Welcome to the Podiatry Arena forums, for communication between foot health professionals about podiatry and related topics.
You are currently viewing our podiatry forum as a guest which gives you limited access to view all podiatry discussions and access our other features. By joining our free global community of Podiatrists and other interested foot health care professionals you will have access to post podiatry topics (answer and ask questions), communicate privately with other members (PM), upload content, view attachments, receive a weekly email update of new discussions, earn CPD points and access many other special features. Registered users do not get displayed the advertisments in posted messages. Registration is fast, simple and absolutely free so please, join our global Podiatry community today!
If you have any problems with the registration process or your account login, please contact contact us.
Preventing Diabetic Foot Ulcer Recurrence in High-Risk Patients
Use of temperature monitoring as a self-assessment tool Diabetes Care 2007;30 14-20
Lawrence A. Lavery, Kevin R. Higgins, Dan R. Lanctot, George P. Constantinides, Ruben G. Zamorano, Kyriacos A. Athanasiou, David G. Armstrong, C. Mauli Agrawal
Quote:
OBJECTIVE—The purpose of this study was to evaluate the effectiveness of a temperature monitoring instrument to reduce the incidence of foot ulcers in individuals with diabetes who have a high risk for lower extremity complications.
RESEARCH DESIGN AND METHODS—In this physician-blinded, randomized, 15-month, multicenter trial, 173 subjects with a previous history of diabetic foot ulceration were assigned to standard therapy, structured foot examination, or enhanced therapy groups. Each group received therapeutic footwear, diabetic foot education, and regular foot care. Subjects in the structured foot examination group performed a structured foot inspection daily and recorded their findings in a logbook. If standard therapy or structured foot examinations identified any foot abnormalities, subjects were instructed to contact the study nurse immediately. Subjects in the enhanced therapy group used an infrared skin thermometer to measure temperatures on six foot sites each day. Temperature differences >4°F (>2.2°C) between left and right corresponding sites triggered patients to contact the study nurse and reduce activity until temperatures normalized.
RESULTS—The enhanced therapy group had fewer foot ulcers than the standard therapy and structured foot examination groups (enhanced therapy 8.5 vs. standard therapy 29.3%, P = 0.0046 and enhanced therapy vs. structured foot examination 30.4%, P = 0.0029). Patients in the standard therapy and structured foot examination groups were 4.37 and 4.71 times more likely to develop ulcers than patients in the enhanced therapy group.
CONCLUSIONS—Infrared temperature home monitoring, in serving as an "early warning sign," appears to be a simple and useful adjunct in the prevention of diabetic foot ulcerations.
Re: Diabetic foot ulcer prevention by home monitoring of temperature
Does dermal thermometry predict clinical outcome in diabetic foot infection? Analysis of data from the SIDESTEP* trial. Int Wound J. 2006 Dec;3(4):302-7
Armstrong DG, Lipsky BA, Polis AB, Abramson MA
Quote:
The purpose of the study was to assess in patients with a diabetic foot infection (DFI), whether differences in skin temperature of the affected foot as compared to the corresponding site on the contralateral foot using dermal thermometry (DT) correlates with infection severity and clinical outcome. As part of the SIDESTEP DFI study, investigators took DT measurements at baseline and the discontinuation of intravenous therapy (DCIV) and performed a systematic evaluation of the infected limb to calculate a wound score. We compared the skin temperature differential between the limbs at the two assessments and determined the correlation between this value and surrogate markers of inflammation and the clinical response to treatment. Among patients enrolled in SIDESTEP, 332 were fully evaluable. The mean temperature differential between the limbs was 2.81 +/- 5.75 degrees F at baseline and 2.43 +/- 4.84 degrees F at DCIV (mean change: -0.37; 95% confidence interval (CI): -0.98, 0.23; P= 0.225). Skin temperature differential at baseline did not correlate with white blood cell count, level of C-reactive protein or erythrocyte sedimentation rate or the infection severity score (r= 0.058, 0.148, -0.002, 0.067, respectively). We observed no overall trend between surface temperature differential at baseline and clinical outcome at DCIV, but patients with a skin temperature differential of >/=10 degrees F at baseline had a significantly lower clinical response than those whose differential was <10 degrees F (81.4% versus 94.3%; difference 12.9%; 95% CI: 3.5, 27.3%, P= 0.007). While there was no overall relationship between skin temperature and poor clinical outcome, there may be a threshold effect in DT (<10 degrees F versus >10 degrees F) between the limbs at baseline that predicts outcome of therapy.
Re: Diabetic foot ulcer prevention by home monitoring of temperature
Reuters have picked up this story: Temperature check may prevent diabetic foot ulcer
Mon Jan 8, 2007 5:17 PM GMT
Quote:
NEW YORK (Reuters Health) - Adding a daily check of foot temperature with an infrared skin thermometer to standard diabetic foot therapy can significantly reduce the recurrence of foot ulcers, doctors in Texas and Chicago report in the medical journal Diabetes Care.
The digital infrared thermometer, called TempTouch, costs approximately $150 and is powered by 9-V batteries, Don Lawson, CEO of the thermometer maker Xilas Medical, told Reuters Health.
Co-investigator Dr. Lawrence A. Lavery, at Texas A&M University Health Science Center in Temple, and his associates point out that elevated skin temperature is a sign of inflammation and tissue injury, but the signs may be too subtle to detect.
The team randomly assigned 173 diabetic patients between 18 and 80 years of age to one of three treatment groups for 15 months. One group received standard therapy, consisting of a foot evaluation every 8 weeks, therapeutic insoles and footwear, and an education program.
A second group received the same treatment, plus instructions to inspect the bottom of their feet with a mirror twice daily.
The enhanced therapy group received the same treatment as the second, but also used the TempTouch thermometer daily and were told to notify the study nurse if the temperature at the same site differed by more than 4 F.
About 30 percent of subjects in the first two groups developed a new foot ulcer, compared with only 8.5 percent in the third group. Ninety percent of the first two groups also had full-thickness ulcers by the time they noticed a problem.
"Once patients identify a hot spot, they are told to modify their activity and stay off their feet until the temperature normalizes," Lawson said, which is probably what reduced the ulcer rate.
Background: A study was conducted to compare the accuracy, reliability, and essential features of nine commercially available handheld infrared thermometers used to manage the neuropathic foot.
Methods: The thermometers were compared using two temperature-control sources simulating physiologic conditions found in a foot-care clinic. With each control source independently set, temperature difference ranges of 0 degrees , 2 degrees , 4 degrees , and 6 degrees C were randomly sampled and analyzed for each thermometer by two testers. The order of testing was randomly assigned for testers and instruments.
Results: There were differences in mean temperature change among thermometers (P < .001) and between testers (P = .0247). Differences in mean temperature change among instruments (<0.5 degrees C), although small, could affect interpretation of skin temperature if temperature comparisons are made using two different instruments. The difference in temperature change between testers (0.06 degrees C) was not large enough to affect decisions in clinical practice. Instrument response time, distance-to-spot ratio, sensor diameter, display resolution, emissivity, and cost were compared.
Conclusions: The low-cost, general-use infrared thermometers used in this study showed good accuracy, reliability, and performance and are appropriate for use in a foot-care clinic.
Purpose
To evaluate the effectiveness of home temperature monitoring to reduce the incidence of foot ulcers in high-risk patients with diabetes.
Methods
In this physician-blinded, 18-month randomized controlled trial, 225 subjects with diabetes at high risk for ulceration were assigned to standard therapy (Standard Therapy Group) or dermal thermometry (Dermal Thermometry Group) groups. Both groups received therapeutic footwear, diabetic foot education, regular foot care, and performed a structured foot inspection daily. Dermal Thermometry Group subjects used an infrared skin thermometer to measure temperatures on 6 foot sites twice daily. Temperature differences >4°F between left and right corresponding sites triggered patients to contact the study nurse and reduce activity until temperatures normalized.
Results
A total of 8.4% (n = 19) subjects ulcerated over the study period. Subjects were one third as likely to ulcerate in the Dermal Thermometry Group compared with the Standard Therapy Group (12.2% vs 4.7%, odds ratio 3.0, 95% confidence interval, 1.0 to 8.5, P = .038). Proportional hazards regression analysis suggested that thermometry intervention was associated with a significantly longer time to ulceration (P = .04), adjusted for elevated foot ulcer classification (International Working Group Risk Factor 3), age, and minority status. Patients that ulcerated had a temperature difference that was 4.8 times greater at the site of ulceration in the week before ulceration than did a random 7 consecutive-day sample of 50 other subjects that did not ulcerate (3.50 ± 1.0 vs 0.74 ± 0.05, P = .001).
Conclusions
High temperature gradients between feet may predict the onset of neuropathic ulceration and self-monitoring may reduce the risk of ulceration.
Re: Diabetic foot ulcer prevention by home monitoring of temperature
Press Release: Dermal Thermometry Helps Diabetics Keep Their Feet
Quote:
William Buchanan takes his temperature every morning, but he doesn't hold a thermometer under his tongue. He holds it to the bottom of his feet.
The 76-year-old retired right-of-way agent for the New York Telephone Company has Type II diabetes and has subsequently lost sensation in his feet. He uses the TempTouch to help prevent ulcers that could lead to amputation..
Two years ago, Buchanan, who lives in Queens, was shopping with his wife when he took a spill in a parking lot..
"I got up and walked to the car, no problem," he said. "The next morning I used 'the wand' and there was a big difference in readings between my right and left foot.".
An X-ray revealed that Buchanan had broken his left toe..
"If I didn't have that wand to check with, I would have walked around for a couple weeks without feeling it and I would have wound up with an infection," Buchanan said. "And then I would have had a big problem - off with the leg.".
Clinical trials, including one that will be published in December in the American Journal of Medicine, are proving that skin temperature monitoring significantly reduces foot ulcers in diabetics who suffer neuropathy - numbness in their extremities..
Dr. David Armstrong, director of the Scholl College Center for Lower Extremity Ambulatory Research (CLEAR) at Rosalind Franklin University of Medicine and Science and the James A. Lovell Federal Health Center in North Chicago, Ill., was principal investigator and lead author on the latest study using the infrared TempTouch..
Armstrong began using a thermometer to help prevent foot ulcers in his patients 15 years ago as a medical student and resident..
"I spent $700 and bought this fancy thermometer I put in my pocket," he said. "I would tell my patients 'You've got to buy one of these. I know it's a lot of money, but it will help keep your feet on.'".
Diabetics can now use the wand-like, gooseneck TempTouch before they begin their day's activities. A spike in temperature warns that an infection is brewing so they can stay off their feet until the threat of an ulcer subsides..
"A wound will heat up before the skin breaks down," said Armstrong, professor of surgery and associate dean at Rosalind Franklin's Scholl College of Podiatric Medicine. "You can detect infection by checking one foot compared to another foot, one toe compared to another toe.".
Problems with feet account for about one-third of all hospital admissions for people with diabetes, according to Armstrong who lectures around the world on treatment of the diabetic foot and ways to prevent amputations..
The latest clinical trial found that study participants who used the TempTouch were three times less likely to develop ulcers compared to those in the standard therapy group who were instructed on how to visually inspect their feet..
Armstrong insists many people with diabetes have trouble examining their feet and that only between 10 and 20 percent ask their doctor to do so during routine check-ups..
"Many can't reach their feet," Armstrong said. "Many have retinopathy - they can't see well. And the diabetic foot doesn't bother them. They have lost 'the gift' of pain.".
Ruben Zamorano, president of San Antonio-based Xilas Medical, which holds the patent for the TempTouch, said Armstrong and other podiatrists have been working with bio-medical engineers to develop "new weapons" to fight diabetic ulcers, which cost $14,000 per patient to treat in the first year..
"A doctor may heal an ulcer but people go right back into the same situation in the same shoes that caused the problem," Zamorano said. "The whole problem comes back to prevention.".
Xilas donated 5,000 foot thermometers to Texas Medicaid patients who at have a high rate of diabetes-related amputations. The company received a $1 million emerging technology grant from the state in 2006. It has also contracted with insurance companies in New York City and Tennessee..
Armstrong and other leading podiatrists hope "dermal thermometry" becomes a norm in treatment of the diabetic foot..
"Three separate federally-funded trials suggest it works," Armstrong said..
More people with diabetics will begin using hand-held devices like the TempTouch, which costs $150, as they become easier to use and cheaper to manufacture and as more insurers reimburse for them, said Dr. James Christina, director of scientific affairs for the American Podiatric Medical Association..
But while insurance companies pay lip service to preventive care, they are often reluctant to make the up-front investment..
"We still have challenges with getting insurance companies to pay for prevention visits to podiatrists in some cases," Christina said. "That's a big problem. Preventive care can be so cost effective. Studies show a whole-team approach to helping diabetics take care of their feet can help prevent ulcerations and amputations.".
Armstrong, who warned of the "silent tsunami of diabetic amputations" at the International Diabetic Foot Conference in Singapore last summer, warned that complications of diabetes is crippling people in their prime working years. He hopes companies that pay the premiums for employee health care will begin paying for prevention, even if insurers won't..
"Companies will save money by stopping these problems before this tsunami overtakes us," Armstrong said. "The wave is already cresting.".
The aim of this study was to evaluate foot temperature in type 2 diabetic patients with vs. without peripheral neuropathy. The study included 30 patients (group A: 16 men, mean age 63.23+/-7.02 years) with peripheral neuropathy and 30 patients (group B: 17 men, mean age 62.37+/-6.73 years) without peripheral neuropathy. Neuropathy was diagnosed by the Diabetic Neuropathy Index (DNI). Foot temperature was measured with a handheld infrared thermometer (KM 814, Kane-May, UK) on the mid-dorsal aspect of the foot (dorsal temperature) and on the plantar aspect of the foot at the level of the first metatarsal head (plantar temperature). Dorsal temperature was significantly higher in group A than in group B (right foot 32.89+/-1.02 degrees C vs. 31.2+/-1.07 degrees C, p<0.001). The same significant difference was observed for the plantar temperature (32.2+/-0.94 degrees C vs. 30.7+/-1.07 degrees C, p<0.001). In both groups, a significant positive correlation was observed between dorsal and plantar temperature (group A: r (s)=0.913, p<0.001; group B: r (s)=0.956, p<0.001). Finally, in group A, DNI score showed a significant positive correlation with dorsal temperature (r (s)=0.856, p<0.001), as well as plantar temperature (r (s)=0.859, p<0.001).
CONCLUSIONS: Foot temperature is significantly higher in type 2 diabetic patients with neuropathy as compared to those without neuropathy. In patients with neuropathy, a significant positive correlation is observed between foot temperature and clinical severity of neuropathy.
Diabetic foot ulcer prevention by home monitoring of temperature
Linear Mode
