Simple, 'Low-Tech' Steps Can Avert Foot Ulcers : Look to the shoe as a source of pathology, and have patients check their foot temperature each day.

In a second study of 225 similarly high-risk patients that used the same methods, patients in the dermal thermometry group were one-third as likely to ulcerate at 18 months as were those in the standard therapy group (12% vs. 5%), and the thermometry was associated with a longer time to ulceration (Am. J. Med. 2007;120:1042–6).

In the third study, 173 high-risk patients with a history of foot wound and sensory neuropathy with a loss of protective sensation were randomized to one of three groups. Standard therapy consisted of lower-extremity evaluation by a physician every 8 weeks; education focusing on foot complications and self-care practices; therapeutic insoles and footwear; and advice to the patients to inspect their feet every day and to contact the study nurse if they identified any areas of concern (Diabetes Care 2007;30:14–20).

A second group had the standard therapy plus a structured foot exam, in which they were trained to use a mirror twice a day to inspect the bottom of their feet for redness, discoloration, swelling, and warmth by palpation and to log the results. Patients in a third group received standard therapy and were instructed to use the digital infrared thermometer twice daily and to record the temperatures.

At 15 months, the ulceration rate was essentially identical in the standard and structured foot exam groups (29% and 30%, respectively). In contrast, only 8.5% of the group that used the thermometer developed a foot ulcer, a fourfold reduction in risk. Not surprisingly, the patients in the thermometer group who did develop ulcers were less compliant in using the device: Overall, 80% of them recorded temperature values at least 50% of the recommended time, compared with 92% of those who didn't develop ulcers, Dr. Lavery and his associates reported.

The number of patients needed to treat to prevent one foot ulceration with the thermometer is just 4, compared with 30 to prevent microproteinuria with an ACE inhibitor, and 260 to prevent pneumonia with the pneumococcal vaccine.

Use of the thermometer is “inexpensive, practical, and something patients can do,” Dr. Lavery said.

Lawrence A. Lavery, D.P.M., checks the temperature of a patient's foot using a dermal thermometer device. ©Susan Gaetz Photography