermal imaging. The Anglo-Polish reference database. In: 10th Congress of the European Association of Thermology. Zakopane, Poland 2006.
[40]
International Academy of Clinical Thermology Thermography Guidelines Standards and protocols in Clinical Thermographic Imaging 2002.
[41]
Kaabouch N, Chen Y, Hu W-C, Anderson JW, Ames F, Paulson R. Enhancement of the asymmetry-based overlapping analysis through features extraction. J Electron Imaging. International Society for Optics and Photonics 2011; 20(1)013012
[42]
Kaabouch N, Hu W-C, Chen Y. Alternative technique to asymmetry analysis-based overlapping for foot ulcer examination: scalable scanning. J Diabetes Metab OMICS Int 2012; 01(S5)
[43]
Vardasca R, Ring EFJ, Plassmann P, Jones C. Termal symmetry of the upper and lower extremities in healthy subjects. Thermol Int 2012; 22(2): 53-60.
[44]
Bharara M, Schoess J, Armstrong DG. Coming events cast their shadows before: Detecting inflammation in the acute diabetic foot and the foot in remission. Diabetes Metab Res Rev 2012; 28(Suppl. 1): 15-20.
[45]
Branemark PI, Fagerberg SE, Langer L, Säve-Söderbergh J. Infrared thermography in diabetes mellitus. A preliminary study. Diabetologia 1967; 3(6): 529-32.
[46]
Lavery LA, Higgins KR, Lanctot DR, et al. Home monitoring of foot skin temperatures to prevent ulceration. Diabetes Care 2004; 27(11): 2642-7.
[47]
DCCT/EDIC Research Group. Gubitosi-Klug RA, Sun W, et al. Effects of prior intensive insulin therapy and risk factors on patientreported visual function outcomes in the diabetes control and complications trial/epidemiology of diabetes interventions and complications (DCCT/EDIC) cohort.JAMA Ophthalmol. NIH Public Access 2016; 134: pp. (2)137-45.
[48]
Armstrong DG, Holtz-Neiderer K, Wendel C, Mohler MJ, Kimbriel HR, Lavery LA. Skin temperature monitoring reduces the risk for diabetic foot ulceration in high-risk patients. Am J Med 2007; 120(12): 1042-6.
[49]
Lavery LA, Higgins KR, Lanctot DR, et al. Preventing diabetic foot ulcer recurrence in high-risk patients: Use of temperature monitoring as a self-assessment tool. Diabetes Care 2007; 30(1): 14-20.
[50]
Papanas N, Papatheodorou K, Papazoglou D, Monastiriotis C, Maltezos E. Foot Temperature in type 2 diabetic patients with or without peripheral neuropathy. Exp Clin Endocrinol Diabetes 2009; 117(01): 44-7.
[51]
Bagavathiappan S, Philip J, Jayakumar T, et al. Correlation between plantar foot temperature and diabetic neuropathy: A case study by using an infrared thermal imaging technique. J Diabetes Sci Technol 2010; 4(6): 1386-92.
[52]
Papanas N, Papatheodorou K, Papazoglou D, Kotsiou S, Maltezos E. Association between foot temperature and sudomotor dysfunction in type 2 diabetes. J Diabetes Sci Technol 2010; 4(4): 803-7.
[53]
Hosaki Y, Mitsunobu F, Ashida K, et al. Non-invasive study for peripheral circulation in patients with diabetes mellitus. Annu reports Misasa Med Branch 2002 ; 72: 31-7.
[54]
Bagavathiappan S, Philip J, Jayakumar T, Raj B. Infrared thermal imaging for medical diagnosis. Med Equip Autom 2009; pp. 65-7.
Article Metrics
49
2
1
1