Contralateral foot temperature monitoring during Charcot immobilisation: A systematic review

Abstract

Aims: Contralateral temperature difference (CTD) is a frequently used marker of healing in Charcot neuro-osteoarthropathy (CN). We aimed to determine whether there is a consistent approach to CTD measurement during healing and the decision-making process around cessation of immobilisation.Materials and Methods: Medline, Scopus, and Web of Science were searched until February 2022 for peer-reviewed studies using keywords, including (('arthropathy' OR 'osteoarthropathy' OR 'osteopathy' OR 'neuroarthropathy') AND 'Charcot' AND ('temperature')), which returned 789 results excluding duplicates. Included studies monitored CTD in those with active CN to (i) assess the healing process and (ii) assist in determining the transition from immobilisation.Results: Thirty four studies in total (n = 677 participants) were shortlisted and 19 were included after full paper review. Average CTD at presentation varied from 1.6 to 8.0°C with insufficient data to determine if CTD was proportional to severity of Charcot. Evidence of a relationship between CTD and radiographic or scintigraphybased markers of healing varied depending on the methodology employed.Threshold CTD for the cessation of immobilisation ranged from <1°C to <2°C. Most frequently it was <2°C sustained for 2-3 visits. Temperature was monitored typically every 2-6 weeks using handheld thermometry at CN site(s) after resting the feet for 15 min. Device type, accuracy/reliability, and ambient temperature were rarely reported.Conclusions: Further research on CTD and radiographic and radiotracer markers is needed involving larger cohorts. Standardisation in reporting of thermometry device type, accuracy and reliability, foot resting times, and ambient temperature controls is essential to facilitate the comparison of studies, meta-analysis, and evaluation of different immobilisation interventions.

NAC1 transcriptional activation of LDHA induces hepatitis B virus immune evasion leading to cirrhosis and hepatocellular carcinoma development

“…This regulatory mechanism potentially contributes to HBV immune escape, thus promoting the development of liver cirrhosis and HCC [ 36 ]. Understanding the accuracy and reliability of this mechanism is crucial for ensuring the credibility of scientific research [ 37 ]. Firstly, it is important to highlight the reliability and accuracy of the bioinformatics methods employed.…”

Brazilian Society of Angiology and Vascular Surgery 2023 guidelines on the diabetic foot

“…Class IIb/level of evidence C [222][223][224] 4. To diagnose Charcot arthropathy, we suggest performing a weight-bearing X-ray and, if suspicion remains after normal X-ray results, consider nuclear magnetic resonance imaging.…”

“…A 2 °C increase in skin temperature compared to the contralateral foot has been used as a threshold for diagnosing active Charcot arthropathy. 222 In the absence of other signs or symptoms of inflammation (ie, redness or swelling), an isolated increase in foot temperature may not always be indicative of active Charcot neuropathic osteoarthropathy and should be interpreted in the context of other clinical findings. 223 , 224 Although an essential part of the diagnostic evaluation, an isolated elevation in foot skin temperature is insufficient to either diagnose or rule out active disease.…”

“…Pode-se realizar a mensuração da temperatura infravermelho da pele na suspeita de artropatia de Charcot com pele íntegra nos locais de maior temperatura do pé ou tornozelo comparando com o membro contralateral no mesmo ponto anatômico (classe de recomendação IIb, nível de evidência C). Um aumento na temperatura da pele de 2° Celsius do pé em comparação com o mesmo local no pé contralateral tem sido usado como limiar para o diagnóstico de artropatia de Charcot ativa 222 . Na ausência de outros sinais e sintomas de inflamação (ou seja, vermelhidão e inchaço), um aumento isolado na temperatura do pé pode nem sempre ser indicativo de CNO ativa e deve ser interpretado no contexto de outros achados clínicos 223 , 224 .…”

Guidelines on the diagnosis and treatment of active Charcot neuro‐osteoarthropathy in persons with diabetes mellitus (IWGDF 2023)

“…An increase in skin temperature of 2° Celsius or 4° Fahrenheit (which is actually 2.2° Celsius) of the involved foot compared to the same location on the uninvolved foot has been used as a diagnostic threshold for active CNO in several publications 43 . Our systematic review could not identify studies demonstrating the diagnostic accuracy of such measurement when using imaging as a comparator for the diagnosis of active CNO, however, there is evidence in regard to elevated temperature as a sensitive indicator of inflammation in diabetic feet and a precursor to ulceration 22 .…”