雨宮 歩

In this study, we explored non-contact pulse wave measurements from the extremities, particularly the soles, and examined their differences. Two experiments were conducted. First, we identified the optimal method for capturing pulse waves and discovered that the peak intensity of the green signal was the most effective. Then, we analyzed the temporal deviations between the electrocardiogram (ECG) and extremities based on these findings. Differences were observed in the face, palms, and soles of the feet in observing only three subjects. Previous attempts at extremity measurements have been made; however, our study is the first to focus on the foot sole. This study will pave the way for broader medical and research applications.

切除不能な肝細胞がん治療に用いられるtyrosine kinase inhibitor(TKI)の副作用の1つにhand-foot skin reaction(HFSR)がある.本研究は手と足におけるHFSR発生率,HFSRの症状,発生時期を明らかにすることを目的とした.本研究はコホート研究で,切除不能な肝細胞がんに対してレンバチニブ,ソラフェニブ,レゴラフェニブによる治療を受ける患者を対象に,2ヵ月間の診察日に問診と手足の写真撮影を行った.写真はフットケアエキスパートナースを含む3名で皮膚症状を確認した.手足それぞれのHFSR発生日をカプラン-マイヤー曲線を用いて描出し,log-rank検定を実施した.本研究は千葉大学大学院看護学研究科倫理審査委員会の承認を得て実施された.研究に参加した58名のHFSR発生率は84%であり,最も多く観察された症状は角質剥離で,参加者の23%は手に,参加者の39%は足にみられた.HFSR発生日の中央値は,手が21日(95%信頼区間17.6～24.3日),足が7日(95%信頼区間11.6～14.3日)と,足のほうが早くHFSRが発生していた(log-rank検定,p<0.01).本研究結果から,HFSRの早期発見には手だけではなく足の観察も重要であると考えられた.看護師はTKI治療開始前から診察日ごとに患者の手足を観察することで軽微な変化も見逃さず,適切な治療につなげる役割が期待される.(著者抄録)

AIM: The aims of this study were to assess the general quality of life and foot/ankle health-related quality of life among subjects with Werner syndrome (WS) and to determine subjective foot/ankle symptoms associated with quality of life. METHODS: Using a questionnaire survey, patients were asked to provide information on age, sex and presence of subjective symptoms and complete both the 36-Item Short Form Health Survey (SF-36) questionnaire and the Self-Administered Foot Evaluation Questionnaire (SAFE-Q). Statistical analyses were performed using Student's t-test, the Mann-Whitney U test, Fisher's exact test and Spearman's rank correlation. RESULTS: Data from 12 patients with an average age of 54 ± 8.6 years were analyzed. The mean SF-36 score for the domain of physical functioning was 21.2; for role-physical function, 32.6; for bodily pain, 38.5; for general health, 34.4; for vitality, 44.8; for social function, 38.5; for role-emotional function and for mental health, 46.7. The mean mental component summary was as high as the national standard, but it was low in men. The mean SAFE-Q scores were also low. Patients with ulcers had significantly more pain and low general health perception. As compared with the national standard, the role/social component score was not low, and there was a correlation in most domains of the SAFE-Q. CONCLUSION: In WS, the general health-related quality of life was low overall in the physical domain and low only in men for the mental domain, whereas it was low in the social domain when foot/ankle health-related quality of life was low. Geriatr Gerontol Int 2023; ••: ••-••.

Utilizing automatic daily body weight (BW) measurements may be helpful for assessing nutritional status and detecting underlying diseases particularly in older people who require nursing care. This preliminary study aimed to verify effectiveness of eating assistance for maintaining BW in older people using a contact-free load cells under the bed (Bed Sensor System: BSS). BW was measured every night for 3 months in eight nursing home older people with severe cognitive and physical dysfunctions. Body composition of the subject's trunk and each limb was measured using a segmented multi-frequency bioelectrical impedance analyzer (BIA). A monthly BW loss was estimated as a slope of linear regression of the daily BW plot. BSS successfully measured daily BW for the study period in all participants. The 4 residents with eating assistance gained slightly more weight, while the 4 residents without eating assistance lost weight. There was a significant difference between the two groups in the monthly BW change (- 0.79 ± 0.51 kg/month versus 0.20 ± 0.49 kg/month, P = 0.030). None of the BIA-derived parameters was associated with the monthly BW change. BSS revealed effectiveness of eating assistance to maintain BW in nursing home residents with severe cognitive and physical dysfunctions.

切除不能な肝細胞がん治療に用いられるtyrosine kinase inhibitor(TKI)の副作用の1つにhand-foot skin reaction(HFSR)がある.本研究は手と足におけるHFSR発生率,HFSRの症状,発生時期を明らかにすることを目的とした.本研究はコホート研究で,切除不能な肝細胞がんに対してレンバチニブ,ソラフェニブ,レゴラフェニブによる治療を受ける患者を対象に,2ヵ月間の診察日に問診と手足の写真撮影を行った.写真はフットケアエキスパートナースを含む3名で皮膚症状を確認した.手足それぞれのHFSR発生日をカプラン-マイヤー曲線を用いて描出し,log-rank検定を実施した.本研究は千葉大学大学院看護学研究科倫理審査委員会の承認を得て実施された.研究に参加した58名のHFSR発生率は84%であり,最も多く観察された症状は角質剥離で,参加者の23%は手に,参加者の39%は足にみられた.HFSR発生日の中央値は,手が21日(95%信頼区間17.6～24.3日),足が7日(95%信頼区間11.6～14.3日)と,足のほうが早くHFSRが発生していた(log-rank検定,p<0.01).本研究結果から,HFSRの早期発見には手だけではなく足の観察も重要であると考えられた.看護師はTKI治療開始前から診察日ごとに患者の手足を観察することで軽微な変化も見逃さず,適切な治療につなげる役割が期待される.(著者抄録)

目的:持続皮下インスリン注入療法(CSII)を行う小児・青年は増加しているが、皮膚トラブルの問題が報告されている。本研究は、CSIIを行う小児・青年の皮膚トラブルと皮膚トラブルへの対応・予防について、季節や発達観階の視点から明らかにし、皮膚トラブルの予防に向けた支援への示唆を得ることを目的とした。方法:秋〜冬季の対象者は11名、夏季調査は8名、このうち7名は同一対象者であった。平均年齢は秋〜冬季調査11.4±7.1歳、夏季調査7.0±3.1歳、CSII使用期間は1.8年±1.4年と1.5±0.6年、平均HbA1cは7.3±0.9%と7.1±0.5%であった。CSIIの実施方法、皮膚トラブルと予防について面接を行い、季節及び年少児と年長者の比較を行った。また、皮膚トラブルの観察と角質水分量を測定し、秋〜冬季と夏季の比較、かぶれの有無による比較を行った。結果:秋〜冬季は夏季より有意に角質水分量は低く(p=0.003)、かぶれのある部位はかぶれのない部位より有意に角質水分量が低かった(p<0.001)。年少児では注入/挿入に適切な部位が限られ、親は皮膚トラブルの対応に困難を感じていた。年少児の親が行うスキンケアは年長者本人が行うより丁寧に行われていた。結論:皮膚の乾燥を防ぐための丁寧なスキンケアが年間を通して重要である。皮膚トラブルに関するさらなる研究と、セルフケア能力と皮膚トラブルのリスクに応じた少年児の親と年長者自身への指導を糖尿病教育に加える必要がある。(著者抄録)

Callus has been identified as a risk factor leading to severe diabetic foot ulcer; thus, it is necessary to prevent its formation. Callus formation under the first, second, and fifth metatarsal heads (MTHs) is associated with external forces (pressure and shear stress) during walking. However, the gait factors increasing the external forces remain undetermined. Thus, this study aims to identify the factors increasing the external forces to prevent callus formation. In 59 patients with diabetic neuropathy wearing their usual shoes, the external forces, and the lower extremity joint angles were measured using MEMS force sensors and motion sensors. The external forces and their relationship with the lower extremity joint angles and footwear size were determined. Risk factors causing high external forces on the first MTH included small flexion of the knee joint (p = 0.015) and large ankle pronation motion (p = 0.034) to obtain propulsion. For the second MTH, wearing excessively long footwear was identified (p = 0.026). For the fifth MTH, high external force was related to tight width footwear (p = 0.005). An effective intervention for preventing callus formation for the first MTH would involve assisting the push-off foot motion using rocker-sole footwear or gait training. For the second and fifth MTHs, wearing appropriate size footwear would be effective.

【要旨】靴ずれは糖尿病性足潰瘍の発症因子の一つであることが指摘されている．そこで，糖尿病患者が着用している靴の適合性につき，サーモグラフィを用いて検討したので報告する．糖尿病患者30名を対象に，靴を脱いだ後20分間，足部のサーモグラフィを撮影し，同時に着用していた靴のサイズと幅を測定した．足のサイズと幅は過去に外来受診した際に測定した値を診療記録より収集した．データがそろった上で，靴を脱いだ後の足の温度変化と足と靴のサイズの差および足と靴の幅の差を比較検討した．対象55肢のうち，靴を脱いだ20分後の足部の皮膚温が「一部の趾のみ上昇」していたものが17肢あった．この群における靴のサイズと足のサイズの差は0.59±0.97cmであり，靴を脱いだ20分後の足部の皮膚温が「変化なし」または「足先から低下」していたものの0.87±0.84cmに比べ，有意に小さかった（p=0.029）．なお，靴と足の幅の差については，有意差はなかった．したがって，靴を脱いだ後にみられる「一部の趾のみ上昇」は，履いている靴のサイズが短いことを反映していると考えた．以上のことから，サーモグラフィによる足部の皮膚温測定は足潰瘍の予防に有用である可能性が示唆された．

OBJECTIVES: To examine the correlations between elements of feet-washing behavior, presence of tinea pedis (TP), and patients' background characteristics in order to identify a concrete intervention method to prevent TP.DESIGN AND PARTICIPANTS: A cross-sectional study of 30 patients with diabetes (16 with TP) who were admitted to or visited the university hospital.MAIN OUTCOME MEASURES: The presence of TP was confirmed by the detection of dermatophytes by direct microscopy. Data on elements of feet-washing behavior, such as scrubbing between the toes, were collected by observing recorded videos of participants normally washing their feet as they do at home. The patients' background characteristics included demographic data; diabetes-related factors; patient knowledge regarding diabetes, foot problems, and TP prevention; purpose for feet washing; and any difficulties in feet washing. MAINRESULTS: The number of times patients scrubbed between their toes while washing with soap was significantly lower in patients with TP (odds ratio, 0.95; P =.036; with a cutoff value of 35 times) and those who had difficulty in reaching their feet with their hands (B = -14.42, P =.041).CONCLUSIONS: An effective foot-washing protocol should include specific instructions for patients to scrub between their toes at least 35 times in all 8 spaces while washing with soap. Appropriate advice is also needed for individuals who have difficulty reaching their feet with their hands. Education about appropriate foot-washing behavior may potentially prevent TP.

Abstract: A number of studies have reported the usefulness of monitoring skin temperature at local points in reducing the risk of ulceration. Thermography has the advantage of being able to visualize morphological temperature distribution. We reported that inflammation was detected by thermography in 10% of diabetes mellitus (DM) patients with foot calluses, and the area in which increased skin temperature was observed was limited to the callus. However, no reports have described thermographic findings of calluses deteriorating into foot ulcers. We report a case monitoring the skin temperature distribution using thermography, which might be useful for predicting ulceration. Case: A 53-year-old male patient, diagnosed with type 2 DM, was treated with insulin therapy. The duration of DM was 4 years. He was also diagnosed with dyslipidemia and hypertension. Using thermography, the skin temperature was evaluated in the patient with calluses on the 5th metatarsal heads. Areas of increased skin temperature were observed, involving not only the callused part, but also the plantar arch. We shaved his calluses once a month and explained the importance of his therapeutic shoes to prevent the ulcers. After 43 months, an ulcer developed. Discussions: Thermographic findings of an extended area of increased skin temperature not limited to the callus may suggest the progression of a callus to ulcer. Expansion of the area of increased skin temperature might show the inflammation or infection extending along the fascia. Based on these findings, thermography could provide a useful assessment of callus in DM patients with a high risk of progression.

INTRODUCTION: Callus is one of the main causes of diabetic foot ulcers. Therefore, preventing callus formation is very important. In a previous study, it was clarified that callus formation under the first metatarsal head (MTH) is associated with high shear stress time integral/pressure time integral (SPR-i). another study, it was clarified that rocker sole shoes are effective in reducing peak pressure under the first MTH. Therefore, we hypothesized that rocker sole shoes reduce SPR-i under the first MTH. This study aimed to clarify the effect of rocker sole shoes for external forces and leg motions in comparison with that of the normal sole shoes. METHODS: In-shoe external forces and leg motions were measured during walking wearing the normal sole shoes or the rocker sole shoes in healthy participants. As the external forces, the peak plantar pressure (PP), pressure time integral (PI), peak shear stress (PSS), and shear stress integral (SSI) of each gait cycle were calculated. Additionally, shear stress-pressure ratios (SPR) were calculated by dividing shear stress by pressure; concretely, peak values (SPR-p) and time integral values (SPR-i). As the leg motion, hip and knee joint motions were analyzed for the axis of flexion- extension. Three axes of ankle joint motion (inversion-eversion, plantar flexion-dorsiflexion, and adduction-abduction) were analyzed. RESULTS AND DISCUSSION: Six participants attended, and twelve feet were analyzed. When wearing the rocker sole shoes, the SPR-i under the first MTH was significantly smaller than when wearing the normal sole shoes. The SPR-i higher than 0.60 is associated with callus formation under the first MTH. In three of five feet with callus, SPR-i exceeded 0.60 in the normal sole shoes. The SPR-i of all three feet became smaller than 0.60 when wearing the rocker sole shoes. Although the knee (flexion-extension) and ankle (plantar flexion-dorsiflexion) joint motion became smaller when wearing the rocker sole shoes, there was no significant difference in walking speed. It is considered that propulsion was maintained by the push-off support provided by rocker sole shoes. CONCLUSION: It was suggested that rocker sole shoes are effective preventing callus formation under the first MTH.

糖尿病足潰瘍予防を目的に，われわれは足底にかかる力に着目し客観的なアセスメントのための計測装置を開発してきた．具体的には，1）足底圧分布センサと小型の脚運動を計測可能なモーションセンサとの組み合わせによる歩行計測システム，2）薄型のシートタイプのずれ力計測のセンサによる歩行時のずれ力計測システム，3）小型の3軸力覚センサを用いた局所の圧力とずれ力の計測システムである．これらのシステムによりこれまで困難であった歩行時の胼胝部位におけるずれ力の計測などが実現できるようになってきた．また，システムを用いた臨床調査により胼胝発症に関係するエビデンスも出てきており，それらを患者へフィードバックするシステムの改良も行っている．本稿では，それらのシステムの紹介ならびに利用することで判明したエビデンスについて紹介する．

Introduction: Callus is one of the main causes of diabetic foot ulcers. Therefore, preventing callus formation is very important. In a previous study, it was clarified that callus formation under the first metatarsal head (MTH) is associated with high shear stress time integral/pressure time integral (SPR-i). In another study, it was clarified that rocker sole shoes are effective in reducing peak pressure under the first MTH. Therefore, we hypothesized that rocker sole shoes reduce SPR-i under the first MTH. This study aimed to clarify the effect of rocker sole shoes for external forces and leg motions in comparison with that of the normal sole shoes.Methods: In-shoe external forces and leg motions were measured during walking wearing the normal sole shoes or the rocker sole shoes in healthy participants. As the external forces, the peak plantar pressure (PP), pressure time integral (PI), peak shear stress (PSS), and shear stress integral (SSI) of each gait cycle were calculated. Additionally, shear stress-pressure ratios (SPR) were calculated by dividing shear stress by pressure; concretely, peak values (SPR-p) and time integral values (SPR-i). As the leg motion, hip and knee joint motions were analyzed for the axis of flexion-extension. Three axes of ankle joint motion (inversion-eversion, plantar flexion-dorsiflexion, and adduction-abduction) were analyzed.Results and Discussion: Six participants attended, and twelve feet were analyzed. When wearing the rocker sole shoes, the SPR-i under the first MTH was significantly smaller than when wearing the normal sole shoes. The SPR-i higher than 0.60 is associated with callus formation under the first MTH. In three of five feet with callus, SPR-i exceeded 0.60 in the normal sole shoes. The SPR-i of all three feet became smaller than 0.60 when wearing the rocker sole shoes. Although the knee (flexion-extension) and ankle (plantar flexion-dorsiflexion) joint motion became smaller when wearing the rocker sole shoes, there was no significant difference in walking speed. It is considered that propulsion was maintained by the push-off support provided by rocker sole shoes.Conclusion: It was suggested that rocker sole shoes are effective in preventing callus formation under the first MTH.

Pressure and shear stress are the factors of diabetic foot ulcers and callus formation. However, in-shoe shear stress of callus measurement could not have been measured because of technical difficulties. The purpose of this study is to verify reliability and validity of the established measurement system for in-shoe pressure and shear stress. For reliability, coefficients of variation (CV) and intraclass correlation coefficients (ICC) were confirmed. For known-groups validity, callus and non-callus feet were compared. Mean CV was 9.7%. Mean ICC was 0.943. For validity test, mean peak pressure and shear stress of the six callus feet was significantly higher than that of the eighteen non-callus feet. The pressure and shear stress that causes callus and diabetic foot ulcer will be identified in diabetic neuropathy patients.

Aim. Callus is a risk factor, leading to severe diabetic foot ulcer; thus, prevention of callus formation is important. However, normal stress (pressure) and shear stress associated with callus have not been clarified. Additionally, as new valuables, a shear stress-normal stress (pressure) ratio (SPR) was examined. The purpose was to clarify the external force associated with callus formation in patients with diabetic neuropathy. Methods. The external force of the 1st, 2nd, and 5th metatarsal head (MTH) as callus predilection regions was measured. The SPR was calculated by dividing shear stress by normal stress (pressure), concretely, peak values (SPR-p) and time integral values (SPR-i). The optimal cut-off point was determined. Results. Callus formation region of the 1st and 2nd MTH had high SPR-i rather than noncallus formation region. The cut-off value of the 1st MTH was 0.60 and the 2nd MTH was 0.50. For the 5th MTH, variables pertaining to the external forces could not be determined to be indicators of callus formation because of low accuracy. Conclusions. The callus formation cut-off values of the 1st and 2nd MTH were clarified. In the future, it will be necessary to confirm the effect of using appropriate footwear and gait training on lowering SPR-i.

AIM: The purpose of the present study was to assess the difference in foot temperature between tinea unguium-positive older adults with subungual hyperkeratosis and tinea unguium-negative older adults with subungual hyperkeratosis to develop a temperature-based screening method for tinea unguium. METHODS: The present cross-sectional, observational study investigated 51 residents with subungual hyperkeratosis in two facilities covered by long-term care insurance between October 2011 and December 2011. One dermatologist recorded the clinical signs of abnormal toenails. Nail specimens were collected from all abnormal nails, and the presence of tinea unguium was confirmed when fungus was detected by direct microscopy. Foot temperature was measured by infrared thermography. A receiver operating characteristic curve was used to assess the ability to determine whether residents with subungual hyperkeratosis have tinea unguium and to determine the cut-off point. RESULTS: Among the people with subungual hyperkeratosis, the mean toe temperature in the tinea unguium-positive group (30.2 ± 2.6°C) was significantly lower than that in the tinea unguium-negative group (32.8 ± 3.2°C, P = 0.001). The area under the receiver operating characteristic curve was 0.74 (95% confidence interval 0.621-0.876), and the threshold temperature was set at 33.0°C, resulting in a sensitivity of 81.8% and specificity of 65.7%. CONCLUSION: Our study suggests that foot temperature can be used to screen for tinea unguium in people with subungual hyperkeratosis. This non-invasive and simple screening method would help clinicians to set priorities in terms of carrying out direct microscopy to diagnose tinea unguium in elderly residents in care facilities.

&emsp;糖尿病足潰瘍の予防法に糖尿病用治療靴（以下，治療靴）の着用がある．医療者が足潰瘍のリスクが高い患者に治療靴の作製を提案しても作製にいたらないケースがあるが，そのプロセスは明らかではないため介入方法は不明である．そこで質的に治療靴の作製と着用継続に関するプロセスを検証した．2008年４月から2012年11月に大学病院を受診し治療靴の作製を提案された糖尿病患者22名に治療靴の提案から作製，着用継続，非作製までのプロセスの半構造化面接をした．コアカテゴリーは≪靴のデザインを重視し，治療靴に頼らない努力を継続すること≫であった．治療靴の作製にいたらなかった群は靴のデザインを重視しており，潰瘍に対し自分なりの解釈をし，非潰瘍性病変は潰瘍化しないという認識のもと治療靴に頼らない努力をしていた．治療靴の作製を促す介入として，靴は機能性が重要だという認識を医療者と患者で共有し，デザイン性を考慮した治療靴を開発する必要がある．

&emsp;糖尿病患者の胼胝予防には足底圧とせん断力を低くコントロールする必要があり，これらは，筋力や歩容が関係する．そこで，足部筋力とわれわれが開発した足底圧，せん断力，角速度同時計測システムで計測したデータとの関係を検証した．運動療法や食事療法の習得を目的とした教育入院中の糖尿病患者４名に対し入院時と退院時における歩行時の足底圧，せん断力，足部と腰部の角速度を測定した．膝下の筋力を推定するため，足の第１趾と第２趾の間の圧迫力が計測可能なチェッカーくん（日伸産業株式会社，埼玉，日本）を用いた．筋力が増強した２名は，腰部ヨー角速度が低下していたが，筋力が減弱した１名は腰部ヨー角速度が上昇していた．足部筋力の増減にかかわらず，足背ピッチ角速度の上昇とせん断力の増加を認めた．腰部ヨー角速度の低下は動揺の少ない安定した歩行を示しており，安定した歩行には足部筋力の増強が効果的な可能性がある．胼胝予防には，筋力の増強だけでなく，歩き方や靴によるせん断力の軽減が必要であることが示唆された．

Tinea pedis (TP) may lead to the development of foot ulcers in diabetic patients; thus, its prevention in diabetic patients is important. TP occurs after dermatophytes on the skin scales of TP patients attach to the feet. Therefore, it is necessary to remove the scales and dermatophytes, and this can be performed using various methods, including foot washing. This study aimed to objectively examine the association between the presence of TP and foot-washing habits. We included 33 diabetic patients, and, of these, 17 had TP. The presence of washing residue on the feet was determined by applying a fluorescent cream to the participants' feet, and images of the feet were captured under ultraviolet light before and after foot washing. Our results showed that diabetic patients with TP had higher levels of washing residue on their feet than those without TP. The importance of washing feet to prevent TP needs to be emphasized through educational programs for diabetic patients. Furthermore, the development of an effective foot-washing technique is essential.

Purpose: High plantar pressure is a major risk factor for diabetic foot ulcers. The relationship between plantar pressure and foot mobility has been investigated in some studies. However, when the foot is in motion, foot mobility is only a small feature of the gait. Therefore, we investigated relationship between high plantar pressure and gait and also studied the motion of the trunk. In addition, we investigated the relationship between gait and patient characteristics to identify patients at high-risk of developing diabetic foot ulcers.Methods: The relationships between elevated plantar pressure, gait features, and patient characteristics were analyzed. Plantar pressure distribution in the stance phase was divided on the four plantar segments. Elevated plantar pressure was defined as being more than the mean plus one standard deviation of the corresponding segment in non-diabetic subjects. Plantar pressure distribution was measured by an F-scan system, and gait features were measured using wireless motion sensors attached to the sacrum and feet. Patient characteristics were obtained from medical records or by interview.Results: Small roll and yaw motions of the body and yaw motion of the foot during the mid-stance phase were related to the elevated plantar pressure in 57 diabetic patients. Furthermore, these gait features were related to sensory neuropathy, diabetes duration, patient weight, toe-gap force, and ankle range of motion.Conclusion: Given our findings, it may be possible to prevent diabetic foot ulcers by increasing foot motion during the mid-stance phase. Passive exercise aimed at expanding ankle range of motion in patients with sensory neuropathy or long-standing diabetes may assist in achieving this. (C) 2014 Elsevier B.V. All rights reserved.

Background: A plantar temperature distribution can be obtained by thermography; however, the advantage has not been effectively utilized in the past. We previously proposed a classification method based on the angiosome concept, but the method was insufficient because it was too subjective and complicated for clinicians. In this study, we propose a new classification system of plantar forepart thermographic patterns using an image segmentation technique. Methods: A cross-sectional observational study was conducted including 32 healthy volunteers and 129 patients with diabetes mellitus (DM). Individual thermographic variations and trends were evaluated. A comparison was conducted between the patterns obtained by our previous angiosome-based research and the patterns found by the new classification system. Results: The system objectively found wider variations of the plantar forepart thermographic patterns in the patients with DM compared with those in the control subjects. In patients with DM, the system showed that the whole-high pattern was most frequent (46%), followed by the butterfly pattern (12%). In the control group, the butterfly pattern was most frequent (44%), followed by the whole-high pattern (19%). Both ankle and toe brachial indices were higher in feet with high temperature area in the inner side of the plantar. Conclusions: Thermographic patterns found by the new computer-based system were similar to those obtained in our previous subjective work. The classification system found forefoot-low pattern and tiptoe-low pattern objectively. The system based on infrared thermography will be a screening tool to assess circulatory status in daily foot care of patients with DM. © Diabetes Technology Society.