Cooling the Foot to Prevent Diabetic Foot Wounds

Peethambaran

et al. 2014

Reducing shear or side-to-side stresses on the plantar surfaces of feet in patients with diabetes is of particular interest lately. Conflicting clinical trial data of custom pressure-reducing footwear suggest that other offloading or footwear approaches may be necessary. 1,2 Gait lab studies suggest shear stresses are in a different location and magnitude versus age-matched controls. 3 Shear stresses in the foot also demonstrate a large association with thermal changes in response to walking in patients with diabetes and peripheral neuropathy. 4 Currently, there are no commercially available products to detect shear inside the shoe. However, relative temperature changes using thermometry may represent antecedent inflammatory changes from shear and pressure occurring prior to clinical expression of foot ulceration at the skin level. Purposeful "cooling" of the foot in clinical trials resulted in effect sizes of 4-to 10-fold reduction in reulceration. 5-7 Autonomic neuropathy can also affect thermoregulation of foot temperature and may be a more sensitive measure 8 for predicting foot ulcer. 9 In this study we measured sudomotor function for small fiber autonomic neuropathy. 10-12 Shear-reducing insoles that permit side-to-side motion in the device to reduce shear at the skin and deeper tissue level may make patients feel unsteady and less confident with walking. Therefore, in this study, we measured gait and balance changes under single and dual task conditions to explore for gait adaptations. In addition, these measurements may 546528D STXXX10.

Section: Discussionmentioning

confidence: 99%

A Novel Shear Reduction Insole Effect on the Thermal Response to Walking Stress, Balance, and Gait

Peethambaran

et al. 2014

“…There are approximately 4-to 10-fold reductions in reulceration for patients using home-based thermometry devices due, ostensibly, to the ability of elevated skin temperatures to act as a surrogate marker for otherwise imperceptible inflammation in the extremity devoid of nociceptive feedback. 10,[73][74][75][76][77] Is There a Peak Pressure Threshold for Ulceration?…”

Section: How Are These Changes Reflected In the Foot-ground Interface?mentioning

confidence: 99%

Diabetic Foot Biomechanics and Gait Dysfunction

Najafi

2010

159

105

In conclusion, there do appear to be gait changes in patients with diabetes. These changes, coupled with local soft tissue changes from advanced glycosylated end products, also alter a patient's gait, putting them at risk of foot ulceration. Better elucidation of these changes throughout the entire spectrum of diabetes disease can help design better treatments and potentially reduce the unnecessarily high prevalence of foot ulcers and amputation.

“…Relative temperature changes using dermal thermometry may represent antecedent inflammatory changes occurring prior to frank diabetic foot ulceration (DFU), Charcot neuroarthropathy (CN), and cellulitis of the foot in patients with diabetes mellitus (DM). [1][2][3][4][5][6][7][8] Monitoring of dermal foot temperatures may represent an important clinical tool for diagnosing and provide an early intervention in patients with diabetes-related foot complications and diabetic peripheral neuropathy (DPN) where the loss of protective sensation leads to potential diagnostic delays. 9,10 When dermal foot temperatures are monitored in patients with previous DFU, there can be a four to tenfold prevention of recurrence with prompt recognition and subsequent offloading of pressure.…”

Section: Introductionmentioning

confidence: 99%

“…9,10 When dermal foot temperatures are monitored in patients with previous DFU, there can be a four to tenfold prevention of recurrence with prompt recognition and subsequent offloading of pressure. 2,[4][5][6]11 These studies have used the contralateral foot as a control to determine whether or not the temperature of the foot of interest is elevated.…”

Section: Introductionmentioning

confidence: 99%

Describing Normative Foot Temperatures in Patients With Diabetes-Related Peripheral Neuropathy

Schmidt

Allison

2019

Background: Prior research shows increased foot temperatures are predictive of diabetes-related foot complications. Our aim was to describe normative skin foot temperatures for individuals with diabetic peripheral neuropathy to better inform new technologies. We also explored for potential risk factors which correlate with changes in foot temperatures. Methods: We conducted a retrospective chart review of adult patients >18 years of age with diabetes mellitus and clinically diagnosed diabetic peripheral neuropathy with pedal digital thermometry performed between 2009 and 2018. A total of 58 patients met these criteria. Univariate modeling was based on covariates that may affect foot temperature including age, peripheral arterial disease, toe pressure, seasonality of measurement, smoking pack-years, caffeine use, insulin use, and calcium channel blocker use. Results: In patients with diabetic peripheral neuropathy, mean toe temperatures of 27.67°C (6.300°C), forefoot of 28.58°C (5.36°C), midfoot of 29.21°C (3.81°C), and rearfoot of 29.88°C(3.83°C) were demonstrated. A modest negative correlation between seasonality and toe and metatarsal temperatures ( r = −0.38, P < .05; r = −0.43 P < .01, respectively) was demonstrated. Midfoot temperatures were modestly and positively correlated to the presence of small fiber symptoms ( r = 0.33, P = .03). Positive modest correlation with rearfoot temperatures and amount of pack-year history ( r = 0.30, P = .03) was seen. Conclusion: Normative foot temperatures in neuropathic patients were found to be inversely associated with seasonality at the toe and metatarsal level. Smoking and pack-year history demonstrate modest correlation previously unseen in temperature analyses and warrant further exploration. Normative temperatures in neuropathic patients can better inform new technologies for the prevention of diabetic foot ulcer and Charcot neuroarthropathy.