Advertisement

Skin Temperature Monitoring Reduces the Risk for Diabetic Foot Ulceration in High-risk Patients

      Abstract

      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.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Pecoraro R.E.
        • Reiber G.E.
        • Burgess E.M.
        Pathways to diabetic limb amputation: basis for prevention.
        Diabetes Care. 1990; 13: 513-521
        • Singh N.
        • Armstrong D.G.
        • Lipsky B.A.
        Preventing foot ulcers in patients with diabetes.
        JAMA. 2005; 293: 217-228
        • Armstrong D.G.
        • Abu-Rumman P.L.
        • Nixon B.P.
        • Boulton A.J.
        Continuous activity monitoring in persons at high risk for diabetes-related lower-extremity amputation.
        J Am Podiatr Med Assoc. 2001; 91: 451-455
        • Armstrong D.G.
        • Lavery L.A.
        • Holtz-Neiderer K.
        • et al.
        Variability in activity may precede diabetic foot ulceration.
        Diabetes Care. 2004; 27: 1980-1984
        • Maluf K.S.
        • Morley R.E.
        • Richter E.J.
        • et al.
        Foot pressures during level walking are strongly associated with pressures during other ambulatory activities in subjects with diabetic neuropathy.
        Arch Phys Med Rehabil. 2004; 85: 253-260
        • Maluf K.S.
        • Mueller M.J.
        Novel Award 2002.
        Clin Biomech (Bristol, Avon). 2003; 18: 567-575
        • Goller H.
        • Lewis D.W.
        • McLaughlin R.E.
        Thermographic studies of human skin subjected to localized pressure.
        Am J Roentgenol Radium Ther Nucl Med. 1971; 113: 749-754
        • Stess R.M.
        • Sisney P.C.
        • Moss K.M.
        • et al.
        Use of liquid crystal thermography in the evaluation of the diabetic foot.
        Diabetes Care. 1986; 9: 267-272
        • Armstrong D.G.
        • Lavery L.A.
        • Liswood P.J.
        • et al.
        Infrared dermal thermometry for the high-risk diabetic foot.
        Phys Ther. 1997; 77: 169-175
        • Benbow S.J.
        • Chan A.W.
        • Bowsher D.R.
        • et al.
        The prediction of diabetic neuropathic plantar foot ulceration by liquid-crystal contact thermography.
        Diabetes Care. 1994; 17: 835-839
        • Bergtholdt H.T.
        • Brand P.W.
        Thermography: an aid in the management of insensitive feet and stumps.
        Arch Phys Med Rehabil. 1975; 56: 205-209
        • Clark R.P.
        • Goff M.R.
        • Hughes J.
        • Klenerman L.
        Thermography and pedobarography in the assessment of tissue damage in neuropathic and atherosclerotic feet.
        Thermology. 1988; 3: 15-20
        • Lavery L.A.
        • Higgins K.R.
        • Lanctot D.R.
        • et al.
        Home monitoring of foot skin temperatures to prevent ulceration.
        Diabetes Care. 2004; 27: 2642-2647
        • Lavery L.A.
        • Higgins K.R.
        • Lanctot D.
        • et al.
        Preventing diabetic foot ulcer recurrence in high-risk patients: the use of temperature monitoring as a self-assessment tool.
        Diabetes Care. 2007; 30: 14-20
        • Peters E.J.
        • Lavery L.A.
        • International Working Group on the Diabetic Foot
        Effectiveness of the diabetic foot risk classification system of the International Working Group on the Diabetic Foot.
        Diabetes Care. 2001; 24: 1442-1447
        • Uccioli L.
        • Faglia E.
        • Monticone G.
        • et al.
        Manufactured shoes in the prevention of diabetic foot ulcers.
        Diabetes Care. 1995; 18: 1376-1378
        • Walker S.C.
        • Helm P.A.
        • Pulliam G.
        Total contact casting and chronic diabetic neuropathic foot ulcerations: healing rates by wound location.
        Arch Phys Med Rehabil. 1987; 68: 217-221
        • Mueller M.J.
        • Sinacore D.R.
        • Hastings M.K.
        • et al.
        Effect of achilles tendon lengthening on neuropathic plantar ulcers.
        J Bone Joint Surg Am. 2003; 85: 1436-1445
        • Lavery L.A.
        • Higgins K.R.
        • Armstrong D.G.
        • et al.
        Randomized clinical trial to evaluate a novel home temperature monitoring device to reduce the incidence of diabetic foot complications (Abstract).
        Diabetologia. 2002; 45: A342
        • Sandrow R.E.
        • Torg J.S.
        • Lapayowker M.S.
        • Resnick E.J.
        The use of thermography in the early diagnosis of neuropathic arthropathy in the feet of diabetics.
        Clin Orthop. 1972; 88: 31-33
        • Stess R.M.
        • Sisney P.C.
        • Koss K.M.
        • et al.
        Use of liquid crystal thermography in the evaluation of the diabetic foot.
        Diabetes Care. 1986; 9: 267-272
        • Armstrong D.G.
        • Lavery L.A.
        • Liswood P.J.
        • et al.
        Infrared dermal thermometry for the high-risk diabetic foot.
        Phys Ther. 1997; 77 (discussion 176-177): 169-175
        • Reiber G.E.
        • Koepsell T.D.
        • Maynard C.
        • et al.
        Diabetes in nonveterans, veterans, and veterans receiving Department of Veterans Affairs health care.
        Diabetes Care. 2004; 27: B3-B9
        • Reiber G.E.
        • Boyko E.J.
        Diabetes research in the Department of Veterans Affairs.
        Diabetes Care. 2004; 27: B95-B98

      Linked Article

      • Erratum
        The American Journal of MedicineVol. 121Issue 12
        • Preview
          Armstrong DG, Holtz-Neiderer K, Wendel C, et al. Skin Temperature Monitoring Reduces the Risk for Diabetic Foot Ulceration in High-risk Patients. Am J Med. 2007;120:1042-1046.
        • Full-Text
        • PDF