A number of effective, low-cost strategies are available to identify and treat the person at risk for diabetic foot ulcers and lower-extremity amputation. These strategies must be more widely adopted by all diabetic care providers to maintain the integrity and function of the lower limb, and thus improve the quality of life for people with diabetes.

https://www.algeos.com/filemanager/research/Preventative%20foot%20care%20in%20people%20with%20diabetes.pdf

Preventive Foot Care in People With Diabetes

Objective The purpose of this study was to evaluate the effectiveness of a temperature monitoring instrument to reduce the incidence of foot ulcers in individuals with diabetes who have a high risk for lower extremity complications. Research design and methods In this physician-blinded, randomized, 15-month, multicenter trial, 173 subjects with a previous history of diabetic foot ulceration were assigned to standard therapy, structured foot examination, or enhanced therapy groups. Each group received therapeutic footwear, diabetic foot education, and regular foot care. Subjects in the structured foot examination group performed a structured foot inspection daily and recorded their findings in a logbook. If standard therapy or structured foot examinations identified any foot abnormalities, subjects were instructed to contact the study nurse immediately. Subjects in the enhanced therapy group used an infrared skin thermometer to measure temperatures on six foot sites each day. Temperature differences >4 degrees F (>2.2 degrees C) between left and right corresponding sites triggered patients to contact the study nurse and reduce activity until temperatures normalized. Results The enhanced therapy group had fewer foot ulcers than the standard therapy and structured foot examination groups (enhanced therapy 8.5 vs. standard therapy 29.3%, P = 0.0046 and enhanced therapy vs. structured foot examination 30.4%, P = 0.0029). Patients in the standard therapy and structured foot examination groups were 4.37 and 4.71 times more likely to develop ulcers than patients in the enhanced therapy group. Conclusions Infrared temperature home monitoring, in serving as an "early warning sign," appears to be a simple and useful adjunct in the prevention of diabetic foot ulcerations.

/pdf/preventing-diabetic-foot-ulcer-recurrence-in-high-risk-49fcfkgxd4.pdf

Preventing Diabetic Foot Ulcer Recurrence in High-Risk Patients: Use of temperature monitoring as a self-assessment tool

http://mr3health.com/wp-content/uploads/2015/08/Armstrong-VA-AJM-2007.pdf

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

The relationship of static foot structure to dynamic foot function.

Ulceration, unsteadiness, and uncertainty: the biomechanical consequences of diabetes mellitus

The hypothesis that loss of tissue mass in the foot contributes to foot ulceration in diabetics has never been quantitated. We developed normal criteria for the thickness of the sole of the foot at the heel, and the five metatarsal heads of both feet, using high-resolution ultrasound (10 MHz). We studied 24 normal patients ranging in weight from 125 to 250 lbs. We examined the soles of the feet of 38 diabetics without foot ulcers and 11 diabetics with foot ulcers or a history of foot ulcers who were in the same weight range as the normals. Of statistical significance, the heel thickness in controls was greater than that of the diabetics, which in turn was greater than that of the diabetics with foot ulcers. The thickness of the sole over the first and second metatarsals was also greater in the controls compared with diabetics. We conclude that high-resolution ultrasound is an effective determinant of the thickness of the sole of the foot and that diabetics have variations from the norm in the heel and at the first and second metatarsal heads.

Sonography of the sole of the foot. Evidence for loss of foot pad thickness in diabetes and its relationship to ulceration of the foot.

Liquid crystal thermography (LCT) was used to determine temperature variations on the plantar surface of feet. The purpose was to identify thermal emission patterns associated with diabetic foot ulcers. Three population groups were screened: group I, 16 nondiabetic controls; group II, 21 diabetic patients with no history of pedal ulcers; and group III, 28 diabetic patients with active pedal ulceration or history of foot ulcerations. The results demonstrate a generalized increase in plantar foot temperature in group III compared with groups I and II. Temperature readings under metatarsal heads 1-5, great toe, heel, and lateral band were significantly increased (P less than .01) in group III. Additionally, the warm lateral surface displayed by group III patients was not significantly different in temperature from the medial arch of the foot. In groups I and II, the lateral band was significantly cooler (P less than .01) than the medial arch. In group III patients with active ulceration on only one foot, no significant difference in temperature was found between the foot with active ulceration compared with the contralateral nonulcerated foot. When patients with active pedal ulceration were compared with patients with a history of foot ulcers, no significant difference in temperature was seen at five of seven sites tested. A warm concentric color band surrounding active plantar ulcers was identified in group III. This pattern extended from the center of the ulcer to a distance of 8 mm. A significant change in temperature (P less than .01) was noted at 6- and 8-mm distances from the center of the ulcer. In addition, a mottled thermographic pattern was observed more frequently in group III patients than in groups I and II.(ABSTRACT TRUNCATED AT 250 WORDS)

Use of Liquid Crystal Thermography in the Evaluation of the Diabetic Foot

A process and apparatus for forming customized footwear, such as shoes, boots or inner bladders for shoes or boots, and particularly an athletic shoe or boot, is disclosed in which an impression of the foot is used to make a positive mold, around which the shoe, boot or bladder is constructed. In the improved process a range-of-motion measuring apparatus is used to accurately determine the neutral position of the bone structure of the rearfoot complex of the foot. The foot is maintained in that position by means of the apparatus while the impression or casting of the foot is being made. The process provides a shoe, boot or inner liner or bladder therefor which will evenly support the foot in a neutral position. The range-of-motion measuring apparatus includes a beam generating laser that is directed toward a mirror mounted on the leg of the person being fitted. The mirror, in turn, is directed to reflect the laser beam onto a measuring device, such as a scale, which can be used to electronically or visually measure leg rotation during pronation and supination of the foot and, accordingly, to position the bone structure of the foot in its neutral position.

Process and apparatus for forming customized footwear

A method of providing prosthetic sockets (30) for a patient's residual limb (21). While the residual limb (21) is swollen with post-trauma edema (22-25), a resin-impregnated temporary shell forming sock (52) is placed onto the edema-swollen residual limb (21). The resin is activated to cause it to harden into a temporary prosthetic shell (30), but prior to hardening of the resin, the sock (52) is conformed to the patient's edema-swollen limb (21). After swelling of the residual limb (21) has substantially dissipated, a permanent prosthetic socket conforming to the patient's unswollen residual limb (22b-25c) is formed and the temporary prosthetic socket (30) is replaced with the permanent prosthetic socket. A temporary prosthetic socket (30) is also disclosed in which a resin-hardened temporary sock (52) is bonded to a socket liner (49) over a prosthetic attachment assembly (48) in a configuration substantially conforming to the patient's residual limb (21) when in an edema-swollen (22-25) condition.

Method of providing prosthetic sockets and temporary prosthetic socket

Custom molded wrist area impression sleeve ( 21 ) having a configuration substantially covering the wrist area (WA) of a patient. The impression sleeve ( 21 ) is formed from a thin, resin-impregnated, resilient fabric sleeve ( 21 ) mounted over a thin, flexible, resin-impervious release layer ( 23 ), and preferably over a cushioning and thermally insulating foam sleeve ( 25 ). The hardenable sleeve ( 21 ) can include one, and preferably two, longitudinally extending weakened strips ( 30, 40 ) which facilitate severing and act as a hinge ( 40 ) for the resulting hardened wrist brace. In the present method, the wrist area impression sleeve ( 21 ) is hardened on the patient's wrist, cut off and then used as a removable brace or to form a custom orthosis in a fabrication laboratory.

Peter M. Graf

Papers

Sonography of the sole of the foot. Evidence for loss of foot pad thickness in diabetes and its relationship to ulceration of the foot.

Use of Liquid Crystal Thermography in the Evaluation of the Diabetic Foot

Process and apparatus for forming customized footwear

Method of providing prosthetic sockets and temporary prosthetic socket

Custom molded wrist area impression kit and method