title: Diagnostic values for skin temperature assessment to detect diabetes-related foot complications.
abstract: BACKGROUND
  Skin temperature assessment is a promising modality for early detection of diabetic foot problems, but its diagnostic value has not been studied. Our aims were to investigate the diagnostic value of different cutoff skin temperature values for detecting diabetes-related foot complications such as ulceration, infection, and Charcot foot and to determine urgency of treatment in case of diagnosed infection or a red-hot swollen foot.
  
  
  METHODS
  The plantar foot surfaces of 54 patients with diabetes visiting the outpatient foot clinic were imaged with an infrared camera. Nine patients had complications requiring immediate treatment, 25 patients had complications requiring non-immediate treatment, and 20 patients had no complications requiring treatment. Average pixel temperature was calculated for six predefined spots and for the whole foot. We calculated the area under the receiver operating characteristic curve for different cutoff skin temperature values using clinical assessment as reference and defined the sensitivity and specificity for the most optimal cutoff temperature value. Mean temperature difference between feet was analyzed using the Kruskal-Wallis tests.
  
  
  RESULTS
  The most optimal cutoff skin temperature value for detection of diabetes-related foot complications was a 2.2°C difference between contralateral spots (sensitivity, 76%; specificity, 40%). The most optimal cutoff skin temperature value for determining urgency of treatment was a 1.35°C difference between the mean temperature of the left and right foot (sensitivity, 89%; specificity, 78%).
  
  
  CONCLUSIONS
  Detection of diabetes-related foot complications based on local skin temperature assessment is hindered by low diagnostic values. Mean temperature difference between two feet may be an adequate marker for determining urgency of treatment.
authors.affiliation: 1 Diabetic Foot Unit, Department of Surgery, Hospital Group Twente , Almelo, The Netherlands .
authors.forename: Jaap J
authors.initials: JJ
authors.lastname: van Netten
authors.forename: Miranda
authors.initials: M
authors.lastname: Prijs
authors.forename: Jeff G
authors.initials: JG
authors.lastname: van Baal
authors.forename: Chanjuan
authors.initials: C
authors.lastname: Liu
authors.forename: Ferdi
authors.initials: F
authors.lastname: van der Heijden
authors.forename: Sicco A
authors.initials: SA
authors.lastname: Bus
mesh_terms: D000465:Algorithms; D034201:Computers, Handheld; D017719:Diabetic Foot / Q000150:complications / Q000175:diagnosis*; D005260:Female; D005528:Foot / Q000098:blood supply*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D007259:Infrared Rays; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D012680:Sensitivity and Specificity; D012881:Skin Temperature; D017216:Telemedicine / Q000639:trends; D013817:Thermography / Q000379:methods