Heat Shock Relevant Cascade: Building the Podiatrist’s Armour Against Inflammation

Providing better outcomes for patients with diabetic foot ulcers is the key to reduce the burden of traumatic amputations. Recent work from Mir et al. (2009), Christian Medical College, Vellore (India), suggests that heat shock protein 70 gene polymorphism is associated with the severity of diabetic foot ulcer. This is a remarkable concept and we at SALSA bowl feel it could be another armour in our fight against inflammation.

Wikipedia defines Heat Shock Proteins as “Heat shock proteins (HSP) are a class of functionally related proteins whose expression is increased when cells are exposed to elevated temperatures or other stress”. This may be directly related to the diabetic population with lower extremity complications. It is often the repetitive stress/trauma and increased temperature that precedes an underlying ulceration.

What is amazing is that, temperature (or inflammation) is not always bad! Although, inflammation precedes an underlying ulceration, it is also an essential permissive component of the healing cascade. We at SALSA are studying temperature patterns/profiles for both pre-ulcerous patients and patients with active ulcers. We often refer to temperatures as the “Flare response” at the plantar surface. The working hypothesis is that perhaps by identifying this flare at baseline and developing a “Thermal Index” we can predict healers Vs non-healers, much on the lines of Dr. Sheehan’s work regarding identifying which wounds would benefit from the expensive wound care modalities and which ones could be healed with less expensive modalities.

We will continue to watch this space and perhaps, study the association between HSP and plantar temperatures to validate this theory. “Perhaps someone that already has a lot of inflammation doesn’t mount the extra flare required to heal”.

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