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Temperature is a well-known indicator of inflammation of human tissue, however, I believe this fact is often neglegted in the examination of diabetic feet. How come that the otherwise most common measurement in care (human body temperature) is not used at the same frequency on feet?

As I have understood it, numerours research studies also show that temperature, and in specific, temperature differences between the same spots in left and right foot indicate inflammation, and thus may prevent ulcers at an early stage, which is not possible to indicate by other means.

I have also seen products that in a glance give you complete temperature profiles by means of colours in both feet simultaneously. But, why are they not used in the preventive care of diabetics?

It is a low-cost method and if used more frequently, it may prevent amputations in the end!

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I think you will find many Pods dealing with the "diabetic foot" have been using dermal thermometry for many years as an adjunct to their other assessment measures.

Regards

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Graham Curryer

None of us know what we are doing, but some of us know more about what we are not doing than others!::

Hi Graham

Happy new year buddy!

I think there are 2 important riders to this.

1 unreliable with significant iscaemia

2 Although I recommend use of "temp touch" as a matter or course to those with loss of protective sensation but no ischaemia I have stopped doing so when significant hyperkerotis forms at weight-bearing sites.

I have had a couple of patients who are are high risk for lower extremity amputation because of loss of protective sensation with no evidence of iscaemia who were insensitive to temperature gradient testing using end of day home "temptouch" IR dermal temp monitoring. Both had prior history of osteomyelitis secondary to neglected neuropathic ulceration with resultant deformity and limb threatenning pressure distribution issues.

The problem seems to me that with hyperkeratosis formation at the high risk zones, temperature gradient is likely obscured. I checked these ulcerated lesions (ulcer appears superficial non-infected non ischaemic not involving tendon, joint capsule or bone UTDWCS grade IA ulcer sites) pre debridement with my office "dermatemp" and found similar problems with lack of temp gradient so I don't think it was a defect in "temptouch" product.

I am unaware of any research on this issue; any comments?

cheers

Martin


The St. James Foot Clinic
1749 Portage Ave.
Winnipeg
Manitoba
R3J 0E6
phone [204] 837 FOOT (3668)
fax [204] 774 9918
www.winnipegfootclinic.com

Mart,

Happy New year to you and yours.

I have found it more useful in determining wound healed, in a neuropathic wound with no apparent ischaemia, When to remove the cast and begin with an orthoses. I have experienced less re-ulcerations with leaving the cast on until temperatures stabilise to surrounding tissues. Just empirically but clinically appears to work consistently.

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Graham Curryer

None of us know what we are doing, but some of us know more about what we are not doing than others!::

Does anyone have experience from using the SpectraSole Pro 1000 device?
As far as I have understood it, it enables the temperature distribution in the feet to be presented by means of colour images. It seems like it is easy and quick to use as well.

You may wish to look at the TEMPSTAT device from www.VisualFootcaretechnologies which is a patient-screening device recently advocated along with the in-office PRESSURESTAT (no experience with either yet) as part of a Comprehensive Diabertic Foot Exam (CDFE), advocated by ADA. The tempstat wholesales around $75 I believe. Good luck. .

To Chrjoh,

On what do you base your assumption that
"Temperature is a well-known indicator of inflammation of human tissue, however, I believe this fact is often neglegted in the examination of diabetic feet. How come that the otherwise most common measurement in care (human body temperature) is not used at the same frequency on feet?"

I cannot speak for others in the profession or even for different areas of the country, as I have worked only in this Trust for the last 18 years. However, temperature check is a standard part of every initial assessment done in this Trust and we continue to check the patients' feet for hot spots or other signs of inflammation at most appointments.
We don't have any equipment to do this, other than using the backs of our fingers to detect temperature changes: its proved pretty effective so far as an indicator of something requiring further investigation.

Before stating categorically that podiatrists DON'T carry out some practice or other that you feel should be done, you maybe should find out if your assumption is true or just that, an assumption.

All together now: If you ASSUME you make an ASS out of U and ME. (Thank you to Thomas Harris for that little nugget).