Thermal analysis of the diabetic foot using mobile infrared thermography: A pilot study in primary care
DOI:
https://doi.org/10.51326/ec.9.9130415Keywords:
Diabetic Foot, Diabetic Neuropathies, Early Diagnosis, Infrared Thermography, Peripheral Arterial Disease, Primary Health CareAbstract
Introduction: Infrared thermography is a non-invasive tool for early detection of complications associated with the diabetic foot.
Objective: To evaluate the usefulness of mobile infrared thermography as a complementary screening technique for diabetic patients in primary care settings.
Methods: A cross-sectional observational study with 20 diabetic patients was conducted at a primary care center in Málaga, Spain. Thermal images were captured following the TISEM consensus using a FLIR One Edge Pro® device. Thermographic variables including the Thermal Risk Index and thermal asymmetry were analyzed with ThermoHuman® software and correlated with clinical variables such as neuropathy, ankle–brachial index, and self-care knowledge.
Results: Forty-five percent of participants showed moderate to high risk of ulceration according to the International Working Group on the Diabetic Foot. No significant differences in thermal asymmetry were found over time (p > 0.05). Mixed-effects modelling did not reveal significant associations between ankle–brachial index, neuropathy, and thermal asymmetry.
Conclusions: Mobile infrared thermography can detect plantar thermal changes related to ulceration risk. However, further studies are needed to support its systematic implementation in diabetic foot screening.
Downloads
References
1. GBD 2021 Diabetes Collaborators. Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the Global Burden of Disease Study 2021. Lancet. 2023;402(10397):203-34. https://doi.org/10.1016/s0140-6736(23)01301-6
2. International Diabetes Federation. IDF Diabetes Atlas. 11th ed. [Brussels]: International Diabetes Federation; 2025. Disponible en: https://diabetesatlas.org/resources/idf-diabetes-atlas-2025/ [Consultado 01-06-2025]
3. Armstrong DG, Tan TW, Boulton AJM, Bus SA. Diabetic Foot Ulcers: A Review. JAMA. 2023;330(1):62-75. https://doi.org/10.1001/jama.2023.10578
4. Armstrong DG, Boulton AJM, Bus SA. Diabetic Foot Ulcers and Their Recurrence. N Engl J Med. 2017;376(24):2367-75. https://doi.org/10.1056/nejmra1615439
5. Nieto-Gil P, Ortega-Avila AB, Pardo-Rios M, Cobo-Najar M, Blasco-Garcia C, Gijon-Nogueron G. Hospitalisation Cost of Patients with Diabetic Foot Ulcers in Valencia (Spain) in the Period 2009⁻2013: A Retrospective Descriptive Analysis. Int J Environ Res Public Health. 2018;15(9):1831. https://doi.org/10.3390/ijerph15091831
6. Aguilar Diosdado M, Almaraz Almaraz MC, Castro Campos JL, Contreras Rubio JR, Doiz Artazcoz E, Forcada Falcón M, et al. Pie diabético: documento de apoyo. [Sevilla]: Consejería de Salud y Consumo; 2023. Disponible en: https://www.juntadeandalucia.es/sites/default/files/inline-files/2023/12/DA_PieDiabetico_FINAL.pdf [Consultado 01-05-2024]
7. Bus SA, Sacco ICN, Monteiro-Soares M, Raspovic A, Paton J, Rasmussen A, et al. Guidelines on the prevention of foot ulcers in persons with diabetes (IWGDF 2023 update). Diabetes Metab Res Rev. 2024;40(3):e3651. https://doi.org/10.1002/dmrr.3651
8. Faus Camarena M, Izquierdo-Renau M, Julian-Rochina I, Arrébola M, Miralles M. Update on the Use of Infrared Thermography in the Early Detection of Diabetic Foot Complications: A Bibliographic Review. Sensors (Basel). 2023 Dec 31;24(1):252. https://doi.org/10.3390/s24010252
9. Stedman M, Robinson A, Dunn G, Meza-Torres B, Gibson JM, Reeves ND, et al. Diabetes foot complications and standardized mortality rate in type 2 diabetes. Diabetes Obes Metab. 2023;25(12):3662-70. https://doi.org/10.1111/dom.15260
10. Zhang P, Lu J, Jing Y, Tang S, Zhu D, Bi Y. Global epidemiology of diabetic foot ulceration: a systematic review and meta-analysis. Ann Med. 2017;49(2):106-16. https://doi.org/10.1080/07853890.2016.1231932
11. Godavarty A, Leiva K, Amadi N, Klonoff DC, Armstrong DG. Diabetic Foot Ulcer Imaging: An Overview and Future Directions. J Diabetes Sci Technol. 2023;17(6):1662-75. https://doi.org/10.1177/19322968231187660
12. Hernandez-Guedes A, Arteaga-Marrero N, Villa E, Callico GM, Ruiz-Alzola J. Feature Ranking by Variational Dropout for Classification Using Thermograms from Diabetic Foot Ulcers. Sensors (Basel). 2023;23(2):757. https://doi.org/10.3390/s23020757
13. Evangeline NC, Srinivasan S. Application of Infrared Thermography in Assessment of Diabetic Foot Anomalies: A Treatise. En: Borah MD, Laiphrakpam DS, Auluck N, Balas VE, editores. Big Data, Machine Learning, and Applications. Proceedings of the 2nd International Conference, BigDML 2021. LNEE, vol 1053. Singapore: Springer; 2024. p. 555-67. https://doi.org/10.1007/978-981-99-3481-2_43
14. Kurkela O, Lahtela J, Arffman M, Forma L. Infrared Thermography Compared to Standard Care in the Prevention and Care of Diabetic Foot: A Cost Analysis Utilizing Real-World Data and an Expert Panel. Clinicoecon Outcomes Res. 2023;15:111-23. https://doi.org/10.2147/ceor.s396137
15. Gatt A, Formosa C, Cassar K, Camilleri KP, De Raffaele C, Mizzi A, et al. Thermographic patterns of the upper and lower limbs: baseline data. Int J Vasc Med. 2015;2015:831369. https://doi.org/10.1155/2015/831369
16. Gatt A, Falzon O, Cassar K, Ellul C, Camilleri KP, Gauci J, et al. Establishing Differences in Thermographic Patterns between the Various Complications in Diabetic Foot Disease. Int J Endocrinol. 2018;2018:9808295. https://doi.org/10.1155/2018/9808295
17. Carabott M, Formosa C, Mizzi A, Papanas N, Gatt A. Thermographic Characteristics of the Diabetic Foot With Peripheral Arterial Disease Using the Angiosome Concept. Exp Clin Endocrinol Diabetes. 2021;129(2):93-8. https://doi.org/10.1055/a-0838-5209
18. Moreira DG, Costello JT, Brito CJ, Adamczyk JG, Ammer K, Bach AJE, et al. Thermographic imaging in sports and exercise medicine: A Delphi study and consensus statement on the measurement of human skin temperature. J Therm Biol. 2017;69:155-62. https://doi.org/10.1016/j.jtherbio.2017.07.006
19. van Doremalen RFM, van Netten JJ, van Baal JG, Vollenbroek-Hutten MMR, van der Heijden F. Infrared 3D Thermography for Inflammation Detection in Diabetic Foot Disease: A Proof of Concept. J Diabetes Sci Technol. 2020;14(1):46-54. https://doi.org/10.1177/1932296819854062
20. van Doremalen RFM, van Netten JJ, van Baal JG, Vollenbroek-Hutten MMR, van der Heijden F. Validation of low-cost smartphone-based thermal camera for diabetic foot assessment. Diabetes Res Clin Pract. 2019;149:132-9. https://doi.org/10.1016/j.diabres.2019.01.032
21. Kanazawa T, Nakagami G, Goto T, Noguchi H, Oe M, Miyagaki T, et al. Use of smartphone attached mobile thermography assessing subclinical inflammation: a pilot study. J Wound Care. 2016; 25(4):177-80, 182. https://doi.org/10.12968/jowc.2016.25.4.177
22. Fernández-Cuevas I. Aplicación de la termografía infrarroja para la prevención, seguimiento de lesiones y apoyo al diagnóstico en el deporte y la salud. En: 15º Congreso Internacional de Ciencias del Deporte y la Salud. [Zaragoza]: COLEFA; [2019]. p. 140-58. Disponible en: https://www.researchgate.net/profile/Ismael-Fernandez-Cuevas/publication/339816234_Aplicacion_de_la_termografia_infrarroja_para_la_prevencion_seguimiento_de_lesiones_y_apoyo_al_diagnostico _en_el_deporte_y_la_salud/links/5e6755944585153fb3d1e1fa/Aplicacion-de-la-termografia-infrarroja-para-la-prevencion-seguimiento-de-lesiones-y-apoyo-al-diagnostico-en-el-deporte-y-la-salud.pdf [Consultado 04-05-2024]
