Recurrence of diabetic foot ulceration remains one of the most pressing challenges in podiatric and endocrinology practice. Within one year of healing, approximately 40% of patients develop a new ulcer, and the five-year recurrence rate approaches 65% (Armstrong et al., New England Journal of Medicine, 2017). Because tissue breakdown is preceded by localized inflammation from repetitive mechanical stress, an emerging prevention strategy focuses on detecting that inflammation before the skin breaks. At-home foot skin temperature monitoring is now supported by more than a decade of randomized evidence and inclusion in international clinical guidelines.
The Physiological Rationale
Repetitive mechanical loading on insensate feet produces low-grade, often subclinical inflammation that raises regional skin temperature several days before visible tissue damage. In foundational work by Lavery and colleagues, a temperature asymmetry greater than 2.2 °C (4 °F) between the same site on the contralateral foot reliably predicted neuropathic ulceration within the following week (Lavery et al., Diabetes Care, 2007). The contralateral comparison controls for systemic factors such as ambient temperature, fever, or generalized peripheral vascular disease, leaving local “hotspots” as a specific marker of focal tissue stress.
Randomized Evidence for Ulcer Prevention
Multiple randomized controlled trials have established the clinical efficacy of structured home thermometry. Lavery and colleagues (American Journal of Medicine, 2007) randomized 173 high-risk patients to standard care, structured foot examination, or enhanced therapy with a hand-held infrared thermometer. The thermometry group developed significantly fewer ulcers (8.5%) than the standard therapy (29.3%) or structured examination (30.4%) groups over 15 months. A complementary trial by Armstrong and colleagues in patients with prior ulceration reported a roughly threefold reduction in recurrence with daily monitoring.
A 2022 systematic review and meta-analysis pooled five RCTs (772 participants meeting IWGDF risk category 2 or 3) and reported a relative risk for ulcer recurrence of 0.51 in favor of home temperature monitoring — the largest preventive effect identified among any ulcer-prevention intervention studied to date (Golledge et al., Diabetes/Metabolism Research and Reviews, 2022). A more recent systematic review by Novais and colleagues (Nursing & Health Sciences, 2025) reaffirmed these findings across both hand-held thermometer and smart-mat platforms.
Technology Platforms and Real-World Performance
Two principal delivery modalities are in use. Hand-held infrared thermometers require the patient to measure six to eight standardized plantar sites bilaterally each morning, record the readings, and act on any 2.2 °C asymmetry by reducing weight-bearing activity and contacting the clinician. Smart-mat systems, by contrast, generate a full plantar thermogram in roughly 20 seconds when the patient stands on the device; data are transmitted automatically to a monitoring service that alerts the clinician when a hotspot persists.
A prospective cohort showed that a smart-mat platform predicted impending ulceration with 97% sensitivity and a median lead time of approximately five weeks (Frykberg et al., Diabetes Care, 2017). A 2024 multicenter postmarket registry of more than 1,000 patients with prior diabetic foot complications subsequently demonstrated high adherence and significant reductions in ulcer incidence and lower-extremity amputations compared with historical controls (Frykberg et al., JMIR Diabetes, 2024).
Cost-Effectiveness and Practical Considerations
Petersen and colleagues conducted an 18-month multicenter randomized cost-effectiveness analysis in patients with recently healed plantar ulcers (Diabetes Research and Clinical Practice, 2024). Ulcer recurrence was significantly lower with at-home temperature monitoring (36%) than with usual care (47%), and the intervention was at least cost-equivalent, with system savings from fewer hospitalizations and amputations offsetting device and monitoring costs.
Practical limitations remain. Daily measurement requires consistent adherence, can be cognitively demanding in older patients, and depends on willingness to modify activity when a hotspot is identified. Vision impairment, limited hand dexterity, and lack of a caregiver to assist can all reduce real-world effectiveness. Standardized measurement technique, clear interpretation of asymmetry thresholds, and instruction to offload when a hotspot appears are therefore essential to translating trial benefits into clinical practice.
Clinical Summary
For patients with diabetes and a prior history of foot ulceration, Charcot neuroarthropathy, or partial foot amputation, at-home skin temperature monitoring is among the most consistently supported preventive interventions in the modern diabetic foot literature. Randomized trials, recent meta-analyses, and a multicenter cost-effectiveness study converge on a clinically meaningful reduction in ulcer recurrence when daily monitoring is paired with prompt activity modification. The intervention is non-invasive and complements — rather than replaces — foundational measures such as therapeutic footwear, regular podiatric examination, and glycemic control.
References
- Armstrong DG, Boulton AJM, Bus SA. Diabetic foot ulcers and their recurrence. New England Journal of Medicine. 2017;376(24):2367–2375.
- Lavery LA, Higgins KR, Lanctot DR, et al. Preventing diabetic foot ulcer recurrence in high-risk patients: use of temperature monitoring as a self-assessment tool. Diabetes Care. 2007;30(1):14–20.
- Lavery LA, Higgins KR, Lanctot DR, et al. Home monitoring of foot skin temperatures to prevent ulceration. The American Journal of Medicine. 2007;120(12):1042–1046.
- Golledge J, Fernando ME, Alahakoon C, et al. Efficacy of at-home monitoring of foot temperature for risk reduction of diabetes-related foot ulcer: a meta-analysis. Diabetes/Metabolism Research and Reviews. 2022;38(6):e3549.
- Novais T, et al. Foot temperature monitoring in people with diabetes mellitus: a systematic review of incidence and risk with meta-analysis. Nursing & Health Sciences. 2025;27(1):e70206.
- Frykberg RG, Gordon IL, Reyzelman AM, et al. Feasibility and efficacy of a smart mat technology to predict development of diabetic plantar ulcers. Diabetes Care. 2017;40(7):973–980.
- Frykberg RG, et al. Effectiveness of a continuous remote temperature monitoring program to reduce foot ulcers and amputations: multicenter postmarket registry study. JMIR Diabetes. 2024;9:e46096.
- Petersen BJ, Linders DR, Bus SA, et al. Cost-effectiveness of temperature monitoring to help prevent foot ulcer recurrence in people with diabetes: a multicenter randomized controlled trial. Diabetes Research and Clinical Practice. 2024;212:111673.
- Bus SA, Sacco ICN, Monteiro-Soares M, et al. Guidelines on the prevention of foot ulcers in persons with diabetes (IWGDF 2023 update). Diabetes/Metabolism Research and Reviews. 2024;40(3):e3651.
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