Aan de Stegge Wouter B, Van Netten Jaap J, Bus Sicco A
Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.
Department of Vascular Surgery, Hospital Group Twente, Almelo, The Netherlands.
Diabetes Metab Res Rev. 2023 Jul;39(5):e3621. doi: 10.1002/dmrr.3621. Epub 2023 Feb 19.
Most diabetic foot ulcers are caused by tissue stress from being ambulatory in people without protective sensation. These ulcers are suggested to be preceded by local skin temperature increase due to inflammation of the underlying tissue, a so-called hotspot. Evidence to support this mechanism of ulcer development is meagre at best. We investigated if foot ulcers are preceded by increased skin temperature in people with diabetes and foot ulcer history.
Participants measured temperature at 6-8 plantar foot locations each day for 18 months and identified a hotspot with a temperature difference >2.2°C between corresponding foot locations for two consecutive days.
Twenty-nine of 151 participants developed a non-traumatic ulcer while adhering to temperature measurements. In the 2 months prior to ulceration, 8 (28%) had a true hotspot (i.e. at/adjacent to the ulcer location) and the hotspot was on average no longer present 9 days before ulceration. Seven (24%) participants had a false hotspot (i.e. at another location) and 14 (48%) had no hotspot.
The skin of the majority of the ulcers does not heat up before it breaks down or, when it does, not directly before breakdown, questioning the foot temperature increase-uslcer association.
大多数糖尿病足溃疡是由无保护性感觉的患者行走时的组织压力所致。有人认为，这些溃疡之前会因深层组织炎症导致局部皮肤温度升高，即所谓的热点。支持这种溃疡形成机制的证据充其量也很稀少。我们调查了有糖尿病和足溃疡病史的患者在发生足溃疡之前皮肤温度是否会升高。
参与者连续18个月每天在足底6至8个部位测量温度，并确定连续两天相应足部位置温度差>2.2°C的热点。
151名参与者中有29人在坚持测量温度期间发生了非创伤性溃疡。在溃疡形成前的2个月里，8人（28%）出现了真正的热点（即在溃疡部位或其附近），且热点平均在溃疡形成前9天不再出现。7人（24%）出现了假热点（即在其他部位），14人（48%）未出现热点。
大多数溃疡在破溃前皮肤并未升温，或者即便升温，也不是在破溃前直接升温，这对足部温度升高与溃疡的关联提出了质疑。
