William Buchanan takes his temperature every morning, but he doesn't hold a thermometer under his tongue. He holds it to the bottom of his feet. The 76-year-old retired right-of-way agent for the New York Telephone Company has Type II diabetes and has subsequently lost sensation in his feet. He uses the TempTouch to help prevent ulcers that could lead to amputation. Two years ago, Buchanan, who lives in Queens, was shopping with his wife when he took a spill in a parking lot. "I got up and walked to the car, no problem," he said. "The next morning I used 'the wand' and there was a big difference in readings between my right and left foot." An X-ray revealed that Buchanan had broken his left toe. "If I didn't have that wand to check with, I would have walked around for a couple weeks without feeling it and I would have wound up with an infection," Buchanan said. "And then I would have had a big problem - off with the leg." Clinical trials, including one that will be published in December in the American Journal of Medicine, are proving that skin temperature monitoring significantly reduces foot ulcers in diabetics who suffer neuropathy - numbness in their extremities. Dr. David Armstrong, director of the Scholl College Center for Lower Extremity Ambulatory Research (CLEAR) at Rosalind Franklin University of Medicine and Science and the James A. Lovell Federal Health Center in North Chicago, Ill., was principal investigator and lead author on the latest study using the infrared TempTouch. Armstrong began using a thermometer to help prevent foot ulcers in his patients 15 years ago as a medical student and resident. "I spent $700 and bought this fancy thermometer I put in my pocket," he said. "I would tell my patients 'You've got to buy one of these. I know it's a lot of money, but it will help keep your feet on.'" Diabetics can now use the wand-like, gooseneck TempTouch before they begin their day's activities. A spike in temperature warns that an infection is brewing so they can stay off their feet until the threat of an ulcer subsides. "A wound will heat up before the skin breaks down," said Armstrong, professor of surgery and associate dean at Rosalind Franklin's Scholl College of Podiatric Medicine. "You can detect infection by checking one foot compared to another foot, one toe compared to another toe." Problems with feet account for about one-third of all hospital admissions for people with diabetes, according to Armstrong who lectures around the world on treatment of the diabetic foot and ways to prevent amputations. The latest clinical trial found that study participants who used the TempTouch were three times less likely to develop ulcers compared to those in the standard therapy group who were instructed on how to visually inspect their feet. Armstrong insists many people with diabetes have trouble examining their feet and that only between 10 and 20 percent ask their doctor to do so during routine check-ups. "Many can't reach their feet," Armstrong said. "Many have retinopathy - they can't see well. And the diabetic foot doesn't bother them. They have lost 'the gift' of pain." Ruben Zamorano, president of San Antonio-based Xilas Medical, which holds the patent for the TempTouch, said Armstrong and other podiatrists have been working with bio-medical engineers to develop "new weapons" to fight diabetic ulcers, which cost $14,000 per patient to treat in the first year. "A doctor may heal an ulcer but people go right back into the same situation in the same shoes that caused the problem," Zamorano said. "The whole problem comes back to prevention." Xilas donated 5,000 foot thermometers to Texas Medicaid patients who at have a high rate of diabetes-related amputations. The company received a $1 million emerging technology grant from the state in 2006. It has also contracted with insurance companies in New York City and Tennessee. Armstrong and other leading podiatrists hope "dermal thermometry" becomes a norm in treatment of the diabetic foot. "Three separate federally-funded trials suggest it works," Armstrong said. More people with diabetics will begin using hand-held devices like the TempTouch, which costs $150, as they become easier to use and cheaper to manufacture and as more insurers reimburse for them, said Dr. James Christina, director of scientific affairs for the American Podiatric Medical Association. But while insurance companies pay lip service to preventive care, they are often reluctant to make the up-front investment. "We still have challenges with getting insurance companies to pay for prevention visits to podiatrists in some cases," Christina said. "That's a big problem. Preventive care can be so cost effective. Studies show a whole-team approach to helping diabetics take care of their feet can help prevent ulcerations and amputations." Armstrong, who warned of the "silent tsunami of diabetic amputations" at the International Diabetic Foot Conference in Singapore last summer, warned that complications of diabetes is crippling people in their prime working years. He hopes companies that pay the premiums for employee health care will begin paying for prevention, even if insurers won't. "Companies will save money by stopping these problems before this tsunami overtakes us," Armstrong said. "The wave is already cresting."
Rosalind Franklin University of Medicine and Science educates medical doctors, health professionals and biomedical scientists in a personalized atmosphere. The University is located at 3333 Green Bay Road, North Chicago, IL 60064, and encompasses Chicago Medical School, College of Health Professions, Dr. William M. Scholl College of Podiatric Medicine, and School of Graduate and Postdoctoral Studies. Visit at http://www.rosalindfranklin.edu and http://www.lifeindiscovery.com.
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