Prediction of Diabetic Foot Ulceration: The Value of Using Microclimate Sensor Arrays.

Petra Jones,Matthew Mccarthy,David Webb,Melanie Davies,Francesco Zaccardi,Kamlesh Khunti,Richard Bibb

doi:10.1177/1932296819877194

Abstract

Accurately predicting the risk of diabetic foot ulceration (DFU) could dramatically reduce the enormous burden of chronic wound management and amputation. Yet, the current prognostic models are unable to precisely predict DFU events. Typically, efforts have focused on individual factors like temperature, pressure, or shear rather than the overall foot microclimate. A systematic review was conducted by searching PubMed reports with no restrictions on start date covering the literature published until February 20, 2019 using relevant keywords, including temperature, pressure, shear, and relative humidity. We review the use of these variables as predictors of DFU, highlighting gaps in our current understanding and suggesting which specific features should be combined to develop a real-time microclimate prognostic model. The current prognostic models rely either solely on contralateral temperature, pressure, or shear measurement; these parameters, however, rarely reach 50% specificity in relation to DFU. There is also considerable variation in methodological investigation, anatomical sensor configuration, and resting time prior to temperature measurements (5-20 minutes). Few studies have considered relative humidity and mean skin resistance. Very limited evidence supports the use of single clinical parameters in predicting the risk of DFU. We suggest that the microclimate as a whole should be considered to predict DFU more effectively and suggest nine specific features which appear to be implicated for further investigation. Technology supports real-time in-shoe data collection and wireless transmission, providing a potentially rich source of data to better predict the risk of DFU.

Highlights

Foot ulceration is a global problem associated with huge healthcare costs
The most important complication of foot ulceration is its predisposition to infection, which is in itself recognized as a significant cause of morbidity and mortality.[3]
In the United Kingdom, for 20% of people with a diabetic foot ulceration (DFU), it takes between 14 days and 2 months to be assessed by a specialist footcare team, but for 9% it can be more than two months.[7]

Summary

Methods

The background literature search for this systematic review on PubMed was conducted with no restrictions on start date covering articles until February 20, 2019. Microclimate describes the environmental conditions of the foot including temperature, pressure, shear stress, and humidity, including properties of the skin and underlying soft tissues (see Figure 1) For each of these components, it may be possible to derive thresholds which in combination give rise to an increased risk of DFU. Contralateral temperature differences (hotspots) are important but have so far not provided acceptable specificity and sensitivity in prediction Standardization of both the anatomical regions being monitored and the rest period prior to measurement[35] is key, but we suggest combining this with the analysis of other microclimate indicators such as pressure. The maximum physical force exerted on a region such as the plantar area of the foot, known as peak pressures, has been

Results

Conclusion

Introduction

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