{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T18:41:19Z","timestamp":1777747279074,"version":"3.51.4"},"reference-count":17,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2023,2,19]],"date-time":"2023-02-19T00:00:00Z","timestamp":1676764800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabetes Metabolism Res"],"published-print":{"date-parts":[[2023,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>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\u2010called 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Material and Methods<\/jats:title>\n                    <jats:p>Participants measured temperature at 6\u20138 plantar foot locations each day for 18\u00a0months and identified a hotspot with a temperature difference &gt;2.2\u00b0C between corresponding foot locations for two consecutive days.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twenty\u2010nine of 151 participants developed a non\u2010traumatic ulcer while adhering to temperature measurements. In the 2\u00a0months prior to ulceration, 8 (28%) had a true hotspot (i.e. at\/adjacent to the ulcer\u00a0location) and the hotspot was on average no longer present 9\u00a0days before ulceration. Seven (24%) participants had a false hotspot (i.e. at another location) and 14 (48%) had no hotspot.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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\u2014uslcer association.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/dmrr.3621","type":"journal-article","created":{"date-parts":[[2023,2,8]],"date-time":"2023-02-08T09:33:10Z","timestamp":1675848790000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Does the skin heat up before it breaks down in diabetic foot ulceration?"],"prefix":"10.1002","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4834-1691","authenticated-orcid":false,"given":"Wouter B.","family":"aan de Stegge","sequence":"first","affiliation":[{"name":"Department of Rehabilitation Medicine Amsterdam UMC University of Amsterdam Amsterdam Movement Sciences  Amsterdam The Netherlands"},{"name":"Department of Vascular Surgery Hospital Group Twente  Almelo The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6420-6046","authenticated-orcid":false,"given":"Jaap J.","family":"Van Netten","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine Amsterdam UMC University of Amsterdam Amsterdam Movement Sciences  Amsterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8357-9163","authenticated-orcid":false,"given":"Sicco A.","family":"Bus","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine Amsterdam UMC University of Amsterdam Amsterdam Movement Sciences  Amsterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,2,19]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/nejmra1615439"},{"key":"e_1_2_12_3_1","first-page":"205","article-title":"Thermography: an aid in the management of insensitive feet and stumps","volume":"56","author":"Bergtholdt HT","year":"1975","journal-title":"Arch Phys Med Rehabil"},{"key":"e_1_2_12_4_1","first-page":"171","article-title":"Repetitive mechanical stress and denervation in plantar ulcer pathogenesis in rats","volume":"61","author":"Manley MT","year":"1980","journal-title":"Arch Phys Med Rehabil"},{"key":"e_1_2_12_5_1","first-page":"829","volume-title":"The Diabetic Foot","author":"Brand 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