Advertisement
-
1
World Health Organization: Diabetes estimates and projections [World Health Organization Web site]. Available at: http://www.who.int/ncd/dia/database4.htm. Accessed October 14. ,2003. .
-
2
Huse DM, Oster G, Killen AR, et al: The economic costs of non-insulin-dependent diabetes mellitus. .JAMA 262::2708. ,1989. .
-
3
Armstrong DG, Lavery LA, Quebedeaux TL, et al: Surgical morbidity and the risk of amputation due to infected puncture wounds in diabetic versus nondiabetic adults. .South Med J 90::384. ,1997. .
-
4
Pecoraro RE, Reiber GE, Burgess EM: Pathways to diabetic limb amputation: basis for prevention. .Diabetes Care 13::513. ,1990. .
-
5
Reiber GE, Pecoraro RE, Koepsell TD: Risk factors for amputation in patients with diabetes mellitus: a case control study. .Ann Intern Med 117::97. ,1992. .
-
6
Palumbo PJ, Melton LJ: “Peripheral Vascular Disease and Diabetes,” in Diabetes in America, ed by MI Harris, RF Hamman, p 1, National Institutes of Health, Bethesda, MD. ,1985. .
-
7
Brand PW: “The Diabetic Foot,” in Diabetes Mellitus: Theory and Practice, 3rd Ed, ed by M Ellenberg, H Rifkin, p 803, Medical Examination Publishing, New York. ,1983. .
-
8
Brand PW: “The Insensitive Foot (Including Leprosy),” in Disorders of the Foot and Ankle, 2nd Ed, ed by M Jahss, p 2170, WB Saunders, Philadelphia. ,1991. .
-
9
Brand PW: “Other Insensitive Foot Types Similar to Diabetes,” in Management of the Diabetic Foot, ed by B Ma, p 15, Williams & Wilkins, Baltimore. ,1987. .
-
10
Manley MT, Darby T: Repetitive mechanical stress and denervation in plantar ulcer pathogenesis in rats. .Arch Phys Med Rehabil 51::171. ,1980. .
-
11
Armstrong DG: Infrared dermal thermometry: the foot and ankle stethoscope. .J Foot Ankle Surg 37::75. ,1998. .
-
12
Armstrong DG, Lavery LA, Liswood PJ, et al: Infrared dermal thermometry for the high-risk diabetic foot. .Phys Ther 77::169. ,1997. .
-
13
Armstrong DG, Lavery LA: Monitoring neuropathic ulcer healing with infrared dermal thermometry. .J Foot Ankle Surg 35::335. ,1996. .
-
14
Armstrong DG, Lavery LA: Monitoring healing of acute Charcot’s arthropathy with infrared dermal thermometry. .J Rehabil Res Dev 34::317. ,1997. .
-
15
Lavery LA, Higgins KR, Holguin D, et al: Home skin temperature monitoring reduces the incidence of diabetic foot complications. .Diabetes 51: (suppl 1):1039-P. ,2002. .
-
16
Gabay C, Kushner I: Acute-phase proteins and other systemic responses to inflammation. .N Engl J Med 340::448. ,1999. .
-
17
Jurkovich GJ, Pitt RM, Curreri PW, et al: Hypothermia prevents increased capillary permeability following ischemia-reperfusion injury. .J Surg Res 44::514. ,1988. .
-
18
Tisherman SA, Rodriguez A, Safar P: Therapeutic hypothermia in traumatology. .Surg Clin North Am 79::1269. ,1999. .
-
19
Belitsky RB, Odam SJ, Hubley-Kozey C: Evaluation of the effectiveness of wet ice, dry ice, and cryogenic packs in reducing skin temperature. .Phys Ther 67::1080. ,1987. .
-
20
Chesterton LS, Foster NE, Ross L: Skin temperature response to cryotherapy. .Arch Phys Med Rehabil 83::543. ,2002. .
-
22
Bazzett HC: The effect of heat and cold on the blood volume and circulation. .JAMA 111::1841. ,1938. .
-
23
Morsi E: Continuous-flow cold therapy after total knee arthroplasty. .J Arthroplasty 17::718. ,2002. .
-
24
Young AJ, Sawka MN, Epstein Y, et al: Cooling different body surfaces during upper and lower body exercise. .J Appl Physiol 63::1218. ,1987. .
-
25
Sawada S, Araki S, Yokoyama K: Changes in cold-induced vasodilatation, pain and cold sensation in fingers caused by repeated finger cooling in a cool environment. .Ind Health 38::79. ,2000. .
-
26
Feigin V, Anderson N, Gunn A, et al: The emerging role of therapeutic hypothermia in acute stroke. .Lancet Neurol 2::529. ,2003. .
-
27
Dalton Dietrich W, Kuluz JW: New research in the field of stroke: therapeutic hypothermia after cardiac arrest. .Stroke 34::1051. ,2003. .
-
28
Montaner J: Editorial comment: cooling matrix metal-loproteinases to improve thrombolysis in acute ischemic stroke. .Stroke 34::2171. ,2003. .
-
29
Kabon B, Bacher A, Spiss CK: Therapeutic hypothermia. .Best Pract Res Clin Anaesthesiol 17::551. ,2003. .
-
30
Jian S, Yongming Q, Zhihua C, et al: Feasibility and safety of moderate hypothermia after acute ischemic stroke. .Int J Dev Neurosci 21::353. ,2003. .
-
31
Yenari MA, Zhao H, Giffard RG, et al: Gene therapy and hypothermia for stroke treatment. .Ann N Y Acad Sci 993::54. ,2003. .
-
32
Krieger DW, De Georgia MA, Abou-Chebl A, et al: Cooling for acute ischemic brain damage (cool aid): an open pilot study of induced hypothermia in acute ischemic stroke. .Stroke 32::1847. ,2001. .
-
33
Hale SL, Kloner RA: Myocardial hypothermia: a potential therapeutic technique for acute regional myocardial ischemia. .J Cardiovasc Electrophysiol 10::405. ,1999. .
-
34
Felberg RA, Krieger DW, Chuang R, et al: Hypothermia after cardiac arrest: feasibility and safety of an external cooling protocol. .Circulation 104::1799. ,2001. .
-
35
Dixon SR, Whitbourn RJ, Dae MW, et al: Induction of mild systemic hypothermia with endovascular cooling during primary percutaneous coronary intervention for acute myocardial infarction. .J Am Coll Cardiol 40::1928. ,2002. .
-
36
Frykberg RG, Lavery LA, Pham H, et al: Role of neuropathy and high foot pressures in diabetic foot ulceration. .Diabetes Care 21::1714. ,1998. .
-
37
Armstrong DG, Boulton AJ: Continuous Internet-based activity monitoring provides a surrogate marker for nocturnal polyuria in persons with diabetes mellitus at high risk for foot ulceration. .Diabet Med 19::1034. ,2002. .
-
38
Armstrong DG, Lavery LA, Kimbriel HR, et al: Activity patterns of patients with diabetic foot ulceration: patients with active ulceration may not adhere to a standard pressure off-loading regimen. .Diabetes Care 26::2595. ,2003. .
-
39
Armstrong DG, Nguyen HC, Lavery LA, et al: Offloading the diabetic foot wound: a randomized clinical trial. .Diabetes Care 24::1019. ,2001. .
-
40
Armstrong DG, Lavery LA, Vazquez JR, et al: Clinical efficacy of the first metatarsophalangeal joint arthroplasty as a curative procedure for hallux interphalangeal joint wounds in persons with diabetes. .Diabetes Care 26::3284. ,2003. .
Cooling the Foot to Prevent Diabetic Foot Wounds
A Proof-of-Concept Trial
Department of Medicine, Manchester Royal Infirmary, University of Manchester, Manchester, England.
Search for other papers by David G. Armstrong in
Current site
Google Scholar
PubMed
Search for other papers by Melinda B. Sangalang in
Current site
Google Scholar
PubMed
Search for other papers by David Jolley in
Current site
Google Scholar
PubMed
Search for other papers by Frank Maben in
Current site
Google Scholar
PubMed
Search for other papers by Heather R. Kimbriel in
Current site
Google Scholar
PubMed
University of Arizona, Tucson.
Search for other papers by Brent P. Nixon in
Current site
Google Scholar
PubMed
Search for other papers by I. Kelman Cohen in
Current site
Google Scholar
PubMed
The etiology of neuropathic diabetic foot wounds can be summarized by the following formula: pressure × cycles of repetitive stress = ulceration. The final pathway to ulceration consists of an inflammatory response, leading to tissue breakdown. Mitigation of this response might reduce the risk of ulceration. This proof-of-concept trial evaluates whether simple cooling of the foot can safely reduce the time to thermal equilibrium after activity. After a 15-min brisk walk, the six nondiabetic volunteers enrolled were randomly assigned to receive either air cooling or a 10-min 55°F cool water bath followed by air cooling. The process was then repeated with the intervention reversed, allowing subjects to serve as their own controls. There was a rise in mean ± SD skin temperature after 15 min of activity versus preactivity levels (87.8° ± 3.9° versus 79° ± 2.2° F; P = .0001). Water cooling immediately brought the foot to a point cooler than preactivity levels for all subjects, whereas air cooling required an average of nearly 17 min to do so. Ten minutes of cooling required a mean ± SD of 26.2 ± 5.9 min to warm to preactivity levels. No adverse effects resulted from the intervention. We conclude that cooling the foot may be a safe and effective method of reducing inflammation and may serve as a prophylactic or interventional tool to reduce skin breakdown risk. (J Am Podiatr Med Assoc 95(2): 103–107, 2005)
