Effective Method to Prevent Diabetic Foot Ulcers Lacking

Foot temperature-guided avoidance therapy found beneficial in high-risk cases only

MONDAY, April 18 (HealthDay News) -- Most of the interventions used to prevent diabetic foot ulcers in insensate feet do not show any evidence of benefit, according to a review published in the April issue of Diabetes Care.

Yadon Arad, M.D., from Tiara Pharmaceuticals in Los Altos, Calif., and colleagues identified 13 studies published between 1960 and 2010 that described or reviewed methods to prevent occurrence of diabetic foot ulcers. The benefit of various primary and secondary interventions for the prevention of future diabetic foot ulcers was evaluated.

The investigators found that most interventions, including enhanced patient education and monitoring, surgical debridement of calluses, bone resection at pressure points, specialized footwear, peroneal and tibial nerve decompression or neurolysis, and Achilles tendon lengthening, did not show evidence of preventing diabetic foot ulcers. Although specialized footwear was not found beneficial, shear stress-reducing insoles showed some benefit. Foot temperature-guided avoidance therapy was found beneficial only in high-risk diabetes patients with a history of foot ulceration, foot deformity (such as hallux valgus or claw toes), leg amputation, or peripheral sensory neuropathy.

"On the basis of our review, the evidence for most of the interventions to prevent a foot ulcer falls short. Clinicians lack guidance on what to do after a patient loses sensation," the authors write. "Once a patient has lost Semmes-Weinstein monofilament sensation, self-measurement of sole temperature, followed by off-loading when temperature differences are detected, is currently the only scientifically supported tool for the prediction and prevention of diabetic foot ulcers in an insensate foot."

One of the study authors disclosed financial relationships with Diabetica Solutions Inc., which provided the foot temperature sensing device.

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