Digital thermographic imaging : a novel monitoring approach in charcot neuroarthropahy with potential clinical usefulness

Abstract

Charcot neuroarthropathy is a chronic disabling arthropathy complicating peripheral neuropathy, often in the setting of diabetes. Establishing a definitive diagnosis is challenging and largely clinical. Recovery is often protracted, and difficult to monitor clinically, given paucity of clinical signs and symptoms, and non-specific data borne out of established investigative tools. Strict off-loading of the affected joint(s) (commonly the ankle and / or foot) constitutes the cornerstone of clinical management, although there is currently mounting clinical evidence supporting a role for adjunct bisphosphonate and calcitonin therapy. Asymmetric temperature differences secondary to inflammation within the affected joint(s) is a hallmark of this disease entity, classically presenting with a temperature difference of over 2°C compared with the unaffected contralateral joint. Temperature differences correlate highly with radiographic changes and with markers of bone turnover, and may antedate clinical presentation and foot ulceration. Infrared thermography potentially offers a relatively simple, non-contact, non-ionizing, relatively inexpensive and rapid, method of monitoring healing (‘foot cooling’) and recurrence (‘foot warming’) in the same or contralateral foot.