Guest Editorial: time and place‐shifting the physical examination: technologies are converging to allow more detailed evaluations of the foot and wound

As with other complications of diabetes, the incidence of diabetic foot wounds is growing worldwide. This is burdening the health care systems of both developed and developing nations 1, 2.

During this same period, clinician scientists have worked to devise strategies to assess risk and deliver care in a method that is appropriate to the region where the strategy is implemented(3).

One common factor that exists in almost every locality is the relative paucity of clinicians able to make assessment of a large number of subjects in a limited time. This may pave the way for various technologies to penetrate this space and improve care by allowing quantifiable assessment at a time and potentially a place distant to the point of care. We might politely borrow technological terms of art from our colleagues in telecommunications by coining the phrases ‘medical time‐shifting’ or ‘medical place‐shifting’.

Certainly, these ideas are not new. Radiographic imaging assessments are frequently performed at a distance and time away from the point of care. Many wound healing centres have employed telehealth modalities to serve remote regions in real time. Perhaps an amalgam of these ideas can now be employed using relatively common and accessible digital photography with rather sophisticated three‐dimensional rendering. Such is the promise of newer technologies (Figure 1). Borrowing from the archaeology and fine arts community, rendering of complex three‐dimensional shapes rapidly may now allow us to treat a visual examination much in the way we treat a common radiograph. This, compared with other real‐time capture techniques, could likely allow for more rapid distance consultation or further review at a later date (for archiving and quality assurance).

Figure 1.

(A), (B) Three‐dimensional rendering of foot and wound using basic digital photography (courtesy of Eykona Technologies Ltd, Oxford, UK)

Just as the digital video recorder and sling‐box has allowed us to time‐shift traditional television programming, so can current technologies extend this into the clinic. This can give our patients and us the most valuable benefit of all – time and perspective.