Can Checking Skin Temperature Help Prevent Diabetic Neuropathic Ulceration?

David G. Armstrong DPM MD PhD

Monitoring skin temperature can be an effective method of predicting and preventing diabetic neuropathic foot ulceration, according to a recent study.

The meta-analysis, published in the Journal of Foot and Ankle Research, concluded that a regional increase in skin temperature can predict the potential development of a foot ulceration when one compares the temperature with the same site on the contralateral limb.1 The authors added that the meta-analysis did not support the theory that there is a mean norm foot temperature that one can use as a benchmark to monitor pathological change.

We have been using thermometry as an objective surrogate marker for inflammation for the last 20 years and it’s been a central part of our practice through that time. In the past, we’ve used it primarily for monitoring things like Charcot arthropathy.

However, relatively lately we have been giving people their own thermometer to take home with them to dose their activity by checking their skin temperature just as they might dose their insulin. We believe that this is not only valuable but it looks like the data suggest that checking temperature is maybe one of the most valuable tools in our combined arsenal for prevention.

I think the biggest role for thermometry is not in the doctor’s office but at home. I believe ultimately people will have devices like this and be able to prevent these problems and ultimately reduce the risk for not only ulceration but amputation as well.

Reference
1. Houghton VJ, Bower VM, Chant DC. Is an increase in skin temperature predictive of neuropathic foot ulceration in people with diabetes? A systematic review and meta-analysis. J Foot Ankle Res. 2013; 6:31.

Comments

Yes David, the increased skin temperature is an effective indicator for inflammation when comparing different sites as your work and device have shown as well.

Also, voluntarily increasing skin temperature is a helpful guide when training patients with chronic foot ulcers to relax and warm their feet, thereby increasing skin temperature and peripheral perfusion. In a randomized controlled study, we saw 87.5% of patients close their ulcers within 12 weeks when biofeedback-assisted relaxation training, “The WarmFeet Intervention,” was added to the experimental group participants’ homework. "Effect of Biofeedback-Assisted Relaxation Training on Foot Ulcer Healing", JAPMA 91(3): 132-141, 2001. WarmFeet can be the ultimate help in healing, pain relief and preventive methods for the diabetic and PAD patients. It is educational, non-invasive, inexpensive and enjoyable!

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