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Open AccessArticle

Application of Multiscale Entropy in Assessing Plantar Skin Blood Flow Dynamics in Diabetics with Peripheral Neuropathy

Department of Biomedical Engineering, Xi’an Technological University, Xi’an 710021, China
Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong 999077, China
Rehabilitation Engineering Lab, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, 1206 South Fourth Street, MC-588, Champaign, IL 61820, USA
Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing 100083, China
Department of Physical Medicine and Rehabilitation, Carle Hospital, Urbana, IL 61801, USA
Author to whom correspondence should be addressed.
Entropy 2018, 20(2), 127;
Received: 22 January 2018 / Revised: 10 February 2018 / Accepted: 12 February 2018 / Published: 15 February 2018
Diabetic foot ulcer (DFU) is a common complication of diabetes mellitus, while tissue ischemia caused by impaired vasodilatory response to plantar pressure is thought to be a major factor of the development of DFUs, which has been assessed using various measures of skin blood flow (SBF) in the time or frequency domain. These measures, however, are incapable of characterizing nonlinear dynamics of SBF, which is an indicator of pathologic alterations of microcirculation in the diabetic foot. This study recruited 18 type 2 diabetics with peripheral neuropathy and eight healthy controls. SBF at the first metatarsal head in response to locally applied pressure and heating was measured using laser Doppler flowmetry. A multiscale entropy algorithm was utilized to quantify the regularity degree of the SBF responses. The results showed that during reactive hyperemia and thermally induced biphasic response, the regularity degree of SBF in diabetics underwent only small changes compared to baseline and significantly differed from that in controls at multiple scales (p < 0.05). On the other hand, the transition of regularity degree of SBF in diabetics distinctively differed from that in controls (p < 0.05). These findings indicated that multiscale entropy could provide a more comprehensive assessment of impaired microvascular reactivity in the diabetic foot compared to other entropy measures based on only a single scale, which strengthens the use of plantar SBF dynamics to assess the risk for DFU. View Full-Text
Keywords: multiscale entropy; regularity; skin blood flow; diabetic foot ulcers multiscale entropy; regularity; skin blood flow; diabetic foot ulcers
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Liao, F.; Cheing, G.L.Y.; Ren, W.; Jain, S.; Jan, Y.-K. Application of Multiscale Entropy in Assessing Plantar Skin Blood Flow Dynamics in Diabetics with Peripheral Neuropathy. Entropy 2018, 20, 127.

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