title: Cooling the foot to prevent diabetic foot wounds: a proof-of-concept trial.
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 degrees 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 degrees +/- 3.9 degrees versus 79 degrees +/- 2.2 degrees 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.
authors.affiliation: Department of Surgery, Southern Arizona Veterans Affairs Medical Center, Tucson, USA.
authors.forename: David G
authors.initials: DG
authors.lastname: Armstrong
authors.forename: Melinda B
authors.initials: MB
authors.lastname: Sangalang
authors.forename: David
authors.initials: D
authors.lastname: Jolley
authors.forename: Frank
authors.initials: F
authors.lastname: Maben
authors.forename: Heather R
authors.initials: HR
authors.lastname: Kimbriel
authors.forename: Brent P
authors.initials: BP
authors.lastname: Nixon
authors.forename: I Kelman
authors.initials: IK
authors.lastname: Cohen
mesh_terms: D000328:Adult; D003080:Cold Temperature; D017719:Diabetic Foot / Q000503:physiopathology / Q000517:prevention & control*; D015444:Exercise; D005260:Female; D005528:Foot; D006801:Humans; D008297:Male; D012881:Skin Temperature; D013997:Time Factors