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OBJECTIVE—To evaluate the effectiveness of at-home infrared temperature monitoring as a preventative tool in individuals at high risk for diabetes-related lower-extremity ulceration and amputation.
RESEARCH DESIGN AND METHODS—Eighty-five patients who fit diabetic foot risk category 2 or 3 (neuropathy and foot deformity or previous history of ulceration or partial foot amputation) were randomized into a standard therapy group (n = 41) or an enhanced therapy group (n = 44). Standard therapy consisted of therapeutic footwear, diabetic foot education, and regular foot evaluation by a podiatrist. Enhanced therapy included the addition of a handheld infrared skin thermometer to measure temperatures on the sole of the foot in the morning and evening. Elevated temperatures (>4°F compared with the opposite foot) were considered to be "at risk" of ulceration due to inflammation at the site of measurement. When foot temperatures were elevated, subjects were instructed to reduce their activity and contact the study nurse. Study subjects were followed for 6 months.
RESULTS—The enhanced therapy group had significantly fewer diabetic foot complications (enhanced therapy group 2% vs. standard therapy group 20%, P = 0.01, odds ratio 10.3, 95% CI 1.2–85.3). There were seven ulcers and two Charcot fractures among standard therapy patients and one ulcer in the enhanced therapy group.
CONCLUSIONS—These results suggest that at-home patient self-monitoring with daily foot temperatures may be an effective adjunctive tool to prevent foot complications in individuals at high risk for lower-extremity ulceration and amputation.
I haven't got in the full text yet but the results reported in the abstract are quite exciting. In my brief reading of Paul Brand's work he was one of the first to consider this in the eighties or earlier. Does anyone know why this aspect of self-monitoring has taken so long to get some interest?
__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________ God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University This is where I am, where are you?
I appreciate the comments regarding thermometry in the high risk diabetic foot. While there is an emerging body of evidence that this seems to be an effective surrogate marker for inflammation (and therefore pre-ulceration), most centers do not use the technology. This is mainly because of two related issues:
1. Prevention does not yet "pay" in many parts of the world and therefore:
2. Companies that could make these dermal thermometers concentrate on making devices that are generally used in more acute-care scenarios for which there is an established market.
I, for one, look forward to the time when this is not the case. However, it will take administrators (rather than practitioners) with vision to change this paradigm.
Cheers,
DGA
David G. Armstrong
Professor of Surgery
Chair of Research and Assistant Dean
Dr. William M. Scholl College of Podiatric Medicine at
Rosalind Franklin University of Medicine and Science
Director,
Center for Lower Extremity Ambulatory Research (CLEAR)
at Rosalind Franklin University of Medicine and Science
North Chicago
USA
I was intersted in why the 4 degree F was used as the temp differential to indicate a possible problem. Was it arbitory or is their some evidence behind it?
4 degrees F (2 degrees C) was a figure that was used by the group who pioneered thermometry, led by Paul Brand. This was based largely on empiricism.
Studies that we performed in the 1990s seemed to lend credence to the observation that 4 degrees is the lower limit of the 95% confidence interval that defines the presence of pathology (when compared to the same site on the other limb).
It is entirely possible that data may emerge in the future to further enhance precision of this measurement.
Time for stupid question: Where can I get hold of one of these thermometers? I have been using industrial contact thermometers but not with very good results!! These cost £200 plus, granted this was bought for checking Autoclaves and hot air sterilies a few years back now, however.
In Australia a device is available from Otto Bock, that is accurate to 0.1 degrees Celcius, at a price of A$1500. Less accurate devices are available from electronics shops starting at bout A$100
__________________ Stephen Tucker Eastern Health
Podiatry Manager
Infrared Thermometer - UK.
I have found an address - http://www.thermometersdirect.co.uk/
This address is for UK only, and has a whole range of thermometers for sale. I am going to try an ordinary one which seems reasonably accurate! (TN1 - GBP £21.99 - Ref.102427).
Regards,
Colin Bain.
Last edited by C Bain : 21st December 2004 at 04:05 PM.
Hello All,
Genius timpanic thermometers can be operated in a surface mode and may be useful in assessing skin temperature. Our Medical Physics department have recommended I try one. They are available from TYCO, 154 Fareham Road, Gosport, Hampshire, england, PO13 0AS, tel.no. 013429 224114.
My information is that the company is currently offering 'buy one get one free' and the price is approximately #125 + VAT (that should be pounds, my key won't work for some reason!).
ALL THE BEST FOR 2005 EVERYONE.
Abstract
Developing reliable animal models as a means to study the etiology, prevention, and/or treatment of pressure ulcers is not a simple task. Numerous considerations need to be evaluated for appropriateness, such as similarity of the cutaneous layers to those of humans, reproducibility of injuries, the effects of administered anesthetic or analgesic agents, the locations of the created lesions, the typical rates of healing (controls), and/or the overall health status of the animals. The author's laboratory previously developed one such model: a porcine model to aid in investigations of pressure ulcer formation, healing, and prevention. The author and colleagues specifically studied the relationships between temperature, pressure, and time in the formation of cutaneous and/or deep tissue injuries. To do so, an apparatus and procedure were created to apply 12 metal discs (each with a diameter of 51mm) to the dorsal aspect of the swine. At equal pressures ranging between 10-150mmHg, four discs were applied for 1 to 10 hour periods, while their temperatures were servo-controlled between 25-45°C. The severity of resultant tissue injuries correlated with increases in applied parameters. Briefly, no damage was observed in the superficial or deep tissues underlying the sites of the 25°C pressure discs even with 10 hours of applied pressure. Only deep tissue damage resulted from the application of the 35°C discs for five hours, and the application of higher temperatures for shorter durations caused both cutaneous and subdermal damage. In addition, degrees of healing could be easily monitored in such animals for months and was typically uniform relative to the degree of induced damage. This animal model of temperature-modulated pressure ulcers has the potential for significant use in all major areas of this field, i.e., wound formation, healing, and prevention. The use of this approach on transgenic individuals or those with induced disease would also be of great interest.
There is an article in Yahoo! News today(19/4/5) on "........can measure tiny changes in eardrum temperature caused by an increased flow of blood to the side of the brain used to concentrate on a task............" It used an adapted hard hat to hold and position the thermometers. So feet are not the only thing using temperature evaluation as indicators to date!
Source Sydney (Reuters). Nicolas Cherbium, (Australian National University) a quoted source!
I wonder whether any one has any results from the use of Infrared Thermometers to date on the feet. I have watched a small number of my Diabetics' feet improve as I observed the same on the Thermometer! In some cases their general health improved and I have been able to almost predict the reading of temperature ratio drop before taking the reading! I do not have enough patients to say that these observations are anything more than anecdotal to date, however?
Anyone else tried the 'RATIO SYSTEM' out on the feet with Infrared Thermometers?
Regards,
Colin.
P.S. The hard hat wont go over the Right Hallux!
Last edited by C Bain : 19th April 2005 at 03:18 PM.
Unexpected Side-effect in the Taking of Foot Temperatures!?
Hi All,
The use of the Infra-red Thermometer has had a very unexpected side effect on my diabetic and poor circulation patients! Firstly, however, I have as a point of interest standardized my readings on the following Complex Number format:- Rxdeg.Cent./TD/ydeg.Cent.L where some are obvious, and some not so obvious! The Format being similar to a out of Phase Complex-number, [Old 'J'-notation Electrical Engineering or 'i' if you are pure maths.!].
Briefly the Complex-number has the following Elements,
R = Rightfoot.
xdeg.C. = Right temperature in Centigrade variable with time.
// = Separators dividing the three parts of the Complex-number.
TD. = Temperature difference of Right and Left.
ydeg.C. = Left temperature in Centigrade variable with time.
L = Leftfoot.
I have standardized on this Complex-number because it helps me when I am with my patients to automatically record their temperatures and monitor them from month/six weeks to month/six weeks!
Obviously as time goes by result are plotted to help pick out variants and improvements or deterioration! The magic numbers 2.0 to 2.0Plus for TD. signal that I should be looking again carefully and closely at the patient to see if there is anything new or different about him/her to cause the high result!
Do I pay the patient an early visit or have him/her checked out with doctor/nurse/support team if diabetic?
The numbers 1.0 to zero denotes balance in foot circulation? Achievable? And at this stage in the experiment, what does it mean, does it matter?
The Complex-number is recorded at the time on the patient's Medical Record and immediately afterwards in the Medical Diary!
The very,very interesting side effect of this simple double temperature measurement has been almost without fail for both men and women,
1. A steady calming effect on their demeanour, more so than usual before normal chiropody is started!
2. A gratuities attitude developed towards me, possibly, "You know I think he actually does care!"
3. Being thanked even when I have shown concern over reading and advised the patient to talk to her G.P./Health Professional.
I have come to the conclusion that this can only be a modern day 'Placebo Effect' working to the general good of the patient!
I do hope that something positive may come out of these readings through experimentation here and elsewhere otherwise I may become an expert in Placebo and judging from what happen in the previous Thread on this I might have to arrest myself! The Placebo Effect appears to be part of the treatment rather than just experimental recording of temperature variants!
Regards,
Colin.
P.S. By the way I have picked as standard an area approx. 2.54cms. in from the dorsum lateral side of the foot and up 2.54cms. from the 4th. M.P.J. over the 4th. Dorsal M.P.J. Artery area! Picked as the possible furthest point away from the Heart!
P.P.S. Another question to be considered is if the Placebo Effect is calming the patient down will the temperature vary accordingly in the readings???
I know from my own experience when the nurse advances towards me with a hypodermic syringe, my blood pressure automatically goes up. Heat raised for fight or flight!!! (It's called fear!!! The opposite to what the patient is experiencing here I hope, or is she?).
Re: Home Monitoring of Foot Skin Temperatures to Prevent Ulceration
Dear All!
Has anyone of you heard about the Swedish SpectraSole Indicator. It obviously consists of two heat sensitive plates in an insulating binder. It gives instant colour images of the heat distribution in each foot. If there are temperature differences between left and right foot, they will be immediately visible.
Home Monitoring of Foot Skin Temperatures to Prevent Ulceration
Home monitoring- previous research
Linear Mode
