A Comparison Between Pressure Plate , Gait Analysis and Infrared Thermography in the Detection of Diabetic Foot Ulcerations and Integrative and Collaborative Measures to Reduce Early Incidence and Treatment of Diabetes .Introduction and background Diabetes is a national epidemic drastically effecting our population .Until recently , the disease has affected the majority of patients in the later stages of life , but now is becoming a prominent health issue in the younger population . Diabetic ketoacidosis (DKA ) and hyperosmolar hyperglycemia (HHS ) are two crisis manifestations of type I and type 2 diabetes . In DKA , accelerated lipolysis and upregulated production of free fatty acids cause high levels of beta oxidation and ketogenesis ,while in HHS accelerated gluoneogenesis , glycogenolysis , impaired glucose use and elevated cortisol levels lead to protein breakdown .Both of these metabolic conditions are important factors in the process of wound development and wound healing in the diabetic patient . An infection , or prolonged underdosing of insulin can lead to nerve damage (neuropathy ) and loss of feeling in the extremeties , as well as poor healing (processes which require protein synthesis and low oxidative stress . Patients are less aware of situations that cause a wound , and may not feel the wound until it is quite serious . Moreover nerve damage itself contributes to , and can be accompanied by , poor circulation which allows the build up of oxidative waste products in the tissues , and prevents the already compromised healing system to function effectively .These problems typically show up in the extremeties , e . g . feet of diabetic patients . In extreme cases , there can be blocked or narrowed arteries below the knee and undiagnosed broken bones which lead to severe tissue necrosis and require amputation .While neuropathy and ischaemia contribute to ulceration and its resolution , usually there is an external factor that stimulates the problem but its resolution is a complex mixture of metabolic , physical ,and dermatological treatments . Some initiating factors include calluses ,random foot injuries , burns , nail infections , heel friction , foot deformities (e .g . clawed toes , bunions , pes cavus , hallux rigidus ,hammer toe , Charcot ‘s foot , deformities from previous trauma or surgery ,nail deformities , oedema . Once damage has been done its important for the physician to identify if the patient has neuropathy with good circulation or poor circulation (ischaemia ) in order to select the best combination of treatment . If the situation is neuropathic , there is a tendency to feel warmth but with diminished sensation , and the ulceration is usually on the tips of the toes and metatarsal heads .Oedema may also be present and evidence of infection . In the case of underlying ischaemic problems the foot feels cold , with dimished sensation , and ulceration if present is on the foot margins and heels .Ischaemic problems can be mild or critical depending on the degree of blood flow blockage and presence of gangrene .Prevention of wounds and facilitating healing in a compromised physiological state is the preferred course of action from the perspective of both cost and trauma for the patient . To solve the problem may require more than one kind…