The purpose of this study was to describe the use of skin temperature assessment in diabetics with acute Charcot's arthropathy to monitor resolution of inflammation longitudinally throughout the course of treatment and to predict development of neuropathic ulcers. Thirty-nine diabetic subjects presenting with acute Charcot's arthropathy received thermometric monitoring throughout their treatment course. Subjects were treated with a standard protocol involving total contact casting, removable cast walkers, and progression to therapeutic shoes. There was a steady decrease in temperatures during the casting regimen. After temperature gradients normalized, subjects were progressed to custom therapeutic shoe gear and insoles and were followed for a mean 22.6 +/- 7.1 months. Following quiescence, 8% returned during the follow-up period with a new-onset neuropathic ulceration. Temperature gradients during taken the visit prior to ulceration were significantly higher in this group than for the rest of the population. Elevated temperatures were strongly correlated with the location of arthropathy. Temperatures decreased in a predictable manner as acute arthropathy resolved. Additionally, increased temperature gradients may be predictive of future ulceration.