title: Cold immersion recovery responses in the diabetic foot with neuropathy.
abstract: The aim of this article was to investigate the effectiveness of testing cold immersion recovery responses in the diabetic foot with neuropathy using a contact thermography system based on thermochromic liquid crystals. A total of 81 subjects with no history of diabetic foot ulceration were assigned to neuropathy, non neuropathy and healthy groups. Each group received prior verbal and written description of the test objectives and subsequently underwent a comprehensive foot care examination. The room temperature and humidity were consistently maintained at 24 degrees C and less than 50%, respectively, with air conditioning. The right foot for each subject was located on the measurement platform after cold immersion in water at 18-20 degrees C. Whole-field thermal images of the plantar foot were recorded for 10 minutes. Patients with diabetes with neuropathy show the highest 'delta temperature', that is difference between the temperature after 10-minute recovery period and baseline temperature measured independently at all the three sites tested, that is first metatarsal head (MTH), second MTH and heel. This clinical study showed for the first time the evidence of poor recovery times for the diabetic foot with neuropathy when assessing the foot under load. A temperature deficit (because of poor recovery to baseline temperature) suggests degeneration of thermoreceptors, leading to diminished hypothalamus-mediated activity in the diabetic neuropathic group.
authors.affiliation: Southern Arizona Limb Salvage Alliance (SALSA), University of Arizona and Southern Arizona Veterans Affairs, Health Care System, University of Arizona College of Medicine, Tucson, AZ 85724-5072, USA. manish.bharara@gmail.com
authors.forename: Manish
authors.initials: M
authors.lastname: Bharara
authors.forename: Vijay
authors.initials: V
authors.lastname: Viswanathan
authors.forename: Jonathan E
authors.initials: JE
authors.lastname: Cobb
mesh_terms: D000328:Adult; D000368:Aged; D001833:Body Temperature Regulation / Q000502:physiology; D016022:Case-Control Studies; D003080:Cold Temperature; D017719:Diabetic Foot / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D003929:Diabetic Neuropathies / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007031:Hypothalamus / Q000502:physiology; D007101:Immersion / Q000503:physiopathology; D050866:Liquid Crystals; D008297:Male; D008875:Middle Aged; D009730:Nursing Assessment; D018570:Risk Assessment; D012881:Skin Temperature / Q000502:physiology; D013817:Thermography / Q000379:methods* / Q000592:standards; D013823:Thermoreceptors / Q000502:physiology; D013997:Time Factors
references.citation: Microvasc Res. 2003 Jul;66(1):73-6
references.pmid: 12826077
references.citation: Diabetes Care. 1986 May-Jun;9(3):267-72
references.pmid: 3731992
references.citation: Diabet Med. 1995 Apr;12(4):298-301
references.pmid: 7600742
references.citation: Int J Low Extrem Wounds. 2006 Dec;5(4):250-60
references.pmid: 17088601
references.citation: Diabetes Care. 2007 Jan;30(1):14-20
references.pmid: 17192326
references.citation: Clin Biomech (Bristol, Avon). 1996 Oct;11(7):410-417
references.pmid: 11415653
references.citation: Clin Exp Dermatol. 2006 Jan;31(1):6-12
references.pmid: 16309469
references.citation: Diabetes Care. 1992 Mar;15 Suppl 1:29-31
references.pmid: 1559416
references.citation: Pain. 1988 Jul;34(1):1-10
references.pmid: 3405615
references.citation: J Dermatol Sci. 2007 Feb;45(2):113-20
references.pmid: 17169532
references.citation: J Am Podiatr Med Assoc. 2005 Mar-Apr;95(2):103-7
references.pmid: 15778466
references.citation: Diabetes Care. 2004 Nov;27(11):2642-7
references.pmid: 15504999
references.citation: Ann Rheum Dis. 1992 Nov;51(11):1193-6
references.pmid: 1466594
references.citation: Diabetes Care. 1994 Aug;17(8):835-9
references.pmid: 7956627
references.citation: Diabetes Care. 1995 Feb;18(2):216-9
references.pmid: 7729300
references.citation: Med Eng Phys. 2001 Jul;23(6):417-25
references.pmid: 11551818
references.citation: Br Med J (Clin Res Ed). 1986 Jan 11;292(6513):87-90
references.pmid: 3080102
references.citation: Diabetes Res Clin Pract. 2005 Oct;70(1):8-12
references.pmid: 16126117
references.citation: Int Wound J. 2006 Dec;3(4):302-7
references.pmid: 17199766
references.citation: IEEE Eng Med Biol Mag. 2002 Nov-Dec;21(6):73-9
references.pmid: 12613214
references.citation: Arthritis Res Ther. 2005;7(5):R1103-12
references.pmid: 16207327
references.citation: Br Med J (Clin Res Ed). 1986 May 17;292(6531):1295-8
references.pmid: 2939920
references.citation: Postgrad Med J. 2002 Sep;78(923):541-2
references.pmid: 12357015
references.citation: Diabetologia. 1988 Sep;31(9):652-6
references.pmid: 3234641