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Title: The influence of seasonal variation on in-shoe temperature and relative humidity during moderate exercise in a Maltese population : implications for diabetic foot ulceration
Author: Mizzi, Stephen
ISNI:       0000 0004 6058 9865
Awarding Body: Canterbury Christ Church University
Current Institution: Canterbury Christ Church University
Date of Award: 2016
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Temperature and humidity (microclimate) are key factors implicated in the development of pressure ulceration, however, microclimate in-shoe has been relatively understudied in research related to diabetic foot ulceration (DFU). Additionally, the influence of ambient climate on these parameters in-shoe has also been overlooked. Such information is needed since footwear guidelines to prevent DFU commonly emerge from countries with cooler climates and it is not known whether their application in warmer Mediterranean climates is beneficial. Preliminary validation studies demonstrated suitability of the thermistors (ICC r = 1; Bland and Altman limits of agreement of -0.42°C and 95% CI -1.96, 1.14) and relative humidity sensors (ICC r = 1; Bland and Altman limits of agreement of -0.6°C and 95% CI -1.8, 0.6) for use in in-shoe measurement during ambulation when compared with the gold reference instruments. A reliable repeated measure of in vivo application during shod gait with a thermistor and RH sensor attached between first and second toe and beneath the navicular, was demonstrated. To assess influence of season on in-shoe microclimate, 14 healthy participants walked for 38 minutes on a treadmill in winter and in summer, establishing normative data which was then compared with data from diabetic participants (n=5) using the same protocol. Results demonstrated that seasonal variation has a significant influence (p < 0.01) on inshoe temperature, while no difference was exhibited on in-shoe RH kinetics (p > 0.05). It has been demonstrated that after 20 minutes of walking in Summer, in-shoe skin parameters exceeded 30°C and 70% RH in both healthy and DM participants, levels previously stipulated as indicative of unfavourable parameters to skin resilience in other areas of the body. Therefore, this study provides new Mediterranean-relevant evidence related to in-shoe temperature and RH kinetics during activity, suggestive of negative implications to tissue viability, and also highlighting the need for more climate-specific guidelines related to the use of closed footwear, prescribed to prevent diabetic foot ulceration. It is hoped that this novel information will increase awareness on high in-shoe temperature and RH levels, as potential and influential factors within the pathway of diabetic foot ulceration, in Malta and countries with similar climates.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: RA0781 Physical fitness. Exercise ; RC0660 Diabetes