Bergtholdt HT, Brand PW: Thermography: an aid in the management of insensitive feet and stumps. Arch Phys Med Rehabil 56: 205, 1975.
Bergtholdt HT, Brand PW: Temperature assessment and plantar inflammation. Lepr Rev 47: 211, 1976.
Boulton AJ: Diabetic foot: what can we learn from leprosy? Legacy of Dr Paul W. Brand. Diabetes Metab Res Rev 28(suppl 1): 3, 2012.
Armstrong DG, Holtz-Neiderer K, Wendel C, et al: Skin temperature monitoring reduces the risk for diabetic foot ulceration in high-risk patients. Am J Med 120: 1042, 2007.
Lavery LA, Higgins KR, Lanctot DR, et al: Home monitoring of foot skin temperatures to prevent ulceration. Diabetes Care 27: 2642, 2004.
Frykberg RG, Gordon IL, Reyzelman AM, et al: Feasibility and efficacy of a smart mat technology to predict development of diabetic plantar ulcers. Diabetes Care 40: 973, 2017.
Kokate JY, Leland KJ, Held AM, et al: Temperature-modulated pressure ulcers: a porcine model. Arch Phys Med Rehabil 76: 666, 1995.
Sae-Sia W, Wipke-Tevis DD, Williams DA: Elevated sacral skin temperature (T(s)): a risk factor for pressure ulcer development in hospitalized neurologically impaired Thai patients. Appl Nurs Res 18: 29, 2005.
Yavuz M, Brem RW, Glaros AG, et al: Association between plantar temperatures and triaxial stresses in individuals with diabetes. Diabetes Care 38: e178, 2015.
Sun PC, Lin HD, Jao SH, et al: Relationship of skin temperature to sympathetic dysfunction in diabetic at-risk feet. Diabetes Res Clin Pract 73: 41, 2006.
Yavuz M, Brem RW, Davis BL, et al: Temperature as a predictive tool for plantar triaxial loading. J Biomech 47: 3767, 2014.
Boulton AJ, Armstrong DG, Albert SF, et al: Comprehensive foot examination and risk assessment: a report of the task force of the foot care interest group of the American Diabetes Association, with endorsement by the American Association of Clinical Endocrinologists. Diabetes Care 31: 1679, 2008.
Yavuz M, Ersen A, Hartos J, et al: Plantar shear stress in individuals with a history of diabetic foot ulcer: an emerging predictive marker for foot ulceration. Diabetes Care 40: e14, 2017.
Yavuz M: American Society of Biomechanics Clinical Biomechanics Award 2012: plantar shear stress distributions in diabetic patients with and without neuropathy. Clin Biomech 29: 223, 2014.
Yavuz M, Erdemir A, Botek G, et al: Peak plantar pressure and shear locations: relevance to diabetic patients. Diabetes Care 30: 2643, 2007.
Yavuz M, Master H, Garrett A, et al: Peak plantar shear and pressure and foot ulcer locations: a call to revisit ulceration pathomechanics. Diabetes Care 38: e184, 2015.
Yavuz M, Tajaddini A, Botek G, et al: Temporal characteristics of plantar shear distribution: relevance to diabetic patients. J Biomech 41: 556, 2008.
Ruch R, Patton H : Energy Metabolism, 19th Ed, Saunders Press, Philadelphia, PA, 1965.
Lachenbruch C, Tzen YT, Brienza DM, et al: The relative contributions of interface pressure, shear stress, and temperature on tissue ischemia: a cross-sectional pilot study. Ostomy Wound Manage 59: 25, 2013.
Patel S, Knapp CF, Donofrio JC, et al: Temperature effects on surface pressure-induced changes in rat skin perfusion: implications in pressure ulcer development. J Rehabil Res Dev 36: 189, 1999.
Armstrong DG, Lavery LA, Wunderlich RP, et al: 2003 William J. Stickel Silver Award: skin temperatures as a one-time screening tool do not predict future diabetic foot complications. JAPMA 93: 443, 2003.
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.
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.
The mean temperature reading in each foot region was higher than 30.0°C in the DFU and DN groups and lower than 30.0°C in the DC group. Mean differences were greatest between the DFU and DC groups, ranging from 3.2°C in the medial forefoot to 4.9°C in the hallux.
Increased plantar temperatures in individuals with a history of ulcers may include acute temperature increases from plantar stresses, chronic inflammation from prolonged stresses, and impairment in temperature regulation from autonomic neuropathy. Diabetic foot temperatures, particularly in patients with previous ulcers, may easily reach hazard thresholds indicated by previous pressure ulcer studies. The results necessitate further exploration of temperature in the diabetic foot and how it may contribute to ulceration.