Foot temperature assessment during different activities in healthy individuals -implications for Diabetic foot ulceration risk

Vijikumar, Archana (2024) Foot temperature assessment during different activities in healthy individuals -implications for Diabetic foot ulceration risk. Doctoral thesis (PhD), Manchester Metropolitan University.

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Abstract

Objective: Diabetes-related disorders such as neuropathy, and diabetic foot ulcers have been studied in relation to foot temperatures. Recent studies discussed the potential clinical importance of shear force, as well as temperature differentials in the development of diabetic ulcers. However, little has been reported regarding how physiological and dynamic factors affect foot-sole temperature. This thesis investigated the association between foot temperature and walking-related extrinsic mechanical factors and foot temperature and sitting/standing-related intrinsic physiological factors in healthy participants for translation to diabetes. Methods: A pilot study confirmed changing walking speed would manipulate shear force during walking. Insoles were designed with thermal sensors positioned at hallux, first, third metatarsal heads and heel. Foot temperature was investigated in healthy participants (n=21) during sitting, standing, walking, and recovery. Participants walked at three speeds (means: slow – 1.14m/s, self-selected – 1.39m/s, and fast – 1.72m/s) on the treadmill for 30 minutes. Kinetic and kinematic parameters were assessed during walking, and the fat pad thickness and blood flow were assessed and related to foot temperature during sitting and standing. Results: The in-shoe temperature increased during every activity: 10 minutes sitting (0.63 ± 0.4°C), 15 minutes standing (0.54 ± 0.4°C) and at 30 minutes walking at different speeds (fast: 3.8 ± 1.9°C, self-selected: 2.8 ± 1.3°C, and slow: 2.8 ± 1.3°C). During 10 minutes seated recovery foot temperature dropped by ~0.32°C. Walking speed, step length, cadence, force-time integral and peak vertical forces were significantly correlated to in-shoe walking temperature. Shear force-time integral was inversely correlated to the walking temperature. Fat pad thickness at first and third metatarsal heads were inversely correlated to the static temperature. Discussion: These findings provide an additional reference point for evaluating foot temperature changes in pathological situations, which could help in understanding pathophysiology and the development of healthcare guidelines for treating diabetic foot ulceration.