In the past, standard patient education focused on teaching patients self-inspection skills that most patients could not adequately perform such as using a hand mirror for visual inspection. In our study of ulcer risk factors, a large proportion of both patients with and without foot ulcers did not have the visual acuity, manual dexterity, or joint flexibility to perform simple self-examination checks of their feet. Among ulcer patients 49% could not position and/or visualize their feet, and 15% of ulcer patients were legally blind in at least one eye. Even if a family member is available to visually inspect the foot, without an objective measure of injury, most laymen will only be able to identify ulcers once they have occurred.33 State of existing knowledge: Over the last three decades, several authors have suggested that skin temperature monitoring may be a valuable tool to detect “at risk” sites in patients who are insensate.34-41 As early as 1971 Goller34 reported an association between increased local temperature and localized pressure leading to tissue injury. Sandrow and coworkers35 subsequently used thermometry as a tool to diagnosis occult neuropathic fractures in patients with diabetes in 1972.