%0 Journal Article
%T Plantar Temperature Response to Walking in Diabetes with and without Acute Charcot: The Charcot Activity Response Test
%A Bijan Najafi
%A James S. Wrobel
%A Gurtej Grewal
%A Robert A. Menzies
%A Talal K. Talal
%A Mahmoud Zirie
%A David G. Armstrong
%J Journal of Aging Research
%D 2012
%I Hindawi Publishing Corporation
%R 10.1155/2012/140968
%X Objective. Asymmetric plantar temperature differences secondary to inflammation is a hallmark for the diagnosis and treatment response of Charcot foot syndrome. However, little attention has been given to temperature response to activity. We examined dynamic changes in plantar temperature (PT) as a function of graduated walking activity to quantify thermal responses during the first 200 steps. Methods. Fifteen individuals with Acute Charcot neuroarthropathy (CN) and 17 non-CN participants with type 2 diabetes and peripheral neuropathy were recruited. All participants walked for two predefined paths of 50 and 150 steps. A thermal image was acquired at baseline after acclimatization and immediately after each walking trial. The PT response as a function of number of steps was examined using a validated wearable sensor technology. The hot spot temperature was identified by the 95th percentile of measured temperature at each anatomical region (hind/mid/forefoot). Results. During initial activity, the PT was reduced in all participants, but the temperature drop for the nonaffected foot was 1.9 times greater than the affected side in CN group ( £¿£¿ = 0 . 0 4 ). Interestingly, the PT in CN was sharply increased after 50 steps for both feet, while no difference was observed in non-CN between 50 and 200 steps. Conclusions. The variability in thermal response to the graduated walking activity between Charcot and non-Charcot feet warrants future investigation to provide further insight into the correlation between thermal response and ulcer/Charcot development. This stress test may be helpful to differentiate CN and its response to treatment earlier in its course. 1. Background Charcot neuroarthropathy (CN) is a devastating complication of diabetes. It has a similar mortality rate as lower extremity ulceration and a twofold higher rate of major amputation compared to those without CN [1]. It has been estimated that 63% of CN patients will develop a foot ulcer [2]. The combination of foot ulcer and CN increases the risk of amputation 12-fold [3]. The increased mortality risk associated with CN appears to be independent of foot ulcer and other comorbidities [2]. What further complicates CN is that there is no clear definition for it [4]. There are no pathologic markers or diagnostic criteria. Therefore, the diagnosis relies on pattern recognition and clinical intuition [5]. Not surprisingly, the diagnosis can be missed up to 95% of the time [6] and the average diagnostic delay has been estimated at almost 7 months [7]. A significant number of CN patients either
%U http://www.hindawi.com/journals/jar/2012/140968/