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Cooling the Foot to Prevent Diabetic Foot Wounds

A Proof-of-Concept Trial

David G. Armstrong, DPM, MSc, PhD ^* , Melinda B. Sangalang, DPM ^*, David Jolley, DPM ^*, Frank Maben, DPM ^*, Heather R. Kimbriel, BS ^*, Brent P. Nixon, DPM ^*  and I. Kelman Cohen, MD 

^* Department of Surgery, Southern Arizona Veterans Affairs Medical Center, Tucson. Dr. Armstrong is now at the Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science, North Chicago, IL.
Department of Medicine, Manchester Royal Infirmary, University of Manchester, Manchester, England.
University of Arizona, Tucson.
Department of Surgery, Section of Plastic and Reconstructive Surgery, Medical College of Virginia, Richmond.

Corresponding author: David G. Armstrong, DPM, MSc, PhD, Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science, 3333 Green Bay Rd, North Chicago, IL 60064.

Abstract

The etiology of neuropathic diabetic foot wounds can be summarized by the following formula: pressure x 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)

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