Infrared imaging in diabetic foot ulceration

Diabetic foot ulcers present a difficult problem in clinical management because of increased risk of soft-tissue infection in diabetes plus impaired local blood supply due to diabetic vascular disease. Infection of diabetic foot ulcers has particular risk of involvement of the adjacent bone resulting in the serious complication of osteomyelitis. This needs early aggressive antibiotic therapy to avoid even more serious secondary long-term complications, but unfortunately clinical diagnosis and radiological examination may be unhelpful in early osteomyelitis, when antibiotic therapy is most effective. Furthermore the large number of patients plus the chronic nature of diabetic foot ulceration precludes routine investigation for early osteomyelitis by X-ray or isotope bone scanning in every case, for logistic, radiation protection, and cost reasons. This preliminary study has shown significantly increased temperature on infrared imaging, not only around the ulcer, but in the entire foot in patients subsequently confirmed radiologically as having early osteomyelitis.